(FE) Drugs for Renal Conditions

Question 1

What are the common nephrotoxic drugs?

Answer 1

(NA5CCR)
- NSAIDs , acetaminophen
- Acyclovir
- Adefovir
- Aminoglycosides
- Amphotericin B
- ACE-I
- Carboplatin
- Cyclosporin, tacrolimus
- Radiographic IV contrast agents

Question 2

What are the drugs to avoid in AKI?

Answer 2

• NSAIDs
• Diuretics
• ACE-I

Question 3

What are the s/s or complications of CKD and what are their management strategies?

Answer 3

1) Anemia
- Epoitin alfa

2) Hyperkalemia
- Dietary restriction of potassium
- Sodium polystyrene sulfonate/ zirconium cyclosilicate

3) Hyperphosphatemia
- Dietary restriction of phosphate
- Calcium acetate / carbonate
- Sevelamer
- Lanthanum

4) Hypervolemia
- Dietary restriction of sodium
- Loop diuretics (for acute)
- Thiazide diuretics (for mild)

5) Hypocalcemia
- Usually corrected by addressing hyperphosphatemia first
- Calcium supplements

6) Metabolic acidosis
- Sodium bicarbonate / citrate

Question 4

What is the MOA and side effects of erythropoiesis-inducing agents?

Answer 4

EPOITIN ALFA

• Stimulates erythropoiesis
• HTN
• Seizures
• Heart failure, MI
• Stroke
• N&V, diarrhea
• Headache, fever
• URTi
• Oedema

Question 5

What is the MOA and side effects of potassium binders?

Answer 5

SODIUM POLYSTYRENE SULFONATE / ZIRCONIUM CYCLOSILICATE

• Binds to excess potassium in the bowels
• Exchanges potassium calcium or sodium ions found in colon
• Oedema
• Hypokalemia
• Diarrhea/constipation
• Fecal impaction
• N&V
• Bloating

Question 6

What is the MOA and side effects of calcium-based phosphate binders?

Answer 6

CALCIUM CARBONATE / ACETATE , SEVELAMER, LANTHANUM

• Treat hyperphosphatemia and hypocalcemia together
• Oedema
• Hypophosphatemia
• Constipation
• Abdominal discomfort, bloating

Question 7

What is the MOA and side effects of calcium supplements?

Answer 7

CALCITRIOL

• Stimulates intestinal calcium uptake
• Increases reabsorption of calcium by the kidneys
• Constipation
• Excessive nocturia
• Bone pain
• ^ BUN, creatinine, calcium, magnesium , phosphate
• Cardiac arrhythmias

Question 8

What is the MOA and side effects of loop diuretics?

Answer 8

FUROSEMIDE

• Inhibits Na-K-Cl cotransporter in the thick ascending limb of LOH
• Binds to chloride transport channel
  ~ More sodium, chloride and potassium in urine

Question 9

What antibiotics are used to treat UTIs?

Answer 9

• Amoxycillin (usually oxapenams to reduce antibiotic resistance)
• Ciprofloxacin
• TMP
• Fosfomycin (Novel class to inhibit bacterial cell wall synthesis, can cause anaphylaxis and superinfection)
  ~ Can be used to rep
• Nitrofurantoin

Question 10

What are the drugs used to treat urinary incontinence?

Answer 10

1) Beta-3 adrenergic agonist
- eg Mirabegron
- Relaxes bladder muscle and increases the amount of urine that bladder can hold

2) Anticholinergic
- eg Oxybutynin, Tolterodine, Solifenacin
- Calms an overactive bladder (for urge incontinence)

Question 11

What are the drugs used to treat BPH?

Answer 11

1) 5-alpha reductase inhibitors
- eg Dutasteride, Finasteride
- Reduces size of prostate gland by blocking conversion of testosterone into dihydrotestosterone

2) Alpha-1 blockers
- e.g. Tamsulosin, Alfuzosin
- Relaxes bladder neck muscles