pharmacology of CKD Flashcards

1
Q

what is the MOA for statins?

A

selective, competitive inhibitor for hydroxymethylglutaryl-CoA reductase
(converts HMG-CoA to mevalonate in cholesterol synthesis)
reducing hepatic cholesterol synthesis causes an upregulation of LDL-receptors and increased hepatic uptake of LDL-cholesterol from the circulation

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2
Q

what is the drug target for statins?

A

hydroxymethylglutaryl-CoA reductase (HMG-CoA reductase)

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3
Q

what are the main side effects of statins?

A

muscle toxicity risk

constipation/diarrhoea/general GI effects

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4
Q

what should patients on statins be followed up for?

A

hyperkalaemia

acute renal failure

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5
Q

MOA of aspirin

A

irreversible inactivation of COX
prevents arachnidonic acid oxidation to prostaglandins
reduction of thromboxane A2 in platelets reduces aggregation
PGE2 reduction reduces sensation of pain (at sensory neurones) and decreases fever (in brain)

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6
Q

aspirin drug target

A

cycloxygenase enzyme

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7
Q

side effects of aspirin

A

dyspepsia

haemorrhage

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8
Q

what precautions should be taken into account when prescribing aspirin?

A

avoid greater than 160mg in elderly

coadminister PPI if peptic ulcer PMH

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9
Q

MOA trimethoprim

A

direct competitor of dihydrofolate reductase in bacteria
inhibits reduction of dihydrofolic acid - tetrahydrofolic acid (active) which is required for synthesising purines for DNA/protein production

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10
Q

drug target for trimethoprim

A

dihydrofolate reductase in bacteria

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11
Q

side effects of trimethoprim?

A

diarrhoea

skin reactions

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12
Q

what should be monitored when administrating trimethoprim?

A

folate levels

serum electrolytes - hyperkalaemia

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13
Q

MOA of gentamicin

A

binds to bacterial 30s ribosomal subunit

disturbs translation of mRNA leading to formation of dysfunctional proteins

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14
Q

drug target gentamicin

A

30s ribosomal subunit

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15
Q

side effects gentamicin

A

ototoxicity

nephrotoxicity

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16
Q

why is gentamicin ineffective against anaerobic bacteria?

A

can pass through gram -ve cell membrane in an oxygen dependent manner

17
Q

things to take into account when prescribing for patient with reduced renal function

A

may the drug damage the kidney - e.g ibuprofen

is the drug properly eliminated by the kidney - e.g morphine metformin warfarin

18
Q

what treatment should always be initiated for CKD regardless of cause

A

BP control to slow CKD progression

19
Q

proteinuria in CKD

A

marker of glomerular dysfunction

and is damaging itself

20
Q

interventions for proteinuria

A

ACEi/ARB
SGLT-2 inhibitors
salt restriction
stop other BP meds if ACEi reduces bp too low

21
Q

trimethoprim messes with what calculation and why

A

GFR

inhibits active secretion of creatinine so breaks the link between GFR and serum creatinine