Metabolic PPT Flashcards
(149 cards)
1
Q
what helps predict the progression of AKI to CKD?
A
severity and duration of AKI
2
Q
what are the 6 steps used to treat AKI?
A
1 - correction of hypovolaemia and restoration of haemodynamic status
2 - treatment of sepsis (sepsis 6)
3 - avoid nephrotoxic drugs
4 - adjust does of renally excreted drugs
5 - nutrition
6 - referral
3
Q
whats used in the 1st step of AKI treatment?
A
crystalloid stat (hartmann’s solution)
4
Q
what nephrotoxic drugs should be avoided in treatment of AKI/renally impaired patients?
A
NSAIDs, amphoterecin, aminoglycosides, iodinated contrast, ACE inhibitors
5
Q
name some renally excreted drugs who’s dose should be adjusted in AKI
A
Digoxin, LMWH, opioids, penecillin
6
Q
what are the 3 classes of drug that interfere with renal perfusion?
A
NSAIDs, ACEi, ARBs
7
Q
give 2 examples of calcineurin inhibitors
A
tacrolimus, ciclosporin
8
Q
whats the MOA of calcineurin inhibitors?
A
IL-2 productin inhibited which causes arrest of T cell division
9
Q
whats are calcineurin inhibitors used for
A
immunosuppression
10
Q
side effects of calcineurin inhibitors
A
1 - nephrotoxicity due to infrarenal vasocostriction
2 - hypertension
3 - hyperkalaemia
gum hypertrophy (ciclosporin)
11
Q
name some anti-proliferative immunosuppressants
A
azathioprine, cyclophosphamide
12
Q
whats the MOA of azathioprine
A
antagonizes purine synthesis, resulting in less DNA and RNA synthesis for white blood cell synthesis
13
Q
side effects of azathioprine
A
leucopenia, thrombocytopenia, pancreatitis
14
Q
when can azathioprine be used
A
immunosuppression for transplant
15
Q
MOA of cyclophosphamide
A
an alkylating agent which can have 3 effects:
1 - alkyl group binds to DNA and prevents DNA synthesis and RNA transcription
2 - DNA damage via formation of crosslinks
3 - mispairing nucleotides leading to mutation
16
Q
side effects of cyclophosphamide
A
1 -haemorrhagic cyst
2 - alopecia
3 - neutropenia
17
Q
management plan for CKD
A
1 - lifestyle changes
2 - medication for underlying problems e.g. hypertension or high cholesterol
3 - dialysis (advanced ckd)
4 - kidney transplant (advanced ckd)
18
Q
whats the MOA of quinolones
A
inhibit replication of bacterial DNA by blocking the ligase part of bacterial DNA
19
Q
name some quinolones
A
ciprofloxacin, moxifloxacin
20
Q
side effects of quinolones
A
1 - N&V
2 - dizziness
3 - ear pain
21
Q
MOA of trimethoprim
A
antifolate antibacterial agent that inhibits an enzyme important in synthesis of bacterial DNA
22
Q
side effects of trimethoprim
A
1 - itching and rash
2 - diarrhoea
3 - headaches
23
Q
MOA of nitrofurantoin
A
antibiotic that is converted into an intermediate that inhibits citric acid cycle as well as DNA, RNA and protein synthesis
24
Q
side effects of nitrofurantoin
A
1 -respiratory fibrosis
2 - headaches
3 - dizziness
25
name some drugs that are commonly used to treat simple UTIs
trimethoprim, nitrofurantoin
26
what 2 drugs are combined to make co-amoxiclav?
amoxicillin and clavulanic acid
27
MOA of co-amoxiclav
clavulanic acid is a beta lactamase inhibitor so prevents amoxicillin (a beta lactam) from being hydrolysed
28
what classes of drugs are the beta lactam subgroups
cephalosporins, penecillins, monobactams and carbepenems
29
MOA of beta lactams
bactericidal antibiotics that act by inhibiting the synthesis of peptidoglycan layer of bacterial cell walls
30
side effects of co-amoxiclav
1 - thrombocytopenia
2 - diarrhoea
3 - itching
31
what antibiotics can pyelonephritis commonly be treated with?
