Renal Pharmacology

Question 1

What is renin secretion stimulated by?

Answer 1

Macula densa

Sympathetic tone

Question 2

What does aldosterone stimulate?

Answer 2

sodium uptake

potassium excretion

Question 3

What does an ACEi do?

Answer 3

Inhibits vasoconstrictive effect of angiotensin II

• Acts on efferent arteriole
• Removes sodium and water

Question 4

What are ACE inhibitors used for?

Answer 4

Hypertension
Cardiac failure
CKD (Reduces the intra-renal pressure)

Question 5

What are side effects of ACE inhibitors?

Answer 5

Hypotension
- Consider holding if AKI or risk of AKI

Hyperkalaemia
- Inhibits the action of aldosterone

Question 6

What are examples of Angiotensin Receptor Blockers (ARBs)?

Answer 6

Valsartan

Irbesartan

Question 7

What do loop diuretics do?

Answer 7

Inhibits uptake of sodium, potassium, chloride and water

Remove sodium, potassium and water

Question 8

In what conditions are loop diuretics used?

Answer 8

CKD
Nephrotic syndrome
Hypertension
Cardiac failure

Question 9

What are side effects of loop diuretics?

Answer 9

Hypovolaemia

Hypokalaemia
- Can be used with potassium sparing diuretic (amoloride)

Question 10

What are 2 types of loop diuretic?

Answer 10

Furosemide

Bumetanide

Question 11

What do thiazides do?

Answer 11

Inhibits sodium uptake

Remove sodium and water

Question 12

In what conditions are thiazides used?

Answer 12

CKD
Nephrotic syndrome
Hypertension
Cardiac failure

Question 13

What is a side effect of thiazides?

Answer 13

Hypovolaemia

Question 14

What does spironolactone do?

Answer 14

Inhibits aldosterone
- prevents sodium reabsorption in exchange for potassium

Removes sodium and water

Question 15

What conditions is spironolactone used to treat?

Answer 15

Cardiac failure

Liver cirrhosis - ascites

Question 16

What is a side effect of spironolactone?

Answer 16

Hyperkalaemia

Question 17

What does Amiloride do?

Answer 17

Inhibits sodium reabsorption in exchange for potassium

Removes sodium and water

Question 18

What is amiloride used for?

Answer 18

to prevent hypokalaemia

Question 19

What is a side effect of amiloride?

Answer 19

Hyperkalaemia

Question 20

What four classes of drugs are used in CKD?

Answer 20

Anti-hypertensives

Diuretics

Sodium bicarbonate

Statins

Question 21

What do the kidneys do in relation to vitamin D?

Answer 21

They activate it (turn it into calcitriol)

Question 22

How does kidney disease affect calcium phosphate metabolism?

Answer 22

Decreased activation of vitamin D

Decreased calcium level

Stimulates secretion of parathyroid hormone ( four glands in the neck)

• Secondary hyperparathyroidism
• Releases calcium from the bone
• Develop bone disease
  
  • Renal osteodystrophy

Question 23

What does a vitamin D analogue do?

Answer 23

Hydroxylated by liver to active form
Increases uptake of
Calcium from gut
Phosphate from gut

Question 24

What are side effects of Vitamin D analogues?

Answer 24

Hypercalcaemia

Hyperphosphataemia

Question 25

What is an example of a vitamin D analogue?

Answer 25

Alpha calcidol

Question 26

What does erythropoetin do?

Answer 26

Stimulates erythropoiesis | RBC production

Question 27

Where is erythropoetin produced and what is its secretion stimulated by?

Answer 27

Produced by cells in the interstitium | Secretion stimulated by hypoxia

Question 28

When should erythropoetin be given by a clinician?

Answer 28

when eGFR

Question 29

What are the side effects of erythropoetin injection?

Answer 29

Hypertension Pure red cell aplasia - antibodies

Question 30

What do prostaglandins do to the kidney?

Answer 30

vasodilate the afferent arteriole

Question 31

What do ACEi and ARBs do to the kidney?

Answer 31

inhibit efferent arteriolar vasoconstriction Decreases transglomerular pressure Decreased GFR

Question 32

What are the risks of penicillins to the kidneys?

Answer 32

Rarely cause: acute interstitial nephritis Accumulation leads to CNS side effects including seizures

Question 33

What are the risks of opiates in relation to the kidneys?

Answer 33

Accumulation of active metabolites, especially morphine, pethidine and codeine Increased incidence of CNS side effects & respiratory depression

Question 34

Digoxin can be nephrotoxic. What are its effects?

Answer 34

``` Accumulation leading to - bradycardia - visual disturbances - mental confusion Aggravates hyperkalaemia ```

Question 35

What are the risks of metformin? (oral type II diabetes medicine that helps control blood sugar levels)

Answer 35

Lactic acidosis Accumulation leading to hypoglycaemia Avoid if GFR

Question 36

Which herbal preparations should you be aware may be nephrotoxic?

Answer 36

Chinese herbal medicines with 'aristocholic acid' are implicated in interstitial nephritis. 'Cat’s Claw' has anti-inflammatory properties but is implicated in causing AKI and hypotension with antihypertensives (Patients may not consider herbal preparations / teas as medicines)