drugs renal affects Flashcards
Salbutamol is a β2 receptor agonist. what metabolic effect
hypokalaemia
what drugs are used to treat high potassium levels
Please note the above list does not include drugs used to temporarily decrease serum potassium for patients with hyperkalaemia (salbutamol, calcium resonium).
Thiazide diuretics
Loop diuretics
Acetazolamide - treat glaucoma - carbonic anhydrase inhibitor.
what do these 3 drugs cause
decrease serum potassium
ACE inhibitors Angiotensin-2 receptor blockers Spironolactone Potassium sparing diuretics (amiloride, triamterene) Potassium supplements (Sando-K, Slow-K)
what do these drugs too
increase serum potassium
Selective serotonin reuptake inhibitors (SSRIs) are used for what
gloomy face
what side effect do they cause
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
Salbutamol inhalers can cause a
low potassium
SSRI like sertraline
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.
what drugs should you stop in AKI
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)
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?
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.
what does aldosterone do
Stimulates the reabsorption of sodium from the distal tubules, with a consequant excretion of potassium
Remember that spironolactone, an aldosterone antagonist, cause hyperkalaemia
what can alcohol do to adh
Alcohol bingeing can lead to ADH suppression in the posterior pituitary gland subsequently leading to polyuria
Which is the most important blood test to order before administration of the contrast medium?
UandE
drugs that cause high potassium
potassium sparing diuretics ACE inhibitors ARB spironolactone ciclosporin heparin**
prerenal uraemia
kidneys hold on to sodium to preserve volume
drugs that cause low sodium
sulfonylureas* SSRIs, tricyclics carbamazepine vincristine cyclophosphamide
sulfonylureas* SSRIs, tricyclics carbamazepine vincristine cyclophosphamide
drugs causing low sodium
drugs which cause a rise in serum potassium
ACEi ARB spironolactone amiloride - potassium sparing potassium supplements like sandro-k
drugs which cause a decrease in serum potassium
Thiazides
loop diuretics
acetzolamide - glauocma
bicalutamide treats Prostate cancer what drug is it
blocks androgen receptors
why should gentamicin be monitored and how does it damage kidneys
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.
how does penicillin damage kidneys
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.
what drugs should be stopped in AKI
- NSAIDs (except if aspirin at cardiac dose e.g. 75mg od)
- Aminoglycosides
- ACE inhibitors
- Angiotensin II receptor antagonists
- Diuretics
Approximately what proportion of the sodium that is filtered at the glomerulus will be subsequently excreted?
up to 25%
