13 Renal Pharm Flashcards
CKD causees
DM/DN
Hypertension
GN HIV Reflux PCKD Infection/obstruction
AKI proposed drugs
1) anti apoptotic - caspase inhibitors/minocycline
2) Anti inflammatories- Adenosine A2A agonist- Phosphatydlserine binding protein
3) Anti sepsis- insulin
4) GF- Recombinant EPO
5) Vasodilator- Fenoldepam(dopamine) ANP
CKD/RAS inhibitors
Decrease albuminuria
Decrease progression of GFR decline
Decrease risk of ESRD
-not only based on BP reduction
-ACEi and ARB together not redundant in primary kidney disease
(doesnt arrest progression in DN)
CKD EET analogs
Decrease hypertensive damage
Treatment of CKD Anemia
EPO- IV has faster onset SubQ has greater response over time 4-6 hr half life Administered 2-3 times per week
SE/ NVD, HA, Flu-like, HTN causing encephalopathy and seizures, AVshunt thrombosis. RED CELL APLASIA from subQ EPO antibodies- must D/c treatment
Treatment of 2ndary hyperparathyroidism in CKD
Adminster Vitamin D analogues/Calcitriol
- increase Ca channel synthesis via VDR/TF
- Increases endocytic capture of CA
- increases osteoclast activity
- Increases tubular ccalcium resorption
Calcitriol and Vitamin D analogues
Ergocalcifer needs 1alpha -OH in kidney(dont use this)
Alfacalcidol and calcitrol - 3hr halflife but long action
Paricalcitol- IV injection (not first choice)
Treat stage 3 if PTH>70 and CA<4.6
Treat Stage 4
Phosphate binders
Calcium carbonate/accetate
Lanthanum Carbonate
Sevelamer (polymer without cation)
*Bind PO4- decrease 2ndary hyperthyroidism
Hypercalcemia in CKD after transplant
Bisphosphonates- bind hydroyapetite in bone and prevent resorption
- weekly administration
- Alendronate
- Zoledondrate 1x per year
SE- GI disturbances, abdpain, nausea, jaw osteonecrosis
Calcitonin
- Decr. bone resorption
- IM or subQ
- 20 min half life
SE Facial flushing, HA/dizzines, NVD abd pain, bad taste
Colchicine
CKD and gout
*reduces inflammation
*q 6-12 hrs
SE/ GI toxicity and rash
Allopurinol/Febuxostat
Competative XO inhibitors
*prevent creationof xanthine and then uric acid
SE/ GI upset, Acute gout flair, hypersensitivity, Azothioprine interactions
Rasburicase
Recombinant uricase
SE/ fever, NVD, hypersensitivity, hemolysis
Cyclosporine/Tacrolimus
Calcineurin inhibition suppression of IL2 (thrugh Cyclophilinby cyclosporine or FKBP12 by tacrolimus)
Cyclosporine
Calcineurin inhbition through cyclophilin
DECREASES IL2
*concentrates in liver, kidney, spleen, bone
*Cyp3A4 metabolism
*27hr half life
SE/
*Nephrotoxicity (vasoconstriction, ^TGF-B, fibrosis, tubular atrophy)
*hepatic dysfunction, tremor, HA, fatigue, NVD, hyppertrichosis(hair growth), gum hypertrropy, hyperlipidemia, hypoMG,hypoK
Many drug interactions
Tacrolimus
Calcineurin inhibition through FKBP
DECREASED IL2
Oral or IV
Variable metabolism (monitor levels)
No increase in TGFB, less HTN, less hyperlpidemia
SE/ GLUCOSE INTOLERANCE, tremor, HA, insomnia, paresthesia, Pleural effusions, and CDM in kids
Nephrotoxic drugs
NSAIDs
Vancomycin
Ganciclovir
Aminoglycosides
Sirolimus
mTOR inhibitor
- Binds FKBP12 and blocks MTOR
- Stops IL2 dependant cell cycle
Oral adinistration
Cyp metabolism
60hr half life
SE/ Edema, ascites, tachycard, HTN, NVD
HYPERLIPIDEMIA, hypokalemia, hypoPO4, lymphocele,rash
Interactions:Rfampicin (Cyp3A4), Itra and ketoconazole(CYP450 inhibitorrs)
Benefits of sirolimus
Rejection prophylaxis
Less vasoconstriction
NO RENAL INSUFFICCIENCY(it decreases TGFB)
sustained GFR
Mycophenolate mofetil
Antiproliferative for Lymphocytes(tumor rejection drug)
*Blocks IMPDH (blocks de novo purine synthesis)
Oral or IV
Liver metabolism
18hr. half life
SE/ HTN, edema, tachycardia, dyspnea, cough, Neuro SE, Pancytopenia,opportunistic ifections including UTI, skin cancer lymphoproliferative disease
***Check CBCs, GI upset can be releaved with lower dose.
Azithioprine
Purine analogue prodrug (blocks DNA synthesis- anti-rejection)
Oral
3-5hr half life
SE/ BM supresson, hypersensitivity, diziness, malaise, NVD, fever, rash, hypotension, alopecia, opportuistic infections, lymphomas
* ALLOPURINOL INTERACTIN (reduce dose 75%)*
DO CBC often
Basiliximab
IL2 receptor AB
1wk half life, given after surgery and 4 days later
SE: some hypersensitivity
Belatacept
CD80/86 and CD28 costimulation blockers (blocks Tcells)
*EBV positivve patients
8-10 day half life
SE/ Hypersensitivity, Lymphoproliferative disorder if EBV negative
Prednisolone
GR agonist blocks T and b cell activation/proliferation (transplant drug)
8 hour onset of action
Kidney rejection induction and maintainence
Induction:
MonoclonalAB/PAB IV after surgery
Maintainance:
Tacrolimus*
PRednisolone
MMF, Azothioprine, Siroimus
RAS uses in other kidney disease
IgA Nephropathy: ACEI
Nephrotic syndrome: ACEI or ARB
Membranous Nephropathy: ACEi or ARB
Focal segmental glomerulosclerosis: ACEi
Corticosteroids and Immunosuppresants in kidney disease
IgA nephropathy Anti GBM/Goodpastures Membranous nepphropathy Focal segmental glomerulosclerosis Lupis nephritis
