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GERR > Pharmacology - Drugs and the kidney > Flashcards

Pharmacology - Drugs and the kidney Flashcards

1
Q

how the body affects a drug is known as

a.pharmacokinetics
b.pharmacodynamics

A

a.pharmacokinetics

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2
Q

how a drug affects the body is known as

a.pharmacokinetics
b.pharmacodynamics

A

b.pharmacodynamics

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3
Q

which of these drugs is less effective in renal impairment

a.thiazide diuretics
b.loop diuretics
c.trimethoprim

A

a.thiazide diuretics

give loop instead (cautiously)_

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4
Q

which of these drugs has increased efficacy in renal impairment

a. digoxin
b.potassium sparing diuretics
c.opiods
d.nitrofurantoin

A

c.opiods

opiods and sedatives have increased effect of the drug in renal impairment

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5
Q

which of these drugs can cause neuropathy due to increased toxicity in renal impairment

a.digoxin
b.potassium sparing diuretics
c.nitrofurantoin
d.tetracyclines
e.metformin

A

c.nitrofurantoin

^ all of the above have increased toxicity in renal impairment but expressed as different symptoms

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6
Q

which of these drugs can cause increased protein breakdown due to increased toxicity in renal impairment

a.digoxin
b.potassium sparing diuretics
c.nitrofurantoin
d.tetracyclines
e.metformin

A

d.tetracyclines

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7
Q

which of these drugs can cause lactic acidosis due to increased toxicity in renal impairment

a.digoxin
b.pottasium sparing diuretics
c. nitrofurantoin
d.tetracyclines
e.metformin

A

e.metformin

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8
Q

patient on drugs which are potentially nephrotoxic , have acute kidney injury (decreased renal perfusion) accompained by vomiting and diarrhoea what action should be taken

a.drugs stopped , give IV fluids

b.increase dosage of drugs following symptoms subsiding

c. give IV fluids

A

a.drugs stopped , give IV fluids

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9
Q

a reduction in blood perfusion of the kidney is what type of acute kidney injury

a.pre renal
b.intrinsic
c.post renal

A

a.pre renal - blood supply to the kidney

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10
Q

which of these drugs is not associated with pre renal impairment

a.diuretics
b.ACEi/ARBs
c.NSAIDS
d.opiods
e.ciclosporin (DMARD)

A

d.opiods

all others above are associated

and radio contrast media is also associated with pre renal impairment

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11
Q

aminoglycosides, amphotericin B(anti fungal) , antiplatelets,DMARDS, lithium,NSAIDS and radio contrast media are associated with which type of acute kidney injury

a,pre renal
b.intrinsic
c.post renal

A

b.intrinsic - in the kidney itself

anti platelets eg clopidogrel are not usually stopped as they are usually essential

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12
Q

aciclovir and methotrexate are associated with which type of acute kidney injury

a.pre renal
b.intrinsic
c.post renal -stones
d.post renal - retroperitoneal fibrosis

A

c.post renal -stones

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13
Q

atenolol and ergot derivatives are associated with which type of acute kidney injury

a.pre renal
b.intrinsic
c.post renal -stones
d.post renal - retroperitoneal fibrosis

A

d.post renal - retroperitoneal fibrosis

rare inflammatory disorder in which abnormal formation of fiber-like tissue (fibrosis) occurs behind the membrane that lines the cavity of the abdomen (peritoneum)

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14
Q

specific drugs to look out for and STOP in acute kidney injury

Nifty
Ant eaters
Dont
Like
Gnawing
More
Mounds
For food

A

NSAIDS
ACE/ARBs
digoxin
lithium
gentamicin
methotrexate
metformin
flozins- sglt2 inhibitors

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15
Q

which drugs can cause interstitial nephritis

a.NSAIDS
b.ACE/ARBs
c.digoxin
d.lithium
e.gentamicin

A

a.NSAIDS

must ask about over the counter use

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16
Q

what type of kidney problem are ACEi/ARBs contraindicated in

a.renal artery stenosis
b.interstitial nephritis
c.kidney stones

A

a.renal artery stenosis

ACE/ARBs used to vasodilate the efferent arteriole and reduce intraglomerular pressure and therefore reduce proteinuria

