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Renal Pharm - Stevens
n/a
63
Pharmacology
Graduate
03/07/2010

Additional Pharmacology Flashcards

 


 

Cards

Term
64 yo woman
history of MI; in the ER with SOB
previous 2 weeks - dyspnea on exertion and swelling of her legs; sleeps on 3 pillows because coughs and SOB if lays flat
in ED - sitting upright; moderate respiratory distress; tachycardic and hypertensive; JVD to the angle of her jaw
on auscultation of lungs - wet rales bilaterally
pitting edema in both legs up to her knees

what is the term for the fact that she is sleeping on 3 pillows at night?
Definition
orthopnea
Term
64 yo woman
history of MI; in the ER with SOB
previous 2 weeks - dyspnea on exertion and swelling of her legs; sleeps on 3 pillows because coughs and SOB if lays flat
in ED - sitting upright; moderate respiratory distress; tachycardic and hypertensive; JVD to the angle of her jaw
on auscultation of lungs - wet rales bilaterally
pitting edema in both legs up to her knees

a chest x-ray confirms the diagnosis of?
Definition
pulmonary edema consequence of CHF
Term
64 yo woman
history of MI; in the ER with SOB
previous 2 weeks - dyspnea on exertion and swelling of her legs; sleeps on 3 pillows because coughs and SOB if lays flat
in ED - sitting upright; moderate respiratory distress; tachycardic and hypertensive; JVD to the angle of her jaw
on auscultation of lungs - wet rales bilaterally
pitting edema in both legs up to her knees

she is placed on oxygen and immediately given an IV injection of?
Definition
diuretic
furosemide - high ceiling diuretic that gives large effect quickly
Term
64 yo woman
history of MI; in the ER with SOB
previous 2 weeks - dyspnea on exertion and swelling of her legs; sleeps on 3 pillows because coughs and SOB if lays flat
in ED - sitting upright; moderate respiratory distress; tachycardic and hypertensive; JVD to the angle of her jaw
on auscultation of lungs - wet rales bilaterally
pitting edema in both legs up to her knees

what is the mechanism of pulmonary edema with CHF?
Definition
heart stops working effectively
get back-fill pressure into the lungs
increase hydrostatic pressure
drives water into the interstitium
if no inflammation or infection - accumulates around large BV
seen on x-ray or high resolution CT - called thickened septal line
Term
total amount of fluid in body
Definition
about 42L
Term
fluid makes up what percentage of total body weight?
Definition
70%
Term
where is body fluid distributed?
Definition
1. cells - 30-40%
2. interstitium
3. plasma - primary component
Term
what is hematocrit?
Definition
portion of blood that is cells
Term
what portion of the blood is made of red cells?
Definition
about 42% in women, 44-45% in men
Term
what are the 3 phases of a blood sample?
Definition
1. RBC phase
2. buffy white coat - on top of red cell layer; immune and circulating cells
3. serum or plasma phase - on top of buffy coat; fluid phase
Term
what percentage of total volume of blood is fluid?
Definition
55%
Term
how is body fluid is divided?
Definition
intracellular and extracellular fluid
Term
what organ determines the amount of water in the body?
Definition
kidney
Term
what is located in the cortex?
Definition
renal corpuscles (Bowman's capsule) - where glomerular filtration occurs
proximal convoluted tubule
Term
do all loop of Henle's go to the medulla?
Definition
NO
some stay in cortex - close to the apical side of the kidney
Term
what is the functional unit of the kidney?
Definition
nephron
Term
how many nephrons are there?
Definition
about 1 million/kidney
Term
what are the 2 components of the nephron?
Definition
glomerulus and tubule
Term
what is a glomerulus?
Definition
capillary bed that maintains high hydrostatic pressure that drives solutes out of the capillary and into Bowman's space
Term
what is a tubule?
Definition
series of specialized epithelial cells arranged in segments, each of which selectively modifies the initial ultrafiltrate
Term
where is the nephron found anatomically?
Definition
cortex
Term
what is the target in the nephron for diuretic drugs?
Definition
the different ion channels and receptors in the different segments of the tubules
Term
what is unique about the arteriole anatomy of the kidney?
Definition
its the only place where there are 2 arterioles separated by a capillary bed
Term
what part of the kidney ultimately gives the final filtrate?
Definition
collecting duct
Term
why is the endothelium of glomerulus different from other endothelium?
Definition
it is fenestrated - has holes in the middle
Term
why is glomerular endothelium fenestrated?
Definition
podocytes that encase endothelium secrete VEGF
endothelial cells in capillary plexus respond by making holes
Term
what is the purpose of the fenestrated endothelium in glomerular capillaries?
Definition
used to filter solutes
large solutes go through
proteins do not
Term
why are proteins not filtered out of fenestrated glomerular capillary endothelium?
Definition
because of the negative charge on the endothelium

if negative charge is lost (diabetes, pre-eclampsia) - lose protein (proteinuria)
Term
what is the function of podocytes?
Definition
structural support
Term
how do the epithelial cells of Bowman's capsule change as they move into the proximal convoluted tubule?
Definition
they become more columnar
Term
what determines glomerular filtration?
Definition
pressure and oncotic forces
Term
equation for GFR of a single nephron
Definition

