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Y4R3 - Medicine II 🩺 > L9: Kidney & Drugs > Flashcards

L9: Kidney & Drugs Flashcards

(67 cards)

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1
Q

Effect of CKD on Meds
(Pharmacokinetics)

A

(ABSORPTION – DISTRIBUTION – METABOLISM – ELIMINATION)

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2
Q

Effect of CKD on Drug Absorbtion

A
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3
Q

Effect of CKD on Drug Distribution

A
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4
Q

Effect of CKD on Drug Metabolism

A
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5
Q

Effect of CKD on Drug Elimination

A
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6
Q

Effect of Meds on Kidney

A
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7
Q

Mechanisms of medication-induced nephrotoxicity

A

① Functional/Hemodynamic effect: Afferent VC or Efferent VD.

② Glomerular injury.

③ Tubulointerstitial injury: AIN + Analgesic nephropathy + Crystal Nephropathy

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8
Q

Functional/Hemodynamic effect of Meds on Kidney

A
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9
Q

Functional/Hemodynamic effect of Meds on Kidney

  • Mechanism
A

These drugs alter renal blood flow → Decreased GFR

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10
Q

Functional/Hemodynamic effect of Meds on Kidney

  • Examples
A
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11
Q

Medication-induced glomerular disease

A
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12
Q

Medication-induced glomerular disease

  • Direct Cellular Injury
A
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13
Q

Drugs Causing Direct Cellular Injury

  • Epithelial (Podocyte) Cells
A
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14
Q

Drugs Causing Direct Cellular Injury

  • Endothelial Cells
A
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15
Q

Drugs Causing Direct Cellular Injury

  • Mesengial Cells
A
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16
Q

Drugs Causing Immune Mediated Injury

A
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17
Q

Drugs Causing Immune Mediated Injury

  • Immune Complex Diseaeses
A
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18
Q

Drugs Causing Immune Mediated Injury

  • Small vessel vasculitis (ANCA related)
A
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19
Q

Tubulointerstitial injury by Drugs

A
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20
Q

AIN by Drugs

A
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21
Q

AIN by Drugs

  • Antibiotics
A

▪ Penicillins
▪ Cephalosporins
▪ Sulfonamides
▪ Isoniazid
▪ Rifampin

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22
Q

AIN by Drugs

  • Ananlgesics
A

NSAIDs

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23
Q

AIN by Drugs

  • Diuretics & Antihypertensives
A

▪ Furosemide
▪ Thiazides
▪ Triamterene
▪ Amlodipine
▪ Diltiazem

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24
Q

AIN by Drugs

  • PPI
A

Omeprazole

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25
AIN by Drugs - H2 Blockres
▪ Famotidine ▪ Ranitidine
26
AIN by Drugs - Anticonvulsants
▪ Phenytoin ▪ Carbamazepine
27
AIN by Drugs - Others
▪ Allopurinol ▪ Immune Checkpoint Inhibitors (i.e., PD-L1 inhibitors)
28
Analgesic Nephropathy by Drugs
29
Def of **Analgesic Nephropathy**
A kidney disease characterized by papillary necrosis & chronic interstitial nephritis.
30
Etiology of **Analgesic Nephropathy**
- When combination analgesics (e.g., NSAIDs + Paracetamol) are used in large cumulative doses.
31
Pathogensis of **Analgesic Nephropathy**
32
Def of **Crystal Nephropathy**
33
Etiology of **Crystal Nephropathy**
34
Etiology of **Crystal Nephropathy** - Hypercalcemia
35
Etiology of **Crystal Nephropathy** - Excess Vit C
Vit c is converted to oxalate & excreted in the urine → allows calcium oxalate crystals to form.
36
Etiology of **Crystal Nephropathy** - Hyperuricemia
37
Contributing Factors for **Crystal Nephropathy**
38
Meds Usage in renal Disease
① Medications commonly used in renal patients. ② Medications that should be deprescribed in renal patients. ③ Medications that should be monitored closely in renal patients.
39
Medications commonly used in renal patients
40
Benefits of **Diuretics in CKD**
For natriuresis & BP control with a reduced GFR.
41
Risks if **Diuretics in CKD**
42
Risks if **Diuretics in CKD** - Specific to loop & Thiazides
② A range of electrolyte disturbances including dec, k+ & dec. Mg2+ ③ Hypochloremic metabolic alkalosis ④ Hyperuricemia ⑤ At higher doses of thiazides → glucose intolerance, and hyperlipidemia
43
Risks if **Diuretics in CKD** - Specific to K Sparring Diuretics
(MRA, Amiloride) - Hyperkalemia
44
MOA of **RAAS Blockers**
45
RAAS blockers Double-Edged Sword in CKD - Explain
46
Mechanism of **RAAS-Induced Hyperkalemia**
47
RF for **RAAS-Induced Hyperkalemia**
48
Mechanism of **RAAS-Induced AKI**
49
RF for **RAAS-Induced AKI**
50
Usage of Anti-Hyperglycemia Drugs in Kidney Disease
51
Medications that should be deprescribed in renal patients
52
Risks of **NSAIDs in Kidney Disease**
53
Cautions While Using **NSAIDs in Kidney Disease**
54
Risk of **Iodinated Contrast in Kidney Disease**
Contrast-induced nephrotoxicity
55
Caustions while Using **Iodinated Contrast in Kidney Disease**
56
OTC Meds with Kidney Diseases
Unneeded OTC medications & dietary supplements: ① Herbal supplements ② Non-herbal supplements ③ Vitamins
57
Licorice with Kidney Diseases
increase Risk of sodium and water retention, hypokalemia.
58
PPI with Kidney Diseases
- Growing evidence indicates potential kidney and non-kidney-related harm with prolonged usage.
59
Medications that should be monitored closely in renal patients
60
Medications that should be monitored closely in renal patients. - Examples
61
Approach to Safe Medication Prescription in Renal Patients
62
Approach to Safe Medication Prescription in Renal Patients - Assess Kidney Function
63
Approach to Safe Medication Prescription in Renal Patients - Meds History
- The medication list should include all prescriptions, OTC, and dietary supplements. - Ask for history of drug allergies/sensitivities
64
Approach to Safe Medication Prescription in Renal Patients - Meds Review
65
Approach to Safe Medication Prescription in Renal Patients - Adjust regimen
Adjust the dose based on patient’s eGFR and drug pharmacokinetics (Avoid renally cleared medications)
66
Approach to Safe Medication Prescription in Renal Patients - Drug Therapy Monitoring
Monitor the following: ▪ Drug efficacy (Response). ▪ Drug toxicity. ▪ Drug level “If available/applicable”
67
Done
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Y4R3 - Medicine II 🩺 (35 decks)

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