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GERR Pharmacology > Drugs and the Kidney > Flashcards

Drugs and the Kidney Flashcards

1
Q

What is the pharmacokinetic profile of penicillin

A

1- oral absorption variable
2-widely distributed in body fluids
3- mainly renal excretion ( tubular secretion )
4- short plasma half- life

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2
Q

What happens to medications someone is taking if they become renal impaired

A

Dose often will have to be adjusted if the drug is eliminated by the kidneys

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3
Q

What happens to Tazocin dosage in the event of renal impairment

A

Dose is adjusted by extending the time period between each dose from 8 hours to 12 hours. Same amount is still given but dose is reduced in 24 hr period

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4
Q

List drugs that will become less effective in renal impairment and their alternatives

A

1- Thiazide diuretics
Alternative : Loop diuretics
2- Nitrofurantoin ( antibiotic )
Alternative : Trimethoprim

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5
Q

What drugs will have an increased effect due to renal impairment

A

Opioids or Sedatives

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6
Q

What drugs will have increased toxicity in renal impairment and list the the results

A

1- Digoxin ( arrhythmias/nausea)
2- K+ sparring diuretics ( hyperkalaemia )
3- Nitrofurantoin (neuropathy)
4- Tetracyclines ( increased protein breakdown)
5- Metformin ( lactic acidosis)

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7
Q

60% of AKI occurs due to what and why

A

Pre-renal impairment due to decreased renal perfusion and altered auto regulation

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8
Q

What can cause sudden changed in blood volume causing pre-renal impairment

A

1- Vomiting / Diarrhoea
2- Bleeding
3- Cardiac Failure
4- Cirrhosis

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9
Q

What is most effected with drops in BP

A

Brain and Kidneys

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10
Q

What is the medical regimen for pre-renal impairment AKI

A

Discontinue nephrotoxic drugs and support blood pressure

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11
Q

List drugs that can cause Pre-renal impairment ( Hint : 4 )

A

1- Diuretics: reduce blood volume = reduce blood flow
2- Antihypertensives : ACE inhibitors, ARBS and vasodilators
2- NSAIDs : can cause peripheral oedema
3- Ciclosporin ( DMARD )
4 Radio contrast media

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12
Q

List drugs that cause intrinsic renal impairment AKI ( Hint: 9)

A 
1- Aminoglycosides ( gentamicin ) 
2- Amphotericin B 
3- Antimicrobials 
4: Anti-platelets (clopidogrel )
5- Anti-convulsants 
6- DMARDs 
7- Lithium 
8- NSAIDs 
9- Radio contrast media
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13
Q

What can cause post-renal impairment AKI

A

1- Crystals / Stones
2- Retroperitoneal fibrosis
3- prostate enlargement

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14
Q

What drugs can cause stones or crystals (not super important , extremely rare)

A

1- Aciclovir

2- Methotrexate

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15
Q

What drugs can cause retroperitoneal fibrosis ( not super important , extremely rare)

A

1- Ergot derivatives ( for migrant not used anymore )
2- Methyldopa
3- Hydralazine
3- atenolol

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16
Q

What are specific drugs to look out for for AKI ( Hint:7)

A 
1- NSAIDS 
2- ACE-I / ARBS 
3- Diuretics 
4- lithium 
5- Digoxin 
6- Gentamicin 
7- Methotrexate
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17
Q

Are NSAIDs nephrotoxic

A

yes all of them are

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18
Q

What can NSAIDs do to kidney

A

1- acute tubular necrosis
2- interstitial nephritis
3- glomerulonephritis
4- renal papillary necrosis

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19
Q

Explain the relationship with ACE-I and ARBs with renal impairment

A

Can help and harm the kidney ( complex ) .
Help : control BP and reduce intra glomerular pressure, reduce proteinuria
Harm: associated with deterioration of renal function

20
Q

If there is hyper filtration what could improve Kidney function

A

ACE-I & ARBs

21
Q

If someone has AKI would you continue ACE-I & ARBS

A

No have to stop them because there is a hypo filtration problem not hyper.

