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Drugs Flashcards

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1
Q

amphotercin B

A

nephrotoxic
pores in cell membrane and renal vasoconstriction
liposomal less toxic
Tx: volume expansion

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2
Q

VEGF inhibitors

A

nephrotoxic
interrupts fenestrated glomerular epithelium
results in HTN, proteinuria, thrombotic microangiopathy

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3
Q

EGFR inhibitors

A

nephrotoxic

hypomagnesemia and may inhibit P-gp

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4
Q

lithium

A

nephrotoxic
enters cell through ENaC
inhibits aquaporin 2 causing NDI

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5
Q

calcineurin inhibitors

A

nephrotoxic: difficult to tell in drug effect or transplant rejection

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6
Q

cisplatin

A

nephrotoxic and ototoxic
taken up by Ctr1 (copper) and OCT2
promotes cell death

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7
Q

calcium gluconate

A

IV: ~ 30 min
stabilizes membrane potential of myocardium
Tx: hyperkalemia

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8
Q

insulin

A

stimulates Na-H exchanger leading to a higher Na concentration to stimulate Na-K ATPase to take up K into cell
Tx: hyperkalemia

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9
Q

albuterol

A

Inhalation: B2 agonist
activates (phosphorylates) Na-K ATPase to take up K into cell
Tx: hyperkalemia

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10
Q

acetazolamide

A

PCT
carbonic anhydrase inhibitor: inhibits NaHCO3 reabsorption
effect: hyperchloremic systemic acidosis, alkaline urine, chloride reabsorption
Tx: glaucoma, cystinuria, seizure, mountain sickness

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11
Q

furosemide (Lasix)

A

loop diuretic
dilates veins: decrease LV filling pressure
SULFA drug
AE: ototoxicity, increase BUN, hyperglycemia, hyperuricemia, fluid and electrolyte imbalance, sialadentitis (inflammation of salivary glands)
DI: Lithium, indomethacin, probenecid, warfarin
secreted by organic acid transporter

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12
Q

bemtanide

A

loop diuretic
more POTENT than furosemide
useful with warfarin

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13
Q

torsemide

A

loop diuretic
vasodilator: lowers BP
longer T1/2

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14
Q

loop diuretics

A

block Na/K/2Cl transporter in TALH: high delivery of Na to distal nephron causing Na and H20 excretion
increase renal PG: increase RBF
stimulate renin release and maintain GFR
increase excretion: K, Ca, Mg, H (mild metabolic alkalosis)
Tx: edema, IV for acute pulmonary edema, hypercalcemia, protect against renal failure, washout toxins, HTN, SIADH
MOST POTENT diuretic
give NSAID to prevent resistance

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15
Q

thiazide diuretics

A

inhibit Na/Cl cotransporter in DCT: moderate Na/water excretion
Ca/Na counter transporter is more active: decrease Ca urinary excretion
increase Na to CD: increase K secretion
increase Mg excretion
Tx: edema, HTN, diabetes insipidus, hypercalciuria, osteoporosis, nephrogenic diabetes insipidus
AE: hypokalemia, hypomagnesia, hyperuricemia, hypercalcemia, hyperglycemia, lipid disorders, reduced GFR
GFR needs to be greater than 60 mL/min

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16
Q

K sparing diuretics

A 
inhibits Na reabsorption and K secretion
cortical collecting duct
decrease Na to CD: decrease K secretion
COMBINE with thiazides
AE: hyperkalemia, megaloblastic anemia in patients with cirrhosis
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17
Q

