drugs and the kidney

Question 1

what is GFR

Answer 1

sum of the filtration across all the nephrons - ml/min

Question 2

where is creatinine actively secreted from

Answer 2

the proximal tubule

Question 3

Creatinine always

Answer 3

OVERESTIMATES GFR (it’s GFR + tubular secretion)

Question 4

The Cockcroft-gault equation predicts

Answer 4

creatinine clearance

Question 5

when is the CG equation imprecise?

Answer 5

at near normal GFR - imprecise

Question 6

When does the CG equation overestimate GFR?

Answer 6

when renal function is severely impaired

Question 7

what does the CG equation incorporate that is helpful when person like Arn shwatz comes in?

Answer 7

it incorporates weight into the equation

Question 8

what are the four variables used to estimate GFR in MDRD and CKD-EPI?

Answer 8

Age
Sex
Serum creatinine
Race

Question 9

MDRD tends to

Answer 9

UNDERESTIMATE GFR

Question 10

All equations depend on creatinine being

Answer 10

in steady state

Question 11

Angiotensin 2 is the

Answer 11

active form of angiotensin

Question 12

3 functions of Angiotensin 2

Answer 12

• increase aldo
• vasoconstrict
• increase sodium reabs

Question 13

which drugs work at the proximal convoluted tubule?

Answer 13

CAinhibitors

Question 14

Thiazides work at which level of the kidney

Answer 14

distal convoluted tubule

Question 15

any drugs that work proximal to the cortical collecting duct cause

Answer 15

potassium wasting

Question 16

how do the carbonic anhydrase inhibitors work?

Answer 16

they result in increased distal delivery of bicarb

Question 17

how do loop diuretics work?

Answer 17

Block the Na2ClK pump

block reabsorption of sodium, so increase its delivery distally

Question 18

how do thiazides work

Answer 18

work at the distal CT, block NaCl channel

Question 19

2 mechanisms of action of potassium sparing diuretics

Answer 19

block aldo binding

bind the ENaC

Question 20

how do vaptans work?

Answer 20

promote waterloss, block ADH

Question 21

Pre-renal AKI can be caused by which drugs

Answer 21

• diuretics
• RAAS blockade
• NSAIDs

Question 22

How do NSAIDs cause pre renal AKI

Answer 22

• they cause relative constriction of the afferent arterioles (blocking PGs)
  especially when combined with an ACE i

Question 23

2 drugs that can cause ATN

Answer 23

• aminoglycosides and IV contrast

Question 24

need to adjust drug ? to avoid toxicities

Answer 24

dose and frequency

Question 25

Dose adjustments to prevent renal toxicitiy include

Answer 25

those with a LOW Therapeutic index

Question 26

Adjustments to drugs in renal function are needed when the

Answer 26

GFR

Question 27

when GFR is reduced (

Answer 27

• Thiazides

- Nitrofurantoin in effective

Question 28

metformin is associated with what when the GFR is

Answer 28

Lactic acidosis

Question 29

bisphosp are associated with what when the GFR is

Answer 29

increase fracture risk

Question 30

3 drugs that can have adverse effects in CKD

Answer 30

• metformin
• bisphos
• meperidine

Question 31

Nephrotoxic drug examples

Answer 31

aminoglycosides
ampho B
NSAIDs

Question 32

what changes in drug dosing in kidney disease

Answer 32

Loading dose STAYS THE SAME

- maintenance does changes

Question 33

when do you reduce the dose of a drug vs change the frequency or interval

Answer 33

when a steady state is required