13 Renal Pharm

Question 0

CKD causees

Answer 0

DM/DN
Hypertension

GN
HIV
Reflux
PCKD
Infection/obstruction

Question 1

AKI proposed drugs

Answer 1

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

Question 2

CKD/RAS inhibitors

Answer 2

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)

Question 3

CKD EET analogs

Answer 3

Decrease hypertensive damage

Question 4

Treatment of CKD Anemia

Answer 4

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

Question 5

Treatment of 2ndary hyperparathyroidism in CKD

Answer 5

Adminster Vitamin D analogues/Calcitriol

• increase Ca channel synthesis via VDR/TF
• Increases endocytic capture of CA
• increases osteoclast activity
• Increases tubular ccalcium resorption

Question 6

Calcitriol and Vitamin D analogues

Answer 6

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

Question 7

Phosphate binders

Answer 7

Calcium carbonate/accetate
Lanthanum Carbonate
Sevelamer (polymer without cation)

*Bind PO4- decrease 2ndary hyperthyroidism

Question 8

Hypercalcemia in CKD after transplant

Answer 8

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

Question 9

Colchicine

Answer 9

CKD and gout
*reduces inflammation
*q 6-12 hrs
SE/ GI toxicity and rash

Question 10

Allopurinol/Febuxostat

Answer 10

Competative XO inhibitors
*prevent creationof xanthine and then uric acid

SE/ GI upset, Acute gout flair, hypersensitivity, Azothioprine interactions

Question 11

Rasburicase

Answer 11

Recombinant uricase

SE/ fever, NVD, hypersensitivity, hemolysis

Question 12

Cyclosporine/Tacrolimus

Answer 12

Calcineurin inhibition suppression of IL2 (thrugh Cyclophilinby cyclosporine or FKBP12 by tacrolimus)

Question 13

Cyclosporine

Answer 13

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

Question 14

Tacrolimus

Answer 14

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

Question 15

Nephrotoxic drugs

Answer 15

NSAIDs
Vancomycin
Ganciclovir
Aminoglycosides

Question 16

Sirolimus

Answer 16

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)

Question 17

Benefits of sirolimus

Answer 17

Rejection prophylaxis
Less vasoconstriction
NO RENAL INSUFFICCIENCY(it decreases TGFB)
sustained GFR

Question 18

Mycophenolate mofetil

Answer 18

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.

Question 19

Azithioprine

Answer 19

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

Question 20

Basiliximab

Answer 20

IL2 receptor AB

1wk half life, given after surgery and 4 days later

SE: some hypersensitivity

Question 21

Belatacept

Answer 21

CD80/86 and CD28 costimulation blockers (blocks Tcells)
*EBV positivve patients
8-10 day half life

SE/ Hypersensitivity, Lymphoproliferative disorder if EBV negative

Question 22

Prednisolone

Answer 22

GR agonist blocks T and b cell activation/proliferation (transplant drug)
8 hour onset of action

Question 23

Kidney rejection induction and maintainence

Answer 23

Induction:
MonoclonalAB/PAB IV after surgery

Maintainance:
Tacrolimus*
PRednisolone
MMF, Azothioprine, Siroimus

Question 24

RAS uses in other kidney disease

Answer 24

IgA Nephropathy: ACEI
Nephrotic syndrome: ACEI or ARB
Membranous Nephropathy: ACEi or ARB
Focal segmental glomerulosclerosis: ACEi

Question 25

Corticosteroids and Immunosuppresants in kidney disease

Answer 25

IgA nephropathy
Anti GBM/Goodpastures
Membranous nepphropathy
Focal segmental glomerulosclerosis
Lupis nephritis