spirinolactone

A

aldosterone antagonist

AE: gynecomastia, hirsutism, uterine bleeding

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18
Q

amiloride

A

K sparing: ENac inhibitor

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19
Q

triamterene

A

K sparing: ENac inhibitor

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20
Q

kayexelate

A

K resin: removal of K in GI

Tx: hyperkalemia

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21
Q

eplernone

A

aldosterone antagonist

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22
Q

ethacrynic acid

A

loop diuretic

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23
Q

mannitol

A

osmotic diuretic

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24
Q

hydrochlorothiazide

A

thiazide

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25
metolazone
POTENT thiazide | GFR greater than 30 needed
26
chlorthalidone
thiazide | long T1/2
27
quinothazone
POTENT thiazide
28
arginine vasopressin
ADH
29
desmopressin
ADH like drug | Tx: central diabetes insipidous, bleeding disorders, nocturnal enurisis
30
conivaptan
``` IV V2R antagonism less selective for V2R than tolvaptan Tx: hyponatremia CYP3A4 metabolism AE: numerous, infusion site rxn ```
31
tolvaptan
V2R antagonism CYP3 metabolism AE: hyplerglycemia, GI, clotting
32
osmotic diuretic
inhibit Na/H2O reabsorption in PCT: decrease medullary tonicity impair ability of thin segments of LOH increase excretion: urine, Na, K, Cl excretion initially increase BP Tx: dialysis disequilibrium syndrome, reduce intracranial and intraocular pressure AE: volume overload CI: cardiac failure
33
aldosterone antagonist
late DT and CD reduce ENac: increase Na excretion and reduce K Tx: diuretic with thiazide, CHF, cirrhosis
34
ADH like drug
V2R agonist increase water permeability in CD Tx: ADH-sensitive diabetes insidious, nephrogenic diabetes insipidous
35
vaptans
VR2 antagonist | Tx: SIADH
36
demeclocycline
V2R antagonist | Tx: SIADH
37
terlipressin
IV; restricted use V1R agonist: smooth muscle contration Tx: ileus, reduce bleeding in esophageal varices and acute hemorrhagic gastritis
38
renal cancer Tx in children
majority curable | classic cytotoxic agents in combination
39
renal cancer Tx in adults
targeted drugs | TKI first, then mTOR inhibitor
40
standard Wilm's tumor or clear cell sarcoma in childrenTx
nephrectomy radiation vincristine, dactinomycin +/- doxorubicin OR vincristine, doxorubicin, cyclophosphamide, etoposide
41
recurrent Wilm's tumor Tx
alternate 1. vincristine, doxorubicin, cyclophosphamide 2. etoposide, cyclophosphamide
42
recurrent clear cell sarcoma Tx in children
cyclophosphamide and carboplatin if not used initially brain involvement: ICE: ifosfamide, carboplatin, etoposide surgical resection and/or radiation
43
Tx for rhabdoid and neuroepithelial tumor in children
none
44
carboplatin
intrastrand DNA links
45
cyclophosphamide
inter and intra-strand links | AE: hemorrhagic cystitis
46
doxorubicin
intercalate, Topo-II inhibition, radicals | AE: cardiotoxic
47
dactinomycin
intercalate, DNA dependent RNA synthesis inhibition; single strand breaks: free radical, topo-II AE: hepatic dysfunction, extravasional necrosis
48
etoposide
topo-II inhibitor | AE: hematologic, BP instability
49
ifosfamide
inter and intrastrand links | AE: hemorrhagic cystitis
50
vincristine
blocks tubulin polymerization | AE: peripheral neuropathy: "stocking glove"
51
MESNA
give with cyclophosphamide | Tx hemorrhagic cystitis
52
VEGF inhibitors
``` clear cell renal carcinoma bevacizumab axitinib sunitinib sorafenib pazopanib: EGFR inhibitor all TKI: PDGFR inhibitor AE: HTN ```
53
mTOR inhibitors
bind FKBP12: inhibit immune, cell cycle, angiogenesis; promote apoptosis Tx: clear cell renal carcinoma CYP3A4 substrate AE: maculopapular rash, mucosistis, anemia, fatigue, pulmonary infiltrates, blood dyscrasia
