Drugs and Renal Disease Flashcards
How are penicillin’s removed?
mainly renal excreted
What drugs are less effective in renal impairment
Thiazide diuretics
Nitrofurantoin
Alternative drugs to use in renal impairment
Loop diuretics
Trimethoprim
What do opioids and sedatives do to the effect of the drug
Increases the effect of the drug
What can an increase in toxicity lead to
Digoxin K+ sparing diuretics Nitrofurantoin Tetracyclines Metformin
What happens in acute kidney injury
Decrease in renal perfusion
sudden changes in volume state
What action should be taken if blood pressure changes in acute kidney injury
Should discontinue potentially nephrotoxic drugs
Examples of pre- renal impairment drugs
Diuretics Anti-hypertensives NSAIDs Ciclosporin Radio contrast media
Examples of drugs that can cause acute kidney injury renal impairment
Aminoglycosides Amphotericin B Other anti microbials Anti convulusants DMARDs Lithium NSAIDs anti- platelets
What drugs should be stopped in renal diseae
Stop the DAMN drugs
Diuretics
Ace inhibitors + ARBs
Metformin
NSAIDs
What renal problems can NSAIDs cause
Interstitial nephritis
Why should ace- i and ARBs be stopped in renal disease
Decrease BP
decrease in intraglomerular pressure
decrease proteinuria
affects pressure more than afferent pressure
avoid losing protein to protect kidney
Features of diuretics in renal disease
Increase in electrolyte disturbance when combined
Increase nephrotoxicity when combined with loop diuretics
Impaired diuresis when combined with NSAIDs
Hypotensive when combined with ACE-I and vasodilators
What excretes lithium
Kidney
Why should lithium be avoided in severe renal impairment
lithium renal excretion will decrease when kidneys are impaired
lithium can blocked the effect of ADH on the kidney leading to diabetes insipidus
long term tubulo-interstitial damage
risk of lithium toxicity will increase if co prescribed with diuretics/ ACEi/ ARBs
