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Drug induced Kidney Disease Flashcards

1
Q

What are the 2 most common manifestations of drug induced kidney disease?

A
  1. GFR decrease

2. CR and BUN increase

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2
Q

What causes acute tubular necrosis (tubular epithelial cell damage)?

A
  1. Aminoglycosides
  2. Radiocontrast
  3. Cisplatin (chemo)
  4. Amphotericin B
  5. Cyclosporine
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3
Q

Causes of hemodynamically mediated kidney injury?

A
  1. ACE
  2. ARB
  3. NSAIDs
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4
Q

Medications that are affected by edema which increase the volume of distribution (3)

A
  1. Vancomycin
  2. Aminoglycosides
  3. Heparin (low-molecular weight)
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5
Q

Most common electrolyte disorder?

A

Hyperkalemia

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6
Q

Name aminoglycosides by order or toxicity (related to number of cationic groups)

A

Neomycin > gentamicin > tobramycin > amikacin

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7
Q

How are aminoglycosides adjusted?

A

based on serum levels

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8
Q

Aminoglycoside nephrotoxicity: clinical presentation

A
  • Nonoliguria
  • reversible, full recovery
  • 5-10 days after therapy initiation
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9
Q

What do aminoglycosides have synergistic toxicity with?

A

NSAIDs

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10
Q

What is important to recommend to a patient who is about to take aminoglycoside?

A

avoid volume depletion (stay hydrated)***

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11
Q

In pre-existing kidney disase (GFR <60ml/min) what two meds should be avoided?

A
  1. NSAID

2. ACE

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12
Q

Since contrast-induced nephrotoxicity is a problem with renal blood flow, who is at higher risk?

A
  • CHF
  • Dehydration
  • Hypotension
  • Diabetes*
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13
Q

Amphotericin B Nephrotoxicity: Key presentation

A
  1. Potassium, sodium, magnesium wasting*
  2. Dysfunction apparent in 1-2 weeks
  3. Decrease in GFR
  4. Damage may be irreversible!***
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14
Q

When will contrast-induced nephrotoxicity present?

A

within 24-48 hours
(peaks at day 3-5)
(recovery in 7-10 days)

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15
Q

What can be done to help prevent amphotericin B nephrotoxicity? (2)

A
  1. Switch to liposomal form (high risk patients)

2. Increase infusion time

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16
Q

Cyclosporine nephrotoxicity

A
  1. Dose dependent

2. Kidney biopsy may be needed to determine transplant rejection versus cyclosporine toxicity

17
Q

ACE and ARB - nephrotoxicity

A
  • decrease in urine output (oligouria)
  • GFR reduced, creatinine increase up to 30% within 3 to 5 days (stabilizes in 1-2 weeks)
  • Reversible
18
Q

Where does ACE medication work on the glomerulus?

A

keeps the efferent arteriole dilated

19
Q

Risk fator for ACE and ARB nephrotoxicity

A
  1. Renal artery stenosis

2. Hypovolemic

20
Q

How to prevent ACE nephrotoxicity?

A

-Choose shorter acting agent in high risk patients

Captopril, enalapril > lisinopril, benazepril

21
Q

Where do NSAIDs affect the glomerulus?

A

afferent arteriole

inhibit synthesis of protaglandins which are vasodilatory –>promotes renal ischemia and GFR reduction

22
Q

NSAID nephrotoxicity: presentation

A
  • within days of hypovolemia
  • oligouria
  • weight gain or edema
  • Creatinine, BUN, K+, BP are elevated
23
Q

NSAID nephrotoxicity: risk factor?

24
Q

NSAID nephrotoxicity: prevention

A
  • Avoid indomethacin (for gout) in high risk

- Use acetaminophen (less PGE inhibition)

25
Q

Name the drugs that cause acute allergic interstitial nephritis (5)

A
  1. Penicillins (Methicillin)
  2. Ciprofloxacin
  3. NSAIDs, COX2
  4. PPIs (ex. lanoprazol)
  5. Loop diuretic (furosemide)
26
Q

Which drug is notorious for causing chronic interstitial nephritis?

A

cyclosporine

27
Q

Which drug is notorious for causing papillary necrosis?

28
Q

Methicillin-Induced Allergic Interstitial Nephritis: clinical

A
  • 14 days after starting antibiotics
  • Fever
  • Rash
  • Eosinophilia
  • Arthralgia
  • Oligouria
29
Q

Methicillin-induced Allergic interstitial nephritis: treatment

30
Q

Which drugs/conditions are associated with intratubular obstruction via crystal preciptiates?

A
  1. Acyclovir
  2. Sulfonamides (can also cause nephrolithiasis!) [ex. prostatitis]
  3. Methotrexate
  4. Hyperuricemia
31
Q

Which drugs can cause precipitation of myoglobin from rhabdo?

A

HMG-CoA reductase inhibitors (lipophilic)

Ex. Simvastatin, Lovastatin

32
Q

Which drugs can cause nephrolithiasis?

A
  1. Ciprofloxacin
  2. Amoxicillin
  3. Nitrofurantoin (Macrobid)
33
Q

Which drugs (2) can cause vasculitis and thrombosis?

A
  1. Hydralazine (vasodilator)

2. Methamphetamines

34
Q

Which 2 drugs are associated with cholesterol emboli?

A
  1. Warfarin
  2. Thrombolytic agents
    * Purple discoloration of the toes and mottled skin on the legs**
35
Q

Which drugs cause glomerular disease and nephrotic range proteinuria?

A
  1. NSAIDs**
  2. Gold
  3. Lithium
  4. Pamidronate

Pharmacology (16 decks)

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