Antibiotics

Question 1

Antimicrobial agents commonly associated

with AKI:

Answer 1

Vancomycin
Aminoglycosides
Amphotericin B

Cause AKI d/t tubular toxicity:
Pentamidine,
Tenofovir, and
Cidofovir

Cause AKI secondary to interstitial nephritis
penicillins, 
cephalosporins, 
quinolones, 
sulfonamides, and 
rifampin.
\:

Question 2

How does vancomycin cause AKI?

Answer 2

when trough levels are high and when used in combination with other nephrotoxic antibiotics.

Question 3

What AKI do aminoglycosides and ampho b cause?

Answer 3

Tubular necrosis

Question 4

AKI mechanism of aminoglycosides?

Answer 4

-freely filtered in the gloms then accumulate within the renal cortex where concentrations greatly exceed those of the plasma

Question 5

AKI manifestation of aminoglycosides

Answer 5

• nonoliguric aki (ex. urine vol. of 400 mL/day) in 10-30% even when plasma levels are in therapeutic range
• manifests after 5-7 days of therapy and even when discontinued
• hypomagnesemia

Question 6

AKI manifestation of amphotericin b

Answer 6

Polyuria, hypomagnesemia, hypocalcemia, nongap metabolic acidosis

Question 7

AKI mechanism of ampho B?

Answer 7

• Renal vasoconstriction sec to increase tuboglomerular feedback
• direct nephron toxicity mediated by ROS
• dose and duration dependent
• drug binds to cholesterol in the tubular membrane and introduces pores

Question 8

AKI mechanism of acyclovir

Answer 8

-precipitate in tubules and cause AKI by tubular obstruction particularly when given as an IV bolus at high doses (500 mg/m2) or in the setting of hypovolemia