ciprofloxacin, co-amoxiclav
32
MOA of gentamicin
an aminoglycoside that inhibits protein synthesis
33
side effects of gentamicin
1 - nephrotoxicity
| 2 - ototoxicity (ear)
34
what drugs are used to treat incontinence and bladder instability?
muscarinic receptor antagonists e.g. oxybutinin, tolterodine
35
how are most drugs eliminated from the body?
hepatic metabolism. Only water soluble drugs are mainly eliminated by the kidneys
36
MOA of oxybutinin
selective antagonist of M1 and M3 receptors, acting as a competitive inhibitor of Ach and promoting bladder relaxation
37
MOA of tolterodine
non-selective antagonist of muscarinic receptors, acting as a competetive inhibitor of Ach, which promotes bladder relaxation
38
side effects of oxybutinin
can cross the blood-brain barrier producing; sedation, insomnia and confusion. Blockage of M3 leads to dry mouth
39
side effects of tolterodine
dry mouth, abdominal pain, constipation
40
name some alpha-1 adrenoceptor antagonists
doxazosin, tamsulosin
41
MOA of alpha-1 adrenoceptor antagonists
inhibit contraction of hypertrophied smooth muscle in prostatic tissue and the internal urethral sphincter without affecting detrusor. this improve urinary flow rate and other symptoms
42
name some 5-alpha reductase inhibitors
dutasteride, finasteride
43
MOA of 5-alpha reductase inhibitors
inhibition of 5-alpha reductase reduces enzymatic conversion of testosterone into dihydrotestosterone in prostatic cells. This helps reduce prostatic volume as DHT is involved in prostatic growth
44
side effects of alpha-1 adrenoceptor antagonists and 5-alpha reductase inhibitors
postural hypotension, dizziness, syncope
45
what drugs can be used to treat BPH or lower urinary tract symptoms?
5-alpha reductase inhibitors, alpha-1 adrenoceptor antagonists
46
cisplatin moa
binds to nuclear DNA and interferes with transcription and replication, killing the fastest proliferating cells
47
side effects of cisplatin
nephrotoxicity, neurotoxicity, N&V
48
moa of sunitinib
blocks multiple tyrosine kinase receptors which are involved in growth of cancer cells
49
moa of bevacuzimab
monoclonal antibody that binds to and neutralises activity of a growth factor. this reduces vascularisation of tumours and inhibits their growth
50
side effects of bevacuzimab
black tarry stools, bleeding gums, aches and pains
51
side effects of sunitinib
neutropenia, vomiting, aching
52
moa of goserelin
inhibits pituitary gonadotropin release, resulting in suppression of LH and testosterone
53
side effects of goserelin
hot flushes, decreased libido, gynaecomastia
54
moa of cyproterone acetate
anti androgen that blocks the binding of dihydrotestosterone to prostatic cancer cells
55
side effects of cyproterone acetate
decreased libido, hot flushes, headaches
56
name some PDE5 inhibitors
sildenafil, tadanafil
57
MOA of PDE5 inhibitors
selectively inhibit PDE5 so inhibit degradation of cGMP, which helps relax penile muscle and allow blood to flow in
58
name a prostaglandin E1 analogue
alprostadil
59
MOA of alprostadil
acts on smooth muscle cell receptors to increase intracellular cAMP, which reduces intracellular calcium and causes vasodilation
60
side effects of PDE5 inhibitors
headaches, dizziness, alopecia
61
side effects of alprostadil
dizziness, painful erection, bleeding
62
what can be used to treat iron deficiency anaemia
ferrous sulfate, iron sucrose
63
what can be used to treat megaloblastic anaemia
folic acid, hydroxocolabamin (vit B12 preparation)
64
side effects of iron preparations
N&V, black stools, rash
65
side effects of folic acid
anorexia, abdominal distention (side effects rare)
66
side effects of EPOs
N&V, headaches, hypertension
67
side effects of hydroxocolabmin
N&V, diarrhoea, headaches
68
what can be used to treat renal anaemia
epoetins e.g. darbepoetin
69
name a human quick acting insulin
humulin-S
70
name an analogue quick acting insulin
humalog, novorapid
71
name a human biphasic insulin
humulin M3
72
name a human isophane insulin
isulatard
73
name an anaolgue biphasic insulin
humalog mix, novomix
74
name an analogue long acting insulin
insulin gargine, insulin degludec
75
name a biguanide
metformin
76
whats the MOA of metformin
not fully understood.