BUT

may be associated with renal function detiorioration if pre renal problem as blood flow to the kidney will be reduced further

withheld when patient is acutely unwell - sick day

17
Q

which of these drugs is used to reduce intraglomerular pressure and therefore reduce proteinuria

a.NSAIDS
b.ACEi/ARBS
c.digoxin
d.lithium
e.gentamicin

A

b.ACEi/ARBS

18
Q

patient on ACE/ARBS and is acutely unwell what action should be done

a.withhold drugs for 1-2 days
b.stop drugs for continued period of time
c.increase dosage
d.give IV fluids

A

a.withhold drugs for 1-2 days

sick day

19
Q

when diuretics are combined with other diuretics what adverse effect is more likely

a.electrolyte disturbances
b.nephrotoxicity
c.impaired diuresis
d.hypotension
e.lithium toxicity

A

a.electrolyte disturbances

20
Q

when diuretics are combined with aminoglycosides what adverse effect is more likely

a.electrolyte disturbances
b.nephrotoxicity
c.impaired diuresis
d.hypotension
e.lithium toxicity

A
21
Q

when diuretics are combined with NSAIDS what adverse effect is more likely

a.electrolyte disturbances
b.nephrotoxicity
c.impaired diuresis
d.hypotension
e.lithium toxicity

A

c.impaired diuresis

22
Q

when diuretics are combined with ACEi/vasodilators what adverse effect is more likely

a.electrolyte disturbances
b.nephrotoxicity
c.impaired diuresis
d.hypotension
e.lithium toxicity

A

d.hypotension

23
Q

which diuretics are likely to cause lithium toxicity when co prescribed

a.loop
b.thiazide
c.potassium sparing
d.osmotic

A

b.thiazides

24
Q

lithium should be………… in severe renal impairment

a.avoided
b.reduced
c.prescribed

A

a.avoided

25
Q

what should be done to the dose of lithium in episodes of illness

a.reduced
b.increased
c.stopped all together

A

a.reduced

renal excretion reduced in illness

26
Q

which of these drugs can can increase risk of dehydration by increasing urination

a. NSAIDS
B.ace/ARB
c. digoxin
d.lithium
e.gentamicin

A

d.lithium

can block the effect of ADH on the kidney (diabetes insipidus)

27
Q

long term use of which drug is associated with tubulo-interstitial damage

a. NSAIDS
B.ace/ARB
c. digoxin
d.lithium
e.gentamicin

A

d.lithium

28
Q

a decrease in kidney function has what effect on digoxin

a.increased half life
b.decreased half life

A

a.increased half life

takes longer for kidney to excrete it
takes longer to reach a steady state

29
Q

risk of digoxin toxicity is increased by..

a.hyperkalaemia
b.hypernatraemia
c.hypokalaemia
d.hyponatraemia

A

c.hypokalaemia

so caution when prescribed with diuretics commonly co prescribed in heart failure

30
Q

how is gentamicin administered

a.oral
b.subcutaneous
c.IV

A

c.IV

31
Q

what should be done to the dose of gentamicin in renal impairment

a.increase
b.decrease
c. no change
d.stop immediately

A

b.decrease

decrease dose and frequency
u and e more often

32
Q

drug induced acute kidney injury is usually …..

a.reversible
b.irreversible

A

a.reversible

if detected early

stope potentially nephrotoxic drugs and ensure appropriate supportive treatment eg IV fluids

33
Q

what tests are done to detect drug induced acute kidney injury

A

serum creatinine
eGFR
urinary sediment

34
Q

at what stage of kidney disease are drug kinetics effected and so dose adjustment is required

a.1
b.2
c.3a
d.3b
e.4

A

d.3b

eGFRb <30

staged 1-5

35
Q

adjustment of dosage in renal impairment is based on

a.eFGR
b.clearance rate
c.BMI

A
35
Q

adjustment of dosage in renal impairment is based on

a.eFGR
b.clearance rate
c.BMI

A

a.eFGR

36
Q

what should be taken with meals in severe CKD?

a.calcium carbonate
b.iron
c.vitamin D

A

a.calcium carbonate

phosphate binding agent

in ckd reduced phosphate filtered, extra phosphate free, draws calcium out of bones making them week

37
Q

in renal osteodystrophy (weakened bones as a complication of CKD)what is given as a daily tablet

a. calcium carbonate
b. 1,25 OH vit D
c. erythropoetins

A

b. 1,25 OH vit D

GERR (53 decks)

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