22
Q

Where is ACE-I & ARBs contraindicated

A

with renal artery stenosis

23
Q

Why would Diuretics be stopped if patient has AKI (Hint: 5 reasons )

A

1- increase electrolyte disturbances when combined with other diuretics.
2- Loop diuretics have increased nephrotoxicity if combined with antibiotic.
3- Will cause diuresis if combined with NSAIDs
4- Cause hypotension if combined with ACE-I and ARBs
5- Will cause lithium toxicity if combined with lithium

24
Q

How is lithium excreted

A

By Kidneys

25
Q

Why should Lithium be stopped if there is severe renal impairment ( Hint: 3 reasons)

A

1- Can block the effect of ADH on kidney and cause diabetes insipidius
2- Long term can cause tubule-interstitial damage
3- if prescribed with diuretics or ACE-I can cause lithium toxicity

26
Q

What is lithium used for

A

Psychological disorders such as bipolarism

27
Q

How is Digoxin excreted and what happens as time to steady state increase

A

Excreted by the kidneys. As time to steady state increases renal function decreases.

28
Q

What can result in Dig toxicity

A

If there is Hyperkalaemia.

29
Q

How is Gentamicin excreted

A

By the kidneys

30
Q

Is gentamicin nephrotoxic

A

yes

31
Q

If gentamicin levels go up what happens to renal function

A

Renal function will go down

32
Q

If patent on gentamicin has renal impairment what should you do

A

Reduce dose and frequency. Instead of 300 mg daily make it 300 mg 36-hrly. Need to measure trough levels and U+ E a lot more often

33
Q

What is the medical regimen for drug-induced AKI

A 
1- reversible if detected early 
2- look at serum creatinine and eGFR 
3- look at urinary sediment 
4- stop nephrotoxic drugs 
5- give supportive treatment ( ex: IV fluids )
34
Q

What is the threshold eGFR that signals CKD

A

anything less than 60ml/min

35
Q

What happens if patient’s eGFR decreases below 30 ( level 4 )

A

Referred to nephrology for dialysis, kidney transplant

36
Q

What happens if eGFR is less than 15 ( level 5 )

A

Established kidney failure. Put on permanent dialysis

37
Q

Does the loading dose stay the same or change during renal impairment

A

Stays the same since loading dose is not affected by clearance but maintenance dose does so that needs to be adjusted.

38
Q

How is dose adjustment usually done

A

Via eGFR or serum creatinine

39
Q

Treatment for severe CKD ( and reasons for them )

A

1- Phosphate binding agents ( calcium carbonate ) : to keep calcium levels normal
2- Secondary HyperPTH / renal osteodystrophy : vitamin D tablet
3- symptomatic anaemia : erythropoietin may be used
4- Dialysis / renal replacement therapy

40
Q

What is Dialysis

A

1- Blood is put through artificial filtration system

2- Solutes diffuse from blood and diffuse into fluid ( mirror what kidneys do )

41
Q

What drugs can be affected by dialysis and why

A

Drugs that are small molecules and have low protein binding will be removed. Will have to be reduced after dialysis
Ex: Theophyline, Metronidazole, Gentamicin, Anti-virals

42
Q

Explain Dialysis in acute poisoning and examples when it is used

A

Used in acute poising by drugs to diffuse drug molecules out.
Ex: aspirin, lithium , methanol , sodium valproate, ethylene glycol

43
Q

Which drugs should be stopped / adjusted first when patient comes in and presents with eGFR of 20

A

Diuretics , ACE-I, metformin , NSAIDs ( DAMN drugs ).

Digoxin should be assessed for toxicity and dose be reduced

44
Q

What is Bumetanide

A

A diuretic

45
Q

What’s the rule for drug half life

A

1- f drug is given once, 5 times the half life is how long it takes to eliminate the drug
2- if drug is given regular then 5 times the half life is when the drug will reach the steady state

46
Q

If there is a regulary given drug with a half life of 4 days when should the plasma drug concentration of steady state be measured.

A

around 20 days after

GERR Pharmacology (9 decks)

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