increases insulin sensitivity
decreases glycogenolysis
increases glucose uptake
77
side effects of metformin
N&V, diarrhoea, lactic acidosis
78
name some sulfonylureas
gliclazide, tolbutamine, glibenclamide
79
MOA of sulfonylureas
inhibit K+ transporter so that there's not an efflux of K+. This depolarises the beta cells and allow the vesicles to release insulin
80
side effects of sulfonylureas
weight gain, hypoglycaemia, N&V
81
name a thiazolidinedione
pioglitazone
82
MOA of thiazolidinediones
activation of peroxisome proliferator activated receptor gamma (PPAR gamma). This decreases peripheral insulin resistance, prevents the release of free fatty acids from adipose tissue
83
side effects of thiazolidinediones
weight gain, fractures, bladder cancer
84
thazolidinediones are contraindicated for what diseases
congestive heart failure, liver failure, DKA
85
name an alpha glucosidase inhibitor
acarbose
86
MOA of acarbose
Inhibits the enzyme glucosidase, present on the apical surface of enterocytes and so prevents glucose absorption, leading to decreased blood glucose
87
side effects of acarbose
flatulence, cramps, diarrhoea
88
for what disease is acarbose contraindicated
IBD
89
name some GLP-1 mimetics
liraglutide, semaglutide
90
MOA of GLP-1 mimetics
bind to GLP-1 receptors on the pancreas which both stimulates insulin secretion and suppresses glucagon secretion. Also slows gastric emptying (reduces rate at which glucose is absorbed into blood)
91
side effects of GLP-1 mimetics
pancreatitis, D&V, dyspepsia
92
name some SGLT-2 inhibitors
canaglifozin, empaglifozin, dopaglifozin
93
MOA of SGLT-2 inhibitors
Inhibits SGLT-2 in the renal pct, which prevents reabsorption of glucose and instead excretes it in urine
94
side effects of SGLT-2 inhibitors
UTIs, hypoglycaemia, perineal gangrene
95
name some dipeptidyl peptide 4 (DPP4) inhibitors
gliptins
96
MOA of DPP 4 inhibitors
inhibits DPP 4 which usually rapidly degrades insulin. This results in higher incretin levels after food. Incretins stimulate insulin release and suppress glucagon release
97
side effects of DPP 4 inhibitors
N&V, pancreatitis, hypoglycaemia (when in combo)
98
name a meglitinide
repaglinide
99
MOA of meglitinides
inhibit K+ channels in beta cells (same mechanism as sulfonylureas but have weaker binding and dissociate quicker)
100
side effects of meglitinides
weight gain, hypoglycaemia
101
What drugs are used in management of DKA
IV fluids, IV insulin, potassium replacement. The doses are dependent on the bodyweight of the patient, how much fluid they have lost and how far into DKA they are.
