Clinical pharmacology of renal disease

Question 1

name 4 drugs which have a narrow therapeutic index.

Answer 1

gentamicin
digoxin
lithium
tacrolimus

Question 2

what alterations can renal impairment cause in the pharmacokinetics?

Answer 2

reduce half life
build up of drug metabolites
decreased protein binding so more free drug available
this all increases the concentration of the drug therefore increasing toxicity

Question 3

what alterations does impaired renal function cause on the pharmacodynamics?

Answer 3

increased sensitivity to pharmacological action

increased sensitivity to the toxic effects and adverse drug reactions

Question 4

what precautions do we have to make when prescribing a drug to a patient who has renal impairment?

Answer 4

reduce the dose
long interval time
chose drug with wide therapeutic index
chose drug with low toxicity
chose drug which is metabolised by the liver and produces non-toxic metabolites
choose drug that is safe to use when there’s a decreased GFR

Question 5

what drug is the most common cause of acute tubular necrosis?

Answer 5

amino glycoside

Question 6

what drugs can cause acute interstitial nephritis?

Answer 6

gold
penicillamine
NSAIDS
cephalosporins

Question 7

what drugs can cause nephrotic syndrome?

Answer 7

gold
penicillamine 
NSAIDS
interferon
captopril

Question 8

what drugs can cause crystal formation?

Answer 8

acyclovir
sulphonamides
methotrexate
vitamin C

Question 9

WHAT DRUGS CAN CAUSE THROMBOTIC MICROANGIOPATHY?

Answer 9

OCP
cocaine 
cyclosporin 
clopidogrel
tacrolimus 
chemotherapy i.e. cisplatin

Question 10

what renal syndromes can NSAIDS cause?

Answer 10

acute renal failure
nephrotic syndrome
hypertension
hyperkalaemia 
papillary necrosis