Clinical pharmacology of renal disease Flashcards

1
Q

Define therapeutic index

A

Comparison between the dose that will bring the desired effect and the dose that will cause toxicity

It is a ratio of the largest, non-toxic does: minimum dose to bring an effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Why is knowing the clearance of an individual important

A

If the clearance is poor and there is a high systemic exposure of the drug, it can cause toxic effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What 3 functions make up clearance in the kidney

A

Filtration
Secretion
Reabsorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What must drugs be to be filtered

A

Free in the plasma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What does no secretion and reabsorption mean for clearance

A

There is total clearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What clearance is measured to measure the GFR

A

creatinine and inulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Where do secretions mainly occur

A

Proximal tubule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How are drugs which are too large to be filtered, cleared

A

they are secrted into the proximal tubule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the effect of secretion on clearance

A

Causes increased clearance because the plasma concentration of the substance decreases while the amount present in the urine increases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How are weak acids cleared from the body

A

Sodium bicarbonate is used to make the urine more alkaline which causes the weak acids to diffuse into the urine to neutralise it (this occurs in aspirin overdose)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the effect of a drug having a higher distribution

A

They have a longer elimination half life and their therapeutic effect is not as driven because it is the drug present in plasma which drives the therapeutic effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Why is the combination of gentamicin and furosemide bad

A

They are nephrotoxic together

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How to do therapeutic drug monitoring (TDM)

A

frequently measure the drug concentrations in the body and adjust them to get the desired effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the benefit of a drug which isn’t excreted by the kidneys

A

It can be used in patients who have low GFR who have low clearance at the kidneys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How can a drug cause acute tubular necrosis

A

While the drug is in the tubule, it can directly affect the epithelial cells which results in AKI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What drugs can cause acute tubular necrosis

A

Aminoglycoside antibiotics: amphotericin B, cisplatin

Statins when used with cyclosporon: coliistimethate, foscarnet

17
Q

What causes acute interstial nephritis

A

Penicillin, cephalosporin , cocaine, omeprazole

18
Q

What drug causes glomerulonephritis

A

biotherapeutics

19
Q

What drug causes thrombotic microangiopathy

A

Cyclosporin , chemotherapy, tacrolimus, theinopyidines, many oestrogen-containing oral contraceptives

20
Q

How do drugs cause obstruction of urine outflow

A

Crystal formation at numerous sites within the tubules or ureters

21
Q

What drugs cause post renal AKI

A

methydergide
acyclovir, indinavir
Sulfonamides
triamterene
methotrexate
Vit C

22
Q

What are DMARDS

A

Disease modifying anti-rheumatic drugs

23
Q

What drugs cause nephrotic syndrome

A

DMARDS like gold and penicillinamine
NSAIDs
interferon
captopril

24
Q
A
25
Q
A