Renal Pharmacology Flashcards Preview

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Flashcards in Renal Pharmacology Deck (42):
1

What are four medical treatments associated with acute kidney injury?

 

Antibiotics, chemotherapy and radiocontrast dyes, thoracic surgery

2

Chronic kidney diseases develops in __ - __% of acute kidney injury survivers?

20-30%

3

What are some drugs on the market for treating acute kidney injury (AKI)?

there are none

4

What can cause renal ischemia-reperfusion in AKI?

Arterial occlusion

Hypotension

Shock

5

In AKI, renal iscemia-reperfusion can lead to...?

  • Microvascular dysfunction
  • Excess vasoconstriction
  • Inflammation, oxidative stress
  • Endothelial injury
  • Endothelial-leukocyte interactions

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6

Acute Kidney Injury - emerging pharmacological agents

Anti apoptotic:

Anti-inflammatory:

Anti-Sepsis:

Growth factor:

Vasodilator:

Anti apoptotic: capsase inhibitors, minocycline

Anti-inflammatory: adenosine A2A agonist

Anti-Sepsis: Insulin

Growth factor: Recombinant erythropoietin

Vasodilator: Fenoldopam, ANP

7

What are the two most common causes of CKD?

Diabetic Nephropathy and Hypertension

8

What GFR is associated with each stage of CKD?

Stage 1:

Stage 2:

Stage 3:

Stage 4:

Stage 5:

Stage 1: ≥ 90

Stage 2: 60 - 89

Stage 3: 30-59

Stage 4: 15-29

Stage 5: <15

9

What is the goal of treatment for CKD?

Inhibit the renin angiotensin system

10

What function to ACEi and ARBs serve in CKD?

  • Decrease progression of albuminuria
  • Decrease progression of GFR decline
  • Decrease risk of ESRD

11

Why don't you take NSAIDs with CKD?

Damage kidneys further

May interact with ACEi or ARB

12

In CKD are ACEi and ARBs more effective together or separately?

Combination therapy tends to work better, but is still controversial

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13

What are the three management goals in diabetic nephropathy?

Good glycemic control (HbA1c < 7%)

Blood pressure control (< 140/90 mmHg)

Medications to minimize proteinuria (ACEi and ARB)

14

What are two upcoming treatments to combat CKD?

Bardoxolone - halted due to safety concerns

EET analogs - pending approval

15

Anema is most prevalent in which stages of CKD?

4-5

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16

What are the symptoms and causes of anemia in CKD?

Symptoms: fatigue and decreased cognition

Causes: decrease in release of erythropoietin

17

  1. What is Epoetin?
  2. How is it administered?
  3. What is it's half life?

  1. A human recombinant synthesized form of erythropoietin
  2. IV (more rapid response) and SubQ (greater response)
  3. 4-6 hour half life

18

What are the unwanted side effects of Epoetin?

  • Nausea, vomiting, diarrhea
  • Headache
  • Flu-like symptoms
  • HTN
  • Thrombosis of arteriovenous shunts (Increased RBCs)

19

What are the physiological roles of calcium?

  • Nerve conduction and regulation of cell membrane permeability
  • Excitation and coupling of all types of muscles
  • Secretion of endocrine and exocrine glands and release of neurotransmitters
  • Intracellular messenger
  • Impulse generation in the heart
  • Coagulation of blood
  • Bones and teeth

20

What 3 hormones regulate plasma calcium?

Parathyroid hormone

Calcitonin

Calcitriol

21

Of the calcium in the plasma, what percentage is bound to albumin?

Does hypoalbuminemia cause a decrease in calcium concentration?

40% (50% is free ionized and important form)

no decrease

22

What form of plasma calcium is favored in acidosis?

Free ionized form

23

How does Kidney failure affect calcium levels?

In kidney failure there is decreased renal excretion of phosphate and diminished production of calcitrol leading to decrease in plasma calcium

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24

How does Kidney failure lead to metabolic bone disease and soft tissue calcifications?

Increased phorphate and reduced calcium feeeback can lead to Secondary Hyperparathyroidism which leads to metabolic bone disease and soft tissue calcifications

25

What are the major factors leading to an increase in PTH and secondary hyperparathyroidism?

Decreased production of Vitamin D3 (calcitriol)

Decreased serum calcium

Increased serum phosphorous

26

What modifications are made in each generation of Vitamin D analogs?

1st gen: Synthetic form of endogenous Vitamin D

2nd gen: Side chain modifications

3rd gen: A-ring modifications (paricalcitol)

27

What is the MOA of Vitamin D analogs?

  • Enhancement of absorption of calcium and phosphate from intestine
  • Enhances recruitment and differentiation of osteoclast precursor for remodeling-resorption of calcium and phosphate from bone
  • Enhances renal tubular reabsorption of calcium

28

Which Vitamin D analog requires kidney 1-α hydroxylation?

 

Ergocalciferol

29

What Vitamin D analogs are used in kidney disease?

What is their half life?

Hydroxylated active forms of alfacalcidol or calcitrol (short half lives - 3 hours)

30

Which vitamin D analog requires IV injections?

Paricalcitol

31

What are the signs of vitamin D deficiency?

At what stages of CKD are vitamin D analogs indicated?

  • Fractures
  • Hyperparathyroidism

Indicated at stage 3 if Ca < 9.5 and P <4.6

Always indicated at stage 4

32

What are the phosphate binders and how do they work?

Calcium carbonate, calcium acetate, lanthanum carbonate

Decrease phosphate absorption by reacting with phosphate to form an insoluble compound

33

What are side effects of phosphate binders?

GI side effects

hypercalcemia

34

How can renal transplant cause hypercalcemia?

Patients already have high levels of PTH due to previous renal failure so addition of functioning kidney leads to extremely high plasma calcium levels

35

What is the function of bisphosphonates in hypercalcemia?

Which is the most long lasting?

Pyrophosphate analogs that bind to hydroxyapatite crystals in bone matrix to inhibit bone resorption

Zoledondrate can suppress bone resorption for up to a year after a single dose

36

What are the three generations of Bisphosphonates?

  • First gen:
    • Etidronate
    • Tiludronate
  • 2nd gen:
    • Pamidronate
    • Aledronate
    • Ibadronate
  • 3rd gen:
    • Risedronate
    • Zoledronate

37

What is the function of calcitonin?

Produced by parafollicular cells of thyroid gland

Secreted when plasma calcium rises

Lowers plasma calcium by limiting bone resorption and increasing phosphate excretion in the urine

38

What are some unwanted side effects of calcitonin?

Facial flushing

Headache

GI

Taste disturbance

39

How do you treat hyperuricemia and gout in kidney disease?

Colchicine

Allopurinol

Febuxostat

Rasburicase

40

Colchicine:

onset of action?

Side effects?

Onset: pain relief begins at about 18 hours and is maximal by 48 hours

SE: GI, Rash

41

What are the SE of the Xanthine Oxidase Inhibitors (Allopurinol and Febuxostat)?

  • GI Upset
  • Risk of acute gout
  • Hypersensitivity (Allopurinol)
  • Drug interactions

42

How does rasburicase work?

What are its SE?

  • Recombinant version of enzyme urate oxidase
    • Promotes uric acid conversion to allantoin
  • Metabolized by peptide hydrolysis in plasma
  • Used primarily as prophylaxis during chemotherapy

SE: Fever, nausea, vomiting, hypersensitivity, hemolysis