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Year 2 - BRS > 1.14 - Pharmacology of CKD > Flashcards

1.14 - Pharmacology of CKD Flashcards

1
Q

What drug types harm the kidney? (2)

A
  • gentamicin
  • NSAIDs - inhibit PG synthesis and reduces renal blood flow
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2
Q

What drug type influences creatinine?

A

Trimethoprim (antibiotic)

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3
Q

What drug types help the kidney? (4)

A

Reduce glomerular hypertension:

  • calcium channel blockers
  • ACE inhibitors
  • angiotensin receptor blockers
  • sodium-glucose co-transporter (SGLT-2) inhibitors
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4
Q

What drug types reduce cardiovascular risk? (2)

A
  • aspirin
  • statins
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5
Q

What are some examples of statins? (2)

A
  • Simvastatin
  • Atorvastatin
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6
Q

What is the primary mechanism of action of statins?

A
  • selective, competitive inhibitor of hydroxymethylglutaryl (HMG)-CoA reductase, responsible for converting HMG-CoA to mevalonate in cholesterol synthesis
  • reduces hepatic cholesterol synthesis which upregulates LDL receptors and increases hepatic uptake of LDL-cholesterol from circulation
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7
Q

How do statins reduce cardiovascular risk?

A
  • reduces the amount of atheroma deposits in arteries and stops further atheroma deposition
  • makes existing deposits less likely to break off and cause a thrombosis
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8
Q

What is the drug target for statins?

A

HMG-CoA reductase

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9
Q

What are the main side effects of statins? (2)

A
  • muscle toxicity - likelihood increases with higher doses and in patients at increased risk of muscle toxicity
  • constipation/diarrhoea and other GI symptoms
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10
Q

What is some extra information about statins?

A
  • effective at reducing the risk of adverse cardiac events in people
  • all patients need to be regularly followed up to monitor for hyperkalaemia and acute renal failure
  • coadministration with potent 3A4 inhibitors may result in increased statin serum concentrations
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11
Q

What is the primary mechanism of action of aspirin?

A
  • irreversible inactivation of COX enzyme
  • prevents oxidation of arachidonic acid to produce prostaglandins
  • reduction of thromboxane A2 in platelets reduces aggregation
  • reduction of PGE2 at sensory pain neurones reduces pain and sensation, and in the brain decreases fever
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12
Q

How does aspirin reduce cardiovascular risk?

A

Low dose aspirin reduces the risk of atherothrombosis

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13
Q

What is the drug target for aspirin?

A

Cyclo-oxygenase (COX)

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14
Q

What are the main side effects of aspirin? (4)

A
  • dyspepsia
  • haemorrhage
  • in elderly, avoid doses >160mg daily (increased risk of bleeding)
  • co-administer PPI if past history of peptic ulcer
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15
Q

What is some extra information about aspirin?

A
  • low dose aspirin is most cost effective medicine for prevention of secondary events of thrombosis
  • COX1 blockade in gastric mucosal cells reduces mucus/bicarbonate production which can expose the stomach lining to acid
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16
Q

What is the mechanism of action for trimethoprim?

A
  • direct competitor of the enzyme dihydrofolate reductase
  • inhibits reduction of dihydrofolic acid to tetrahydrofolic acid (active form) - a necessary component for synthesising purines required for DNA and protein production
17
Q

How does trimethoprim affect the kidneys?

A

Competitive inhibitor of tubular secretion of creatinine (therefore increases creatinine in circulation)

  • eGFR is dependent on serum creatinine so eGFR lower and calculation invalid
  • trimethoprim breaks the link between creatinine and GFR
18
Q

What is the drug target of trimethoprim?

A

Dihydrofolate reductase

19
Q

What are the main side effects of trimethoprim? (2)

A
  • diarrhoea
  • skin reactions
20
Q

What is some extra information about trimethoprim?

A
  • often administered with sulfamethoxazole AKA co-trimoxazole - in combination they block two steps in bacterial biosynthesis of essential nucleic acids and proteins
  • need to monitor blood counts with long term use or those at risk of folate deficiency
  • also monitor serum electrolytes in patients at risk of developing hyperkalaemia
21
Q

What is the primary mechanism of action of gentamicin?

A

Binds to the bacterial 30s ribosomal subunit disturbing the translation of mRNA, leading to the formation of dysfunctional proteins (inhibits protein synthesis in renal cells, causing necrosis of renal cells in PCT –> acute kidney failure)

22
Q

What is the drug target of gentamicin?

A

30s ribosomal subunit (bacterial)

23
Q

What are the main side effects of gentamicin? (2)

A
  • ototoxicity (hearing or balance problems)
  • nephrotoxicity
24
Q

What is some extra information about gentamicin?

A
  • aminoglycoside antibiotic that can pass through gram -ve cell membrane in an oxygen dependent manner (so ineffective against anaerobic bacteria)
  • more likely to be IV administered in hospital for endocarditis, septicaemia, meningitis, pneumonia or surgical prophylaxis
25
Q

What other previously mentioned drug types are involved in CKD? (5)

A
  • calcium channel blockers (check hypertension) - treat
  • ACE inhibitors (check hypertension) - treat
  • angiotensin receptor blockers (check hypertension) - help
  • dapaglifozin (check diabetes - SGLT-2 inhibitor) - treat (reduces proteinuria)
  • NSAIDs (check GORD) - worsen
26
Q

What is the difference between peripheral and renal vasodilation?

A
  • peripheral vasodilation - decreased BP –> decreased glomerular pressure
  • renal vasodilation - increased glomerular pressure
27
Q

What is the difference between GFR and eGFR?

A
  • GFR - the rate of blood flow through the kidneys
  • eGFR - a measure of kidney function, based on serum creatinine (high serum creatinine = low eGFR)
28
Q

What can low eGFR be caused by? (2)

A
  • vasoconstriction of afferent arteriole
  • glomerular hypertension
29
Q

Does vasodilating the afferent arteriole increase or decrease glomerular pressure?

A

Vasodilating increases glomerular pressure, vasoconstricting decreases glomerular pressure

30
Q

What is proteinuria?

A

A marker of glomerular dysfunction AND damaging in its own right

31
Q

What drugs/interventions improve proteinuria? (4)

A
  • ACE inhibitors
  • ARBs
  • SGLT-2 inhibitors e.g. dapaglifozin
  • salt restriction (to normal recommended levels)
32
Q

What are two things to consider when prescribing for a patient with reduced renal function?

A
  • might the drug damage the kidney and hence worsen the kidney injury? (e.g. ibuprofen)
  • is the drug eliminated by the kidney, and hence will it accumulate in the blood if kidney function is impaired, and hence lead to side effects? (e.g. morphine, metformin)
33
Q

When can dapagliflozin (SGLT2 inhibitor) be used apart from as a diabetes drug?

A

Dapagliflozin used in CKD with proteinuria

Year 2 - BRS (84 decks)

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