102
whats the management of hyperosmolar hyperglycaemic state
IV fluids, IV insulin, catheter, anticoagulation (e.g. LMWH)
103
what can be used to treat hypoglycaemia
oral/IV glucose, glucagon
104
what concentrations of glucose are used to treat hypoglycaemia
10,20 or 50% concentrations
105
side effects of oral/IV glucose
hyperglycaemia, irritates veins causing phlebitis or thrombosis
106
sick day treatment for diabetics
dose of insulin should be increased (with blood glucose monitoring) to counteract the hyperglycaemic action of hormones released during stress reactions
107
diabetic treatment prior to surgery
during and immediately after surgery, 10% IV glucose should be given until the person is able to eat and drink again where they can restart normal treatment
108
what class of drugs can be used to treat hyperthyroidism
thionamides (carbimazole, propylthiouracil), beta blockers, radioiodine, oral iodine
109
name some thionamides
carbimazole, propylthiouracil
110
MOA of thionamides
inhibit thyroid peroxidase, reducing production of iodine which is needed for T3 and T4. may take 3-4 weeks to notice effect as T4 has a long half life so can stay in the body longer
111
side effects of thionamides
GI upset, allergic reactions, bone marrow suppression (agranulocytosis)
112
MOA of radioactive iodine
Once absorbed from the gut it can be taken up by thyroid follicles in the thyroid gland. It emits beta particles which destroy follicular cells
113
side effects of radioactive iodine
short term - dry mouth, swollen neck
| long term - infertility, inflammation of salivary glands
114
treatment of hypothyroidisim
levothyroxine, surgery
115
MOA of levothyroxine
levothyroxine is synthetic T4 and so has the same actions
116
side effects of levothyroxine
D&V, headaches, palpitations
117
name some glucocorticoids
hydrocortisone, prednisolone, dexamethasone
118
what can be used to treat hypopituitarism and adrenal insufficiency
glucocorticoids
119
MOA of glucocorticoids
bind to cytosolic glucorticoid receptors which then translocate to the nucleus when they can regulate gene expression
120
name an important mineralocorticoid
fludrocortisone
121
what can be used to treat growth hormone deficiency in children
somatropin - synthetic growth hormone
122
side effects of somatropin
carpal tunnel, fluid retention, parasthesia
123
what class of drug is used to treat galactorrhoea and hyperprolactinaemia
dopamine D2 agonists
124
whats the MOA of dopamine D2 agonists
potent and long acting agonist of D2 receptors, also has inhibitory effect on pituitary cells
125
side effects of dopamine D2 agonists
N&V, sleep disturbances, postural hypotension
126
name dopamine D2 agonist
carbergoline, bromocriptine
127
what can male hypogonadism be treated with
testogel, sustanon
128
MOA of testogel or sustanon
these contain testosterone esters which have the same effect on the body as testosterone
129
side effects of testosterone esters
irritability, weight gain, body and facial hair
130
name some bisphosphonates
alendronic acid, zolendronic acid, risendronate
131
MOA of bisphosphonates
pyrophosphate analogues that bind to crystals in the bone matrix. They are deposited under osteoclasts and stop their resorptive action on bone
132
side effects of bisphosphonates
N&V, headaches, osteonecrosis of jaw
133
what can bisphosphonates be used to treat
hypercalcaemia, menopause, osteoporosis prevention
134
what can vitamin D compounds be used to treat
hypocalcaemia (if irreversible pathology), vitamin D deficiency, hypoparahtyroidism, renal bone disease
135
name some vitamin D compounds
alfacalcidol. calcitriol, ergocaliferol, colecalciferol
136
MOA of vitamin D compounds
Act as synthetic vitamin D. They increase absorption of Ca2+ and phosphate from the gut, and at high conc they stimulate bone resorption.
137
side effects of vitamin D compounds
hypercalcaemia, if mother takes them whilst breastfeeding the infant could be hypercalcaemic
138
treatment of acute severe hypocalcaemia
IV calcium gluconate, folowed by oral calcium supplements
139
how can mild hypocalcaemia be treated
oral calcium supplements between meals
140
how is chronic hypocalcaemia usually treated
vitamin D and oral calcium supplements
141
name some vasopressin analogues
desmopressin, terlipressin
142
MOA of vasopressin analogues
they bind to V2 receptors and stimulate expression of aquaporin-2 channels which allows water reabsorption. Desmopressin is longer acting, more potent and increases clotting factor VIII conc compared to terlipresssin
143
side effects of vasopressin analogues
hyponatraemia, fluid retention, headaches
144
what can desmopressin be used to treat
mild/moderate bleeding in haemophilia A, diabetes insipidus
145
what can terlipressin be used to treat
oesophageal varices
146
name a vasopressin V2 receptor antagonist
tolvaptan
147
MOA of tolvaptan (vasopressin 2 receptor antagonist)
competitive inhibitor of the V2 receptor on renal collecting ducts, so prevents reabsorption of water
148
uses of tolvaptan
treat hyponatraemia caused by syndrome of inappropriate ADH secretion (SIADH), treat diuretic induced hyponatraemia
149
side effects of tolvaptan
hypernatraemia, thirst, hyperglycaemia, acute liver failure
