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Systems 2nd Year Renal > Clinical pharmacology in renal > Flashcards

Clinical pharmacology in renal Flashcards

1
Q

Gentamicin may cause what in renal

A

renal or otoxicity

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2
Q

digoxin may cause what in renal

A

arrhythmia, nausea or death

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3
Q

lithium may cause what in renal

A

renal toxicity and death

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4
Q

tacrolimus may cause what in renal

A

renal and cns toxic

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5
Q

which drugs have narrow therapeutic index then toxicity or death

A

gentamicin
digoxin
lithium
tacrolimus

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6
Q

is drug induced nephrotoxicity common

A

yes

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7
Q

Mechanism of Renal Excretion

A

Glomerular filtration, passive tubular reabsorption, active tubular secretion

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8
Q

All drugs and metabolites filtered at

A

Glomerulus

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9
Q

renal impairment will do what to half life of all drugs

A

prolong so therefore take care with low therapeutic index drugs

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10
Q

what reduces clearance of drugs by kidneys resulting in accumulation

A

reduction in GFR meaning must reduce dose and increase dose interval

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11
Q

what does renal disease do to actions of drugs on tissues

A

blood brain barrier becomes permeable

brain more sensitive

circulatory vol reduced so sensitive to hypertension drugs in particular

increased tendency to bleed beware warfarin or saids

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12
Q

When might gentamicin toxicity be unmasked

A

used with lithium or furosemide

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13
Q

renal impairment may do what in drug binding

A

more free drug available

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14
Q

what is important to do when treating patients who have renal disease

A

Reduce losing dose and maintenance dose

Increase dose interval

go for drugs with high therapeutic index

metabolised by liver with non toxic metabolites

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15
Q

what happens to concentration of drug as it moves from glomerus along kidney tubules

A

more concentrated

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16
Q

what four conditions can drug induced renal toxicity cause

A

acute renal failure
nephrotic syndrome
renal tubular dysfunction with potassium wassting
chronic renal failure

17
Q

Acute Renal failure is

A

sudden deterioation in renal function = rapid rise in creatinine

18
Q

Acute Renal Failure can be

A

Prerenal
Renal or Intrinsic
Post Renal or Obstructive

19
Q

Pre Renal Drug Induced Renal Disease Causes

A 
Water and Electrolyte Abnormalities
Diuresis 
Laxatives
Lithium
NSAIDS
Increased Catabolism
Steroids
Terracyclines
Oestrogens
OCP
20
Q

Renal/Intrinsic Drug Induced Renal Disease Causes

A

Acute Tubular Necrosis
Acute Interstitial Nephritis
Thrombotic Microangiopathy

21
Q

Which drugs are related to Acute Tubular Necrosis

A 
Aminoglycoside Antibiotics
Amphotericin B
Cisplatin
Radioconstrast
Statins with Cyclosporin
22
Q

When does Acute Interstitial Nephritis start

A

3-5 days after drug exposure

23
Q

Drugs implicated in Acute Interstitial Nephritis

A

penicillins, cephalosporins, cocaine, sulfonamides, NSAIDs diuretics, lithium, ranitidine, omeprazole, captopril, lithium, phenytoin, valproic acid, amphotericin B, streptokinase, 5-aminosalicylates, allopurinol, rifampin,
Chinese herbs

24
Q

Thrombotic Microangiopathy can cause

A

severe acute renal failure

25
Q

what changes in kidney happen in thrombotic microangiopathy

A

afferent arteriolar

glomerular thrombosis

26
Q

Drugs implicated in thrombotic microangiopathy

A

cyclosporin, tacrolimus
chemotherapeutic agents mitomycin C bleomycin, cisplatin
ticlopidine, clopidogrel
19 estrogen-containing oral contraceptives
quinine
cocaine

27
Q

where can drug associated obstruction of urine outflow take place

A

Tubules or Ureters due to Crystal Formation

Outside Ureters due to Retroperitoneal Fibrosis eg Methysergide

28
Q

drugs implicated in crystal formation

A

acyclovir, indinavir
sulfonamides,
triamterene
methotrexate,
vitamin C in large doses (due to oxalate crystals).
Guaifenesin and ephedrine can also cause stones to form in kidneys

29
Q

Drugs implicated in Nephrotic Syndrome

A 
The nephrotic syndrome is due to glomerular dysfunction and marked by heavy proteinuria.
Drugs implicated include:
gold, 
NSAIDs,
penicillamine, 
interferon, 
captopril.
30
Q

NSAIDS can cause

A 
acute renal failure,
nephrotic syndrome, 
hypertension, 
hyperkalemia,
papillary necrosis
31
Q

most common drug to cause hospital acquired renal insufficiency

A

ahminoglycosides

32
Q

NSAID induced prerenal acute renal failure results from

A

decreased synthesis of renal vasodilator prostaglandins, which can lead to reduced renal blood flow and reduced glomerular filtration.

33
Q

NSAID-induced acute allergic interstitial nephritis happens due to

A

ibuprofen, naproxen, and fenoprofen and can be associated with nephrotic syndrome

34
Q

Aminoglycoside Induced Renal Injury used in Gram Neg Sepsis mechanism

A

proximal tubular injury leading to cell necrosis.

35
Q

Acute renal failure due to ATN is the most common and is due to

A

ahminoglycosides

36
Q

which drug to use for hypertension with renal involvement

A

ACEIS with reduced dose and longer dose periods

Systems 2nd Year Renal (30 decks)

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