Clinical pharmacology in renal Flashcards
Gentamicin may cause what in renal
renal or otoxicity
digoxin may cause what in renal
arrhythmia, nausea or death
lithium may cause what in renal
renal toxicity and death
tacrolimus may cause what in renal
renal and cns toxic
which drugs have narrow therapeutic index then toxicity or death
gentamicin
digoxin
lithium
tacrolimus
is drug induced nephrotoxicity common
yes
Mechanism of Renal Excretion
Glomerular filtration, passive tubular reabsorption, active tubular secretion
All drugs and metabolites filtered at
Glomerulus
renal impairment will do what to half life of all drugs
prolong so therefore take care with low therapeutic index drugs
what reduces clearance of drugs by kidneys resulting in accumulation
reduction in GFR meaning must reduce dose and increase dose interval
what does renal disease do to actions of drugs on tissues
blood brain barrier becomes permeable
brain more sensitive
circulatory vol reduced so sensitive to hypertension drugs in particular
increased tendency to bleed beware warfarin or saids
When might gentamicin toxicity be unmasked
used with lithium or furosemide
renal impairment may do what in drug binding
more free drug available
what is important to do when treating patients who have renal disease
Reduce losing dose and maintenance dose
Increase dose interval
go for drugs with high therapeutic index
metabolised by liver with non toxic metabolites
what happens to concentration of drug as it moves from glomerus along kidney tubules
more concentrated
what four conditions can drug induced renal toxicity cause
acute renal failure
nephrotic syndrome
renal tubular dysfunction with potassium wassting
chronic renal failure
Acute Renal failure is
sudden deterioation in renal function = rapid rise in creatinine
Acute Renal Failure can be
Prerenal
Renal or Intrinsic
Post Renal or Obstructive
Pre Renal Drug Induced Renal Disease Causes
Water and Electrolyte Abnormalities Diuresis Laxatives Lithium NSAIDS Increased Catabolism Steroids Terracyclines Oestrogens OCP
Renal/Intrinsic Drug Induced Renal Disease Causes
Acute Tubular Necrosis
Acute Interstitial Nephritis
Thrombotic Microangiopathy
Which drugs are related to Acute Tubular Necrosis
Aminoglycoside Antibiotics Amphotericin B Cisplatin Radioconstrast Statins with Cyclosporin
When does Acute Interstitial Nephritis start
3-5 days after drug exposure
Drugs implicated in Acute Interstitial Nephritis
penicillins, cephalosporins, cocaine, sulfonamides, NSAIDs diuretics, lithium, ranitidine, omeprazole, captopril, lithium, phenytoin, valproic acid, amphotericin B, streptokinase, 5-aminosalicylates, allopurinol, rifampin,
Chinese herbs
Thrombotic Microangiopathy can cause
severe acute renal failure
what changes in kidney happen in thrombotic microangiopathy
afferent arteriolar
glomerular thrombosis
Drugs implicated in thrombotic microangiopathy
cyclosporin, tacrolimus
chemotherapeutic agents mitomycin C bleomycin, cisplatin
ticlopidine, clopidogrel
19 estrogen-containing oral contraceptives
quinine
cocaine
where can drug associated obstruction of urine outflow take place
Tubules or Ureters due to Crystal Formation
Outside Ureters due to Retroperitoneal Fibrosis eg Methysergide
drugs implicated in crystal formation
acyclovir, indinavir
sulfonamides,
triamterene
methotrexate,
vitamin C in large doses (due to oxalate crystals).
Guaifenesin and ephedrine can also cause stones to form in kidneys
Drugs implicated in Nephrotic Syndrome
The nephrotic syndrome is due to glomerular dysfunction and marked by heavy proteinuria. Drugs implicated include: gold, NSAIDs, penicillamine, interferon, captopril.
NSAIDS can cause
acute renal failure, nephrotic syndrome, hypertension, hyperkalemia, papillary necrosis
most common drug to cause hospital acquired renal insufficiency
ahminoglycosides
NSAID induced prerenal acute renal failure results from
decreased synthesis of renal vasodilator prostaglandins, which can lead to reduced renal blood flow and reduced glomerular filtration.
NSAID-induced acute allergic interstitial nephritis happens due to
ibuprofen, naproxen, and fenoprofen and can be associated with nephrotic syndrome
Aminoglycoside Induced Renal Injury used in Gram Neg Sepsis mechanism
proximal tubular injury leading to cell necrosis.
Acute renal failure due to ATN is the most common and is due to
ahminoglycosides
which drug to use for hypertension with renal involvement
ACEIS with reduced dose and longer dose periods