54
-nib
oral tyrosine kinase inhibitors conserved ATP binding domain resistance: ATP binding domain, and up regulation of mTOR2 metabolized by CYPs: CYP3A4 AE: hepatic, proteinuria CV: HTN, QT, thromosis, hemorrhage, blood dyscrasia endocrine: thyroid, adrenal, glucose need to monitor
55
aldesleukin (IL-2)
T cell GF activates JAK/STAT AE: capillary leak syndrome (hypotension, tachycardia, hematoligic toxicity, pulmonary edema, renal toxicity); potential for sepsis Tx: clear cell renal carcinoma
56
IFN-alpha 2b
SC activates JAK/STAT AE: neuropsychiatric, infectious disorders, autoimmune, ischemic less common AE: xerostomia, dysguesia, diaphoresis, cough, dizziness Tx: clear cell renal carcinoma
57
temsirolimus
mTOR inhibitor IV weekly metabolize to sirolimus
58
everolimus
mTOR inhibitor | daily oral drug
59
TKI with Steven Johnson syndrome
hypersensitivity sorafenib suntinib
60
bevacizumab
IV infusion VEGF inhibitor Ab AE: thrombosis, HTN, CHF, proteinuria, blood dyscrasia, hemorrhage, GI perforation WOUND HEALING complications
61
renal cancer drugs that cause renal damage
carboplatin ifosfomide IL-2 targeted Tx not including mTOR inhibitors
62
Drugs that induce hyperkalemia
1. block Na channel in distal nephron: K sparing diuretics, trimethoprim, pentamidine 2. block aldosterone production: ACEI/ARBs, NSAIDs, Heparin, tacrolimus 3. block aldosterone receptors (spironolactone, eplerenone) 4. block Na/K ATPase in distal nephron: cyclosporine 5. extrarenal: digoxin, B2 blockers, somatostatin (inhibits insulin) 6. K release from injured: tumor lysis syndrome, rhabdomyolysis, depolarizing paralytic agents
63
drugs that induce hypokalemia
DIURETICS, ANTI-INFECTIVE agents 1. increased excretion: diuretics, foscarnet, laxatives 2. increased uptake: B2 agonist, dextrose, insulin, levothyroxine, theophylline 3. misc: amphotericin B, caspofungin, corticosteroids, itrconazole 4. 2 to hypomagnesemia: aminoglycosides, amphotericin B, cisplatin, cyclosporine, loop diuretics
64
hypokalemia with low Mg
occludes ROMK channel low Mg: K leaves cell and is excreted MUST CORRECT to Tx hypokalemia
65
NSAIDs (kidney injury)
AIN inhibit PG: maintain adequate renal perfusion chronic use: hyponatremia, hyperkalemia and metabolic acidosis, HTN
66
ACEI/ARB (kidney injury)
inhibit renal auto-regulation of GFR bilateral renal artery stenosis, volume depletion hyperkalemia, acute renal injury
67
aminoglycosides (kidney injury)
ATN proximal tubule accumulation resulting in cell death decrease K, Mg, Ca accumulation in DT and CD can impair concentrating abilities Tx: expand volume, limit dose
68
SMX-TMP (kidney injury)
ATN, AIN inhibits ENac; increased Cr without GFR effect Tx: hydrate and alkalinize urine
69
amphotericin B (kidney injury)
pores in cell membrane renal tubular acidosis renal vasoconstriction tx: fluids
70
VEGF inhibitors (kidney injury)
VEGF maintenance of fenestrated glomerular epithelium | HTN, proteinuria, thrombotic microangiopathy
71
EGFR Ab (kidney injury)
cetuximab hypomagnesemia inhibit P-gp
72
lithium (kidney injury)
ENac | dysregulation of AQP-2 and develop NDI
73
calcineurin inhibitors (kidney injury)
cyclosporine, tacrolimus interstitial fibrosis inhibit transfer of NF-AT to nucleus
74
cisplatin (kidney injury)
ATN promote cell death TNF-alpha production in tubular cells
75
acute interstitial nephritis (AIN)
``` onset: 10-14 d Sx: fever, rash, eosinophilia UA: WBC casts, hematuria, proteinuria, eosinophiluria Tx: stop drug, corticosteroids Dx: biopsy ```
76
acute tubular necrosis (ATN)
``` onset: 7-10 d uremic Sx UA: granular casts, renal epithelial cast, oliguria Dx: Hx, exam, labs initiation, maintenance, recovery proximal straight tubule, TALH hypoprefusion + casts and debris collect in tubule; ATP depleted Tx: discontinue contrast ```

SS- Renal (11 decks)

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