drugs renal affects

Question 1

Salbutamol is a β2 receptor agonist. what metabolic effect

Answer 1

hypokalaemia

Question 2

what drugs are used to treat high potassium levels

Answer 2

Please note the above list does not include drugs used to temporarily decrease serum potassium for patients with hyperkalaemia (salbutamol, calcium resonium).

Question 3

Thiazide diuretics
Loop diuretics
Acetazolamide - treat glaucoma - carbonic anhydrase inhibitor.

what do these 3 drugs cause

Answer 3

decrease serum potassium

Question 4

ACE inhibitors
Angiotensin-2 receptor blockers
Spironolactone
Potassium sparing diuretics (amiloride, triamterene)
Potassium supplements (Sando-K, Slow-K)

what do these drugs too

Answer 4

increase serum potassium

Question 5

Selective serotonin reuptake inhibitors (SSRIs) are used for what
gloomy face

what side effect do they cause

Answer 5

antidepressant. They’re mainly prescribed to treat depression, particularly persistent or severe cases, and are often used in combination with a talking therapy such as cognitive behavioural therapy (CBT).

hyponatraemia

Question 6

Salbutamol inhalers can cause a

Answer 6

low potassium

Question 7

SSRI like sertraline

Answer 7

can cause low sodium

SSRIs have been implicated in causing the syndrome of inappropriate ADH, where the patient is has a low sodium with no oedema and is euvolemic.

Question 8

what drugs should you stop in AKI

Answer 8

NSAIds such as diclofenac
ACEi
gentamicin and vancomycin and maybe metformin

Ibuprofen is an NSAID.

NSAIDs reduce prostaglandin production - as prostaglandins are vasodilators, inhibition of their production may lead to vasoconstriction of the afferent arteriole which will caused reduced renal perfusion and reduced eGFR.

In an AKI, it is important to stop all nephrotoxic drugs. This includes NSAIDs, ACE-inhibitors, gentamicin, vancomycin and considering stopping metformin (this should be discussed with the diabetic team)

Question 9

management of Autosomal dominant polycystic kidney disease (ADPKD)

A 72-year-old male was admitted after being found to be delirious in the nursing home. In hospital, he was diagnosed to have a lower respiratory tract infection and subsequently developed sepsis. After admission to ICU, he was found to be profoundly hyponatraemic. The team have prescribed tolvaptan among other agents.

Which best describes the mechanism of action of the aforementioned drug?

Answer 9

Tolvaptan blocks the action of vasopressin at the V2 receptor. This receptor is found on the basolateral membrane of the principal cells in the collecting ducts of the kidney. This reduces water absorption (through decreased aquaporin 2) and increases aquaresis( excreting of water without electrolyte loss) without sodium loss. Desmopressin is a synthetic analogue of vasopressin that exerts agonism at the V2 receptor.

Question 10

what does aldosterone do

Answer 10

Stimulates the reabsorption of sodium from the distal tubules, with a consequant excretion of potassium

Remember that spironolactone, an aldosterone antagonist, cause hyperkalaemia

Question 11

what can alcohol do to adh

Answer 11

Alcohol bingeing can lead to ADH suppression in the posterior pituitary gland subsequently leading to polyuria

Question 12

Which is the most important blood test to order before administration of the contrast medium?

Answer 12

UandE

Question 13

drugs that cause high potassium

Answer 13

potassium sparing diuretics
ACE inhibitors
ARB
spironolactone
ciclosporin
heparin**

Question 14

prerenal uraemia

Answer 14

kidneys hold on to sodium to preserve volume

Question 15

drugs that cause low sodium

Answer 15

sulfonylureas*
SSRIs, tricyclics
carbamazepine
vincristine
cyclophosphamide

Question 16

sulfonylureas*
SSRIs, tricyclics
carbamazepine
vincristine
cyclophosphamide

Answer 16

drugs causing low sodium

Question 17

drugs which cause a rise in serum potassium

Answer 17

ACEi 
ARB 
spironolactone
amiloride - potassium sparing 
potassium supplements like sandro-k

Question 18

drugs which cause a decrease in serum potassium

Answer 18

Thiazides
loop diuretics
acetzolamide - glauocma

Question 19

bicalutamide treats Prostate cancer what drug is it

Answer 19

blocks androgen receptors

Question 20

why should gentamicin be monitored and how does it damage kidneys

Answer 20

cause Aki by renal cell apoptosis

Gentamicin is one of the drugs causing apoptosis of renal tubular epithelial (LLC-PK1) cells. Patients being prescribed gentamicin should have drug concentration and renal function regularly monitored.

Question 21

how does penicillin damage kidneys

Answer 21

Penicillin causes AKI by causing acute interstitial nephritis

Penicillin is known to cause acute tubulointerstitial nephritis due to a reaction resulting in inflammatory infiltrate in the renal interstitium. This process is known to occur with several drugs including common NSAIDs, antibiotics, and anticonvulsants.

Question 22

what drugs should be stopped in AKI

Answer 22

• NSAIDs (except if aspirin at cardiac dose e.g. 75mg od)
• Aminoglycosides
• ACE inhibitors
• Angiotensin II receptor antagonists
• Diuretics

Question 23

Approximately what proportion of the sodium that is filtered at the glomerulus will be subsequently excreted?

Answer 23

up to 25%