Clinical pharmacology in renal

Question 1

Gentamicin may cause what in renal

Answer 1

renal or otoxicity

Question 2

digoxin may cause what in renal

Answer 2

arrhythmia, nausea or death

Question 3

lithium may cause what in renal

Answer 3

renal toxicity and death

Question 4

tacrolimus may cause what in renal

Answer 4

renal and cns toxic

Question 5

which drugs have narrow therapeutic index then toxicity or death

Answer 5

gentamicin
digoxin
lithium
tacrolimus

Question 6

is drug induced nephrotoxicity common

Answer 6

yes

Question 7

Mechanism of Renal Excretion

Answer 7

Glomerular filtration, passive tubular reabsorption, active tubular secretion

Question 8

All drugs and metabolites filtered at

Answer 8

Glomerulus

Question 9

renal impairment will do what to half life of all drugs

Answer 9

prolong so therefore take care with low therapeutic index drugs

Question 10

what reduces clearance of drugs by kidneys resulting in accumulation

Answer 10

reduction in GFR meaning must reduce dose and increase dose interval

Question 11

what does renal disease do to actions of drugs on tissues

Answer 11

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

Question 12

When might gentamicin toxicity be unmasked

Answer 12

used with lithium or furosemide

Question 13

renal impairment may do what in drug binding

Answer 13

more free drug available

Question 14

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

Answer 14

Reduce losing dose and maintenance dose

Increase dose interval

go for drugs with high therapeutic index

metabolised by liver with non toxic metabolites

Question 15

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

Answer 15

more concentrated

Question 16

what four conditions can drug induced renal toxicity cause

Answer 16

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

Question 17

Acute Renal failure is

Answer 17

sudden deterioation in renal function = rapid rise in creatinine

Question 18

Acute Renal Failure can be

Answer 18

Prerenal
Renal or Intrinsic
Post Renal or Obstructive

Question 19

Pre Renal Drug Induced Renal Disease Causes

Answer 19

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

Question 20

Renal/Intrinsic Drug Induced Renal Disease Causes

Answer 20

Acute Tubular Necrosis
Acute Interstitial Nephritis
Thrombotic Microangiopathy

Question 21

Which drugs are related to Acute Tubular Necrosis

Answer 21

Aminoglycoside Antibiotics
Amphotericin B
Cisplatin
Radioconstrast
Statins with Cyclosporin

Question 22

When does Acute Interstitial Nephritis start

Answer 22

3-5 days after drug exposure

Question 23

Drugs implicated in Acute Interstitial Nephritis

Answer 23

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

Question 24

Thrombotic Microangiopathy can cause

Answer 24

severe acute renal failure

Question 25

what changes in kidney happen in thrombotic microangiopathy

Answer 25

afferent arteriolar | glomerular thrombosis

Question 26

Drugs implicated in thrombotic microangiopathy

Answer 26

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

Question 27

where can drug associated obstruction of urine outflow take place

Answer 27

Tubules or Ureters due to Crystal Formation Outside Ureters due to Retroperitoneal Fibrosis eg Methysergide

Question 28

drugs implicated in crystal formation

Answer 28

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

Question 29

Drugs implicated in Nephrotic Syndrome

Answer 29

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

Question 30

NSAIDS can cause

Answer 30

``` acute renal failure, nephrotic syndrome, hypertension, hyperkalemia, papillary necrosis ```

Question 31

most common drug to cause hospital acquired renal insufficiency

Answer 31

ahminoglycosides

Question 32

NSAID induced prerenal acute renal failure results from

Answer 32

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

Question 33

NSAID-induced acute allergic interstitial nephritis happens due to

Answer 33

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

Question 34

Aminoglycoside Induced Renal Injury used in Gram Neg Sepsis mechanism

Answer 34

proximal tubular injury leading to cell necrosis.

Question 35

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

Answer 35

ahminoglycosides

Question 36

which drug to use for hypertension with renal involvement

Answer 36

ACEIS with reduced dose and longer dose periods