Drugs And Ckd Flashcards
Equation to determine drug dosing in Aki on crrt
Crrt clearance (ie what clearance u assume patient to have to figure out appropriate drug dosing). = Unbound fraction of drug x effluent rate Effluent rate= dialysis the plus UF
Haart meds
NRTI- may produce lactic acidosis, give after dialysis: zidovudine, didanosine, zalcitabine, stavudine, lamivudine
NNRTI- nevirapine, delavirdine, efavirenz: potent p450 interaction: cyclosporine, tacrolimus, diltaizem, verapamil– levels go up. Don’t need to dose adjust in renal failure.
PI: no dose adjustment necessary
Eg ritonovir: Aki
Nelfinavir: stones tubular dysfunction
Saquinavir: lactic acidosis and hypocalcemia
Indinavir: stones interstitial nephritis
Activated charcoal works for
Drugs w Small VD or Low protein binding
Not for Tca
Digoxin, salicylate, phenobarbital, carbamazepine, theophylline
Antidote for methanol
Fomepizole or 4 methylpyrazole
Or ethanol
HD if level >50mg/dL
Visual abnormalities renal failure electrolyte imbalance not responsive to conventional therapy
Cofactors folate, increases metabolism of formate to CO2 and water
Antidote for cyanide
Sodium thiosulfate
Antidote for ethylene glycol
Ethanol
Fomepizole
Give cofactors pyridoxine and thiamine, which increase metabolism of glyoxylate to hippuric acid and alpha OH B ketoadipic acid, respectively
If no fomepizole start HD level>50mg/dL continue until <20.
Antidote for benzos
Flumazenil
When do u dialyze for lithium
Level 4-6mmol/L
Or 2.5-4 w severe sx
Or <2.5 in ESRD pt or rising Li level
Need to check levels again 2 and 4hr later to look for rebound
Antidote for salicylate
Activate charcoal in ED
If level <100 can do urinary alkali cation
Supplement glucose bc CNS levels drop
Aim for urine ph 7.5 and blood ph 7.5-7.59 bc acidemic increases CNS salicylate toxicity
Antidepressants that need dose adjustment in ESRD
Paxil and venlafaxine
Drug classes that decrease CNI levels
Anti TB: rifampin rifabutin INH
Anti seizure: barbiturates phenytoin carbamazepine
St. John’s worry
Drug classes that increase CNI levels
Macrolides
CCB diltaizem and verapamil
Mtor inhibitors
Antifungals keto and fluconaxole
CSA blocks entering empathic circulation of what drug
Mmf. So some mmf ends up in stool and there is no second plasma peak. Contrast to tac and mmf.
Pentamidine
ATN most likely. Reversible.
Hyperkalemia
Use for Pcp
Foscarnet
Directly toxic to tubular cells Rise in cr 6-15 days after UA bland Freq poly iris and polydipsia by ADH interference and sometimes DI Reduced Aki by giving saline Hypocalcemia and mag High phos Used for cmv, hsv, vzv
Cidofovir
Dose dependent nephrotocicity
Fanconi
Usually reversible
Should get saline prior and probenecid which blocks the active renal tubular secretion. Prevents uptake of cidofovir into proximal tubular cells
Vincristine
Siadh
Alpha interferon
Proteinuria- can be massive
Looks like minimal change dz on bx
Tma is rare
Interferon gamma
ATN
Tmp smx
Hyperkalemia due to blockade of collecting tubule sodium channel by trimethoprim (similar to amiloride)
TMP also decreases tubular secretion of Cr
Sirolimus
Increases total cholesterol and TG- LDL VLDL HDL
Dose dependent
Moa: decreased catabolism of apoB containing lipoproteins
Reversible generally
Respond to lips reducing agents. Not interaction w atorvastatin
Inhibits erythropoiesis at level of EPO receptor
Ace and arb associated with what hematologic change
Post transplant anemia
Used to rx erythrocytosis
Drug Causes of low mag
Aminoglycosides ?bind to calcium mag receptor
Cisplatin inhibits distal nephron mag
Pentamidine
cNI reduce expression of Claudin 16 and also inhibit distal nephron mg transport
Familial hypomagnesemia and hypercalciuria and nephrocalcinosis FHHNC
Mutation in Claudin 16/19 genes
Loss of cation selectivity in the para cellular pathway
Decreased reabsorption of ca mag with increased urinary loss
Presents in childhood or adolescence with hypocalcemia, recurrent nephrolithiasis and nephrocalcinosis and progresses to CKD
