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Systemic Dx Exam 3 Errata part 2
lingel
95
Medical
Graduate
04/14/2011

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Term
What is digitalis?
Definition
Na/K pump med that lowers pulse rate
Term
What drugs cause slower AV node conduction to slow, contractility to increase and increases intracellular Ca++?
Definition
Na/K pump med
Term
What are SE of Na/K pump meds?
Definition
blurred vision, 'ice blue' tinge to color, haloes on dark objects
Term
What is verapamil's mechanism?
Definition
CCB
Term
What do CCB's do to the heart?
Definition
decrease contractility, slow HR by interfering with SA and AV node repolarization
Term
What can Beta blockers do to the heart?
Definition
block epinephrine, cause decreased HR and contractility
Term
What is a cardiac CI for beta blocker
Definition
severe heart block patients
Term
What three classes of drugs act on the Renin-Angiotensin system to treat HTN?
Definition
ACE inhibitors, Angiotensin II antagonists, Renin inhibitors
Term
What HTN drugs are protective of the kidney for diabetics beyond what the BP drop alone would imply?
Definition
Renin-Angiotensin acting drugs
Term
What HTN tx may initially work but then rebound back to previous levels?
Definition
diuretics
Term
What are thiazides for?
Definition
diuretics used for renal, cardiac, and BP tx.
Term
Name two loop diuretics
Definition
bumetanide is stronger, furosemide is more commonly Rx'd
Term
Name two potassium sparing diuretics
Definition
spironolactone, triamterene
Term
What are CAI's used for?
Definition
a weak diuretic to treat glaucoma or disc edema
Term
What are osmotic diuretics used for?
Definition
glaucoma: mannitol, urea, isosorbide
Term
When is dialysis initiated?
Definition
When GFR < 10 ml/min for non DM; <15 ml/min for DM
Term
Name 7 s/sx that can inititate dialysis tx
Definition
uremia, low GFR rate, persistent edema, acidosis, hyperkalemia, HF, encephalopathy
Term
Name 3 typos of kidney replacement therapies
Definition
hemodialysis, peritoneal dialysis, renal transplantation
Term
What is the fluid that absorbs toxins during dialysis?
Definition
dialysate
Term
How often is hemodialysis needed?
Definition
3.5 hrs 3x/week
Term
What is hemodialysis poor at removing?
Definition
creatinine
Term
What is CAPD?
Definition
Continuous Ambulatory Peritoneal Dialysis
Term
What dialysis tx has fewer dietary restrictions?
Definition
peritoneal dialysis has fewer than hemodialysis
Term
What are the three drugs used to prevent organ rejection in renal transplantation?
Definition
corticosteroid, calcineurin inhibitor, anti-metabolite
Term
What does calcineurin inhibitor do? How does it work?
Definition
Prevent organ rejection; decrease T-cell IL-2 production
Term
What do anti-metabolite drugs do?
Definition
Prevent organ rejection; stops lymphocyte proliferation and activation
Term
Name 3 risks of long term corticosteroid use
Definition
cataract, glaucoma, papilledema
Term
What is Kaposi's sarcoma?
Definition
malignancy induced by renal transplant
Term
What does renal transplant do to incidence of cancer?
Definition
increases 100x
Term
What medications are toxic to kidney?
Definition
aminoglycosides and tetracyclines
Term
what is the tetracycline that is NOT toxic to the kidney
Definition
doxycycline
Term
What two ocular dz's are increased by CKD?
Definition
ARMD and dry eye
Term
What is in uremic frost?
Definition
Ca++ sulfate and phosphate ppt
Term
What is ATN?
Definition
acute tubular necrosis
Term
What is damaged in ATN, what is the result?
Definition
epithelial cells drop ion transport; endothelins increase, nitric oxide is reduced, PG's are reduced --> vasoconstriction
Term
What happens to serum levels in ATN?
Definition
decreased blood volume, increased waste in blood
Term
What are the main s/sx of malignant HTN?
Definition
ocular anomalies due to increased BP
Term
What dz is caused by fibrosis induced stenosis of tubules?
Definition
malignant HTN
Term
What is released in malignant HTN that exacerbates things?
Definition
renin --> vasoconstriction
Term
What do steroids do in ARF?
Definition
cause it, by inhibiting PG synth --> vasoconstriction
Term
What are the 3 glomelular dz's
Definition
nephrotic synd, nephritic synd, MPGN
Term
Name 3 tubule and interstitial dz's
Definition
TIN, pyelonephritis, ATN
Term
What are some DDx's of Nephritic vs Nephrotic syndrome?
Definition
Nephrotic: Massive Proteinura, hypoalbuminemia, hyperlipidemia, hyperlipiduria, pitting edema

