pharmacology of CKD

Question 1

what is the MOA for statins?

Answer 1

selective, competitive inhibitor for hydroxymethylglutaryl-CoA reductase
(converts HMG-CoA to mevalonate in cholesterol synthesis)
reducing hepatic cholesterol synthesis causes an upregulation of LDL-receptors and increased hepatic uptake of LDL-cholesterol from the circulation

Question 2

what is the drug target for statins?

Answer 2

hydroxymethylglutaryl-CoA reductase (HMG-CoA reductase)

Question 3

what are the main side effects of statins?

Answer 3

muscle toxicity risk

constipation/diarrhoea/general GI effects

Question 4

what should patients on statins be followed up for?

Answer 4

hyperkalaemia

acute renal failure

Question 5

MOA of aspirin

Answer 5

irreversible inactivation of COX
prevents arachnidonic acid oxidation to prostaglandins
reduction of thromboxane A2 in platelets reduces aggregation
PGE2 reduction reduces sensation of pain (at sensory neurones) and decreases fever (in brain)

Question 6

aspirin drug target

Answer 6

cycloxygenase enzyme

Question 7

side effects of aspirin

Answer 7

dyspepsia

haemorrhage

Question 8

what precautions should be taken into account when prescribing aspirin?

Answer 8

avoid greater than 160mg in elderly

coadminister PPI if peptic ulcer PMH

Question 9

MOA trimethoprim

Answer 9

direct competitor of dihydrofolate reductase in bacteria
inhibits reduction of dihydrofolic acid - tetrahydrofolic acid (active) which is required for synthesising purines for DNA/protein production

Question 10

drug target for trimethoprim

Answer 10

dihydrofolate reductase in bacteria

Question 11

side effects of trimethoprim?

Answer 11

diarrhoea

skin reactions

Question 12

what should be monitored when administrating trimethoprim?

Answer 12

folate levels

serum electrolytes - hyperkalaemia

Question 13

MOA of gentamicin

Answer 13

binds to bacterial 30s ribosomal subunit

disturbs translation of mRNA leading to formation of dysfunctional proteins

Question 14

drug target gentamicin

Answer 14

30s ribosomal subunit

Question 15

side effects gentamicin

Answer 15

ototoxicity

nephrotoxicity

Question 16

why is gentamicin ineffective against anaerobic bacteria?

Answer 16

can pass through gram -ve cell membrane in an oxygen dependent manner

Question 17

things to take into account when prescribing for patient with reduced renal function

Answer 17

may the drug damage the kidney - e.g ibuprofen

is the drug properly eliminated by the kidney - e.g morphine metformin warfarin

Question 18

what treatment should always be initiated for CKD regardless of cause

Answer 18

BP control to slow CKD progression

Question 19

proteinuria in CKD

Answer 19

marker of glomerular dysfunction

and is damaging itself

Question 20

interventions for proteinuria

Answer 20

ACEi/ARB
SGLT-2 inhibitors
salt restriction
stop other BP meds if ACEi reduces bp too low

Question 21

trimethoprim messes with what calculation and why

Answer 21

GFR

inhibits active secretion of creatinine so breaks the link between GFR and serum creatinine