Clinical Pharmacology Flashcards
How does renal disease affect clinical pharmacology?
If renal function is impaired then there will be a rapid build up of either ACTIVE DRUG or possibly TOXIC OR ACTIVE METABOLITES
What drugs will renal disease not effect so much?
If the drug used or its metabolites have a high therapeutic index or low toxicity then no problem
-benzylpenicillin
What drugs are particularly at risk of large effects by renal disease?
If the drug or its metabolites have a narrow therapeutic index then toxicity or death
- Gentamicin
- Digoxin
- Lithium
- Tacrolimus
What are the side effects of gentamicin?
May cause renal or ototoxicity
What are the side effects of digoxin?
May cause arrhythmia, nausea or death
What are the side effects of lithium?
Renal toxicity and death
What are the side effects of tacrolimus?
Renal and CNS toxicity
What must doctors do in response to reduction in GFR?
PHARMACOKINETIC EFFECTS ->
- REDUCE DOSAGE
- Increase dose interval
- Therapeutic Drug Monitoring of gentamicin, lithium, digoxin, vancomycin etc
Drug induced renal toxicity can cause 4 major syndromes.
What are they?
Acute renal failure
Nephrotic syndrome
Renal tubular dysfunction with potassium wasting
Chronic renal failure
What is acute renal failure?
A sudden deterioration in renal function which results in a rapid rise in creatinine.
Urine volume falls to
What drugs can cause acute tubular necrosis?
Aminoglycoside antibiotics
Amphotericin B
Cisplatin (causes renal failure in up tp 25% of patients after a single dose), radiocontrast agents
Statin drugs given in combination with immunosuppressive agents such as cyclosporin
In what ways do drugs frequently induce renal disease?
Assymptomatic increase in urea and creatinine
Fluid and electrolyte abnormalities
Acute tubular necrosis
Acute and chronic interstitial nephritis
What is the most common drug induced renal disease?
Acute renal failure due to Acute Tubular Necrosis
-Caused by aminoglycosides
Who should you avoid nephrotoxic drugs in?
Volume deplete or hypotensive patients with pre-existing renal disease
Avoid nephrotoxic drugs in patients recieving other nephrotoxic agents
What drugs can cause acute tubular necrosis?
Gentimicin
Cephalosporins
NSAIDs