Nephritic synd: hematuria and lesser proteinuria, oliguria, HTN due to salt/fluid retention,
Term
What are some similarities between Nephrotic and Nephritic?
Definition
both have edema that starts at eyelids, both have protienuria though nephrotic more severe.
Term
What presents with HTN, nephrotic or nephritic syndrome?
Definition
Nephritic
Term
What tx may cause steroid dependence?
Definition
Nephrotic syndrome
Term
What are two RAS related tx for nephrotic syndrome
Definition
ACE inhibitors, Angiotensin II antagonists ( ARB's)
Term
Does nephrotic or nephritic syndrome require thrombo-prophylaxis?
Definition
nephrotic
Term
Does strep infection precede nephritic or nephrotic syndrome?
Definition
Nephritic
Term
When is nephritic syndrome most common?
Definition
In children, and during summer/fall
Term
After strep pyoderma infection, what % will develop nephritic syndrome?
Definition
50.00000%
Term
Name 3 rare causes of nephritic syndrome
Definition
SLE, subacute bacterial endocarditis, idiopathic
Term
What is the tx for nephritic syndrome?
Definition
salt restriction, diuretics

Complete recovery can take 1-2 years, though 90% will fully recover. Rarely causes chronic renal failure
Term
What is MPGN also known as?
Definition
Dense deposit dx
Term
How is MPGN classified?
Definition
3 different subtypes
Term
Does MPGN cause nephrotic or nephritic syndrome?
Definition
nephrotic (note: MPGN causes HTN so nephrotic can be seen with HTN though it does not cause it)
Term
What presents with bilateral clustered drusen?
Definition
type II MPGN
Term
What are long term effects of MPGN?
Definition
VA and VF impairment
Term
Where is 50% of the K absorbed in the kidney?
Definition
proximal tubule via active process
Term
What substances are 'linked' to absorbing together in the proximal tubule?
Definition
water, chloride are passively reabsorbed
Term
What makes the medula around the ascending loop of Henle very hypertonic?
Definition
reabsorption of NaCl
Term
Where does ADH induce water reabsorption?
Definition
Collecting duct
Term
What is important for absorbing Ca++ from the intestine?
Definition
calcitriol; it is dependent on Vit D
Term
What is the test for acute kidney damage?
Definition
NGAL or neutrophil gelatinase associated lipocalin
Term
Hemodialysis risks?
Definition
"HIPIA"

Heart dysfunction

Ionic dysfunction

Pulmonary edema

Infection

Anemia
Term
What is a normal CrCl rate?
Definition
100 ml/min
Term
What is a normal creatinine serum level?
Definition
1 mg/dL
Term
What causes ototoxicity?
Definition
loop diuretics
Term
What is a short course HTN med?
Definition
K+ sparing diuretics
Term
What is DOC for HTN in DM pt's?
Definition
ACE inhibitors
Term
What is the suffix for ACE inhibitors?
Definition
"-pril"
Term
What drug class uses the suffix "sartan"
Definition
Angiotensin II antagonists
Term
What suffix indicates a CCB?
Definition
"dipine"
Term
What HTN drug is no longer used due to CV problems?
Definition
alpha blockers
Term
Clonidine: List what you know
Definition
acts on CNS

Useful for HTN as it does not depend on kidney fxn

available as a patch
Term
What is darusentan?
Definition
experimental endothelin receptor antagonist in phase III trials
Term
What is Wilm's disease?
Definition
2nd most common tumor in the kidney, often in kids (3rd most prev tumor). Often presents with aniridia. Good prognosis
Term
What does Von Hippel Lindau often appear with?
Definition
Renal cell carcinoma
Term
Contrast azotemia and uremia
Definition
Both are due to urea nitrogenic waste accumulation. Azotemia has not s/sx, uremia does have s/sx
Term
What is pyelonephritis?
Definition
bacterial infection of kidney
Term
What causes Fabry?
Definition
error of galactosidase A causes glycosphingolipid metabolism to fail
Term
Fabry s/sx
Definition
burning sensation in hands

Spoke like cataract

Tortuous BV in conj

rash on butt, groin, thighs

hypohydrosis

corneal whorl or verticillata present in90%, first sx.
Term
How is Fabry treated?
Definition
test for it with enzyzme assay, then genetic testing.

IV enyzme replacement given every 2 weeks
Term
what age does TINU affect?
Definition
12328
Term
Who is affected most often by TINU?
Definition
female 3x than male
Term
What % of TINU pt's have bilateral uveitis?
Definition
77.00000%
Term
What % of TINU pt's have bilateral uveitis as their first sx?
Definition
35.00000%
Term
How often does bilateral uveitis recur?
Definition
50.00000%
Term
What % of pt's have fever, weight loss, fatigue?
Definition
50.00000%
Term
What is a tx for TINU?
Definition
oral corticosteroids
Term
What is spared in TINU?
Definition
glomeruli and renal vessels
Term
Is TINU acute or chronic?
Definition
can be both
Term
What can cause TINU?
Definition
pyelonephritis, drugs or metabolic disorders, physical injury
Term
What is non-infectious TINU called?
Definition
interstitial nephritis
Term
Where is a thickened basement membrane of the glomerulus seen?
Definition
Diabetic nephropathy
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