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Renal Pathology > Clinical Pharmacology in Renal Disease > Flashcards

Clinical Pharmacology in Renal Disease Flashcards

1
Q

If renal function is impaired, there is a rapid build up of what?

A

Active drug

Toxins or active metabolites

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2
Q

When is there not a problem of a drug or metabolites in renal impairment?

A

If the drug or metabolites have a high therapeutic index or low toxicity

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3
Q

Example of a drug which has a high therapeutic index / low toxicity

A

Benzylpenicillin

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4
Q

What toxicities can gentamicin cause?

A

Nephrotoxicity

Ototoxicity

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5
Q

What can a build up of digoxin cause?

A

Arrythmia
Nausea
Death

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6
Q

What can a build up of lithium cause?

A

Toxicity

Death

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7
Q

What can a build up of tacrolimus cause?

A

Renal toxicity

CNS toxicity

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8
Q

Mechanisms of renal excretion

A

Glomerular filtration
Passive tubular reabsorption
Active tubular secretion

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9
Q

Where are all drugs and their metabolites filtered?

A

At the glomerulus

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10
Q

What does a reduction in GFR lead to in respect to drugs?

A

Reduces clearance of drugs by the kidney resulting in accumulation
Protein binding also reduced

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11
Q

What must be done in respect to drugs when there is a reduction in GFR?

A

Reduce doseage
Increase dose interval
TDM monitor blood levels for toxic drugs like gentamicin, lithium, digoxin and vancomycin

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12
Q

What is the pharmacodynamic effect of renal disease on drugs?

A

Alters the actions of drugs on the tissues

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13
Q

How does renal disease alter the action of drugs on the tissues?

A

The BBB becomes more permeable and the brain becomes more sensitive to tranquilisers, sedatives and opitates
Circulatory volume may be reduced making the patient more sensitive to antihypertensive agents, ACEIS or ARBs
Increased tendency to bleed to beware of warfarin or NSAIDs

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14
Q

In renal disease, the direct nephrotoxic actions of drugs are synergistic. What does this mean?

A

For example gentamicin toxicity may be unmasked when used in conjunction with furosemide or lithium

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15
Q

Ideally, if a patient suffers from renal impairment, we should use drugs that what?

A

Have a high therapeutic index

Are metabolised by the liver with the production of non toxic metabolites

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16
Q

Are ACEIs potentially nephrotoxic?

A

Yes

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17
Q

What can ACEIs produce in the kidneys?

A

Severe acute renal dysfunction

18
Q

What can direct vasodilators do to the kidneys?

A

Profound hypotenson

Salt and water retention

19
Q

What may thiazides and thiazide type diuretics precipitate?

A

Gout

20
Q

What are the common forms that renal involvement usually takes?

A 
Salt and water abnormalities
- dehydration 
- oedema
Acute renal failure
- acute tubular necrosis
- acute intersitial nephritis 
Chronic renal failure
21
Q

Drug induced renal toxicity can cause what four major syndromes?

A

Acute renal failure
Nephrotic syndrome
Renal tubular dysfunction with potassium wasting
Chronic renal failure

22
Q

Definition of acute renal failure

A

A sudden deterioration in renal function which results in a rapid rise in creatinine

23
Q

Types of acute renal failure

A

Prerenal
Renal / intrinsic
Post renal / obstructive

24
Q

Who often gets acute renal failure?

A

Elderly patients who are sick, with a poor fluid intake, who are on multiple medications and who are not being monitored aggressively

25
Q

What drugs cause drug induced pre-renal disease and how?

A 
Water and electrolyte abnormalities 
- diuretics
- laxatives
- lithium 
- NSAIDs
Increased catabolism
- steroids
- tetracyclines
Vascular occlusion 
- oestrogens / OCP
26
Q

What are the 3 types of intrinsic acute renal failure?

A

Acute tubular necrosis
Acute interstitial nephritis
Thrombotic microangiopathy

27
Q

Drug causes of acute tubular necrosis

A

Aminoglycosides
Amphotericin B
Cisplatin / radiocontrast agents
Statins in combination with immunosuppresive agents e.g. cyclosporin

28
Q

Drug causes of acute interstitial nephritis

A 
Penicillins
Cephalosporins
Cocaine
Sulfonamides
NSAIDs diuretics
Lithium 
Ranitidine
Omeprazole
Captopril 
Phenytoin 
Valproic acid
Amphotericin B 
Streptokinase
5-aminosalicylates 
Allopurinol 
Rifampicin
Chinese herbs
29
Q

What can thrombotic microangiopathy cause?

A

Severe acute renal failure

- arteriolar and glomerular thrombosis

30
Q

Drug causes of thrombotic microangiopathy

A 
Cyclosporin 
Tacrolimus 
Chemotherapeutic agents
Clopidogrel 
Ticlopidine
19-oestrogen containing oral contraceptives
quinine
Cocaine
31
Q

Drugs implicated in crystal formation of obstructive renal failure

A 
Acyclovir 
Sulfonamides
Trimaterene
Methotrexate 
Vit C in large doses
Guaifenesin
32
Q

What is nephrotic syndrome marked by?

A

Heavy proteinuria

33
Q

Drugs causing nephrotic syndrome

A 
Gold
NSAIDs
Penicillamine
Interferon 
Captopril
34
Q

What can NSAIDs result in in kidneys?

A 
Acute renal failure
Nephrotic syndrome
HTN
Hyperkalaemia
Papillary necrosis
35
Q

What % of hospital admissions are due to AKI that are drug related?

A

20%

36
Q

What % of patients prescribed ibruprofen does acute renal failure occur in?

A

18%

37
Q

What is the most common drug responsible for acquired renal insufficiency in the hospital?

A

Aminoglycosides

38
Q

Mechanism of NSAID induced pre renal acute renal failure

A

Decreased synthesis of renal vasodilator prostaglandins

Leads to reduced renal blood flow and reduced GF

39
Q

Mechanism of NSAID induced acute allergic interstitial nephritis

A

idiosyncratic reaction

Nephrotic syndrome in 90% cases

40
Q

Mechanism of aminoglycoside induced renal injury

A

Proximal tubular injury leading to cell necrosis

41
Q

How is the prevention of contrast induced nephropathy done?

A

IV 0.9% NaCl pre and post procedure

Renal Pathology (13 decks)

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