GFRsn = Kf x [(Pgc - Pbs) - (∏gc - ∏bs)]

 

Kf = filtration coefficient

Pgc = glomerular capillary hydrostatic presure

Pbs = Bowman's space hydrostatic presure

gc = glomerular capillary oncotic pressure

bs = Bowman's space oncotic pressure

Term
what does Kf represent?
Definition
filtration coefficient = resistance of barrier to fluid flux
Term
based on hydrostatic pressure, when do you get filtration?
Definition
when Pgc > Pbs
Term
which direction does water move?
Definition
towards the most protein - usually in blood
Term
what is the relationship between hydrostatic pressure and oncotic pressure in glomerular filtration?
Definition
oncotic pressure opposes hydrostatic pressure
Term
what is the major determinant of GFR?
Definition
usually fluid pressure in blood > oncotic pressure
Term
examples when fluid pressure in blood is not greater than oncotic pressure in the glomerulus?
Definition
squeeze afferent arteriole - drops driving pressure
lose negative charge barrier - increase protein in Bowman's space - increase GFR
Term
is the hydrostatic pressure the same throughout the entire capillary loop?
Definition
NO - changes as move through the loop
Term
which part of the capillary loop has the highest hydrostatic pressure?
Definition
beginning of the capillary
Term
why does the hydrostatic pressure change as it moves through the capillary loop?
Definition
water is being filtered --> relatively concentrates protein --> increases oncotic pressure --> opposes filtration
Term
what is the effect on hydrostatic pressure across a single capillary segment?
Definition
decreases
Term
what are the major resistance sites in renal circulation?
Definition
afferent and efferent arterioles
Term
what are the major sites that control renal blood flow and why?
Definition
afferent and efferent arterioles because they are the major resistance sites
Term
where is there exchange in renal circulation?
Definition
only the capillaries - glomerular and peritubular
Term
why do the glomerular capillaries filter?
Definition
hydrostatic pressure > oncotic pressure
Term
what happens in glomerular capillaries?
Definition
filtration because hydrostatic pressure > oncotic pressure
Term
why do the peritubular capillaries absorb?
Definition
oncotic pressure > hydrostatic pressure
Term
what happens in the peritubular capillaries?
Definition
absorption because oncotic pressure > hydrostatic pressure
Term
how is the afferent arteriole constricted?
Definition
sympathetic nerves
angiotensin II - trivial role
Term
how does the SNS constrict the afferent arteriole?
Definition
releases NE --> act on a1 receptors --> Gq --> increase Ca --> constriction
Term
what is the effect on GFR of constricting the afferent arteriole?
Definition
decrease GFR
Term
how is the afferent arteriole dilated?
Definition
renal prostaglandins - PGE2 and PGI2
dopamine
Ca antagonists
Term
what is the effect of aspirin on GFR?
Definition
decrease because blocks prostaglandins effect at dilating afferent arteriole
Term
what is the effect of dilating the afferent arteriole on GFR?
Definition
increase GFR
Term
why would dopamine be a better choice than NE in the ICU?
Definition
if a patient has compromised renal function DA will increase GFR instead of decreasing it
Term
what constricts the efferent arteriole?
Definition
NE
angiotensin II
Term
what is the effect on GFR of constricting efferent arteriole?
Definition
increase GFR

even greater if also dilate afferent
Term
what causes dilation of efferent arteriole?
Definition
PGI2
dopamine
Term
what is the effect on GFR of dilating the efferent arteriole?
Definition
increase GFR

even greater when dilate both efferent and afferent arterioles
Term
58 yo COPD patient with HTN and diabetes
2 years since last clinic visit
moved to north dakota for 18 months
inconsistently compliant with meds
no hospitalization but had ED visit in ND for SOB 3 months ago - treated for exacerbation of COPD and had elevated BP
prescribed lisinorpil and hydrocholorothiazide; theophylline was discontinued
moved back to Bayou La Batre
breathing and capacity for exercise are stable
intermittent productive cough of white to yellow sputum - not increased from typical baseline
drinking again and increase in cigarette use
lab results - increase in serum creatinine

what does an increase in serum creatinine indicate?
Definition
reduced GFR
Term
58 yo COPD patient with HTN and diabetes
2 years since last clinic visit
moved to north dakota for 18 months
inconsistently compliant with meds
no hospitalization but had ED visit in ND for SOB 3 months ago - treated for exacerbation of COPD and had elevated BP
prescribed lisinorpil and hydrocholorothiazide; theophylline was discontinued
moved back to Bayou La Batre
breathing and capacity for exercise are stable
intermittent productive cough of white to yellow sputum - not increased from typical baseline
drinking again and increase in cigarette use
lab results - increase in serum creatinine

what may cause a drop in GFR under these circumstances?
Definition
relying on angiotensin II to maintain GFR
fall into acute renal failure with use of ACE inhibitor
Term
what is the effect of GFR with every doubling of serum creatinine?
Definition
GFR is halved
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