Drugs With Toxic Renal Effects

Question 1

Kidney specific risk factor

Answer 1

Healthy cells could be targets of chemotherapeutic agents

Receives significant amount of Cardiac output exposing it to drugs

CYP450 in kidney leading to toxic metabolites

Kidney environment (methotrexate toxicity based on crystallization in renal tubules )

Question 2

Patient specific risk factors

Answer 2

Old age

Female

Neonates
Yes
Because reduced mass muscle and low total body water (increased drug concentration)

Disease state (acute or chronic kidney disease, hepatic failure, hyperbilirubenemia )

Question 3

Nephrotoxic drugs

Answer 3

Antibacterial

NSAIDS

ACE inhibitors

Antivirals

Antifungals

Chemotherapeutic agents

Question 4

Antibacterial with nephrotoxic effects

Answer 4

Aminoglycosides

Sulfamethoxazole trimethoprim sulfa based

Vancomycin

Ciprofloxacin

Question 5

Incidence of nephrotoxic tu at therapeutic dose of amino glycoside

Answer 5

10-25%

Question 6

Most toxic aminoglycoside

Answer 6

Neomycin

And then gentamicin, tobramycin, ami la fin..

Question 7

Aminoglycoside MOA for toxicity

Answer 7

Enter adrenal cortex and proximal tubular cels

Bind lysosomes
Form myéloïde lysosomes
And then unclear

Question 8

How to prevent aminoglycoside toxicity

Answer 8

Drug dose calculated based on creatinine clearance

Question 9

Sulfamethoxazole action toxic

Answer 9

Inhibits proximal tubular secretion of creatinine

Crystal nephropathy sometimes

Question 10

Vancomycin toxicity MOA

Answer 10

Acute tubular necrosis

Acute intertistial nephritis

Question 11

Ciorofloxacin toxicity

Answer 11

Acute interstitial nephritis

Crystalluria (in alkaline urine)

Question 12

Why do NSAID cause nephrotoxicity

Answer 12

PG inhibition -> impaired renal vasodilation -> impaired renal hemodynamics

Question 13

NSAID nephrotoxic symptoms

Answer 13

Acute kidney injury

Hyperkalemia Metabolic acidosis (renin impaired )

Question 14

ACE and ARB MOA in toxicit

Answer 14

Antagonize angiotensin II -> interfere renal autoregulatio of GFR-> can cause acute kidney injury

Question 15

Antiviral agents with nephrotoxic effect

Answer 15

Acyclovir

Foscanet

Antiretroviral drugs

Question 16

Acyclovir nephrotoxic effect

Answer 16

High dose IV can cause acute kidney injury and crystal precipitation

Question 17

How to prevent acyclovir nephrotoxicity

Answer 17

Low dose and slow rate infusion

Question 18

Foscanet nephrotoxic effect

Answer 18

Acute kidney injury
Electrolyte abnormalities
Hypocalcemia

Question 19

Most nephrotoxic antiretroviral

Answer 19

Tenofovir

Question 20

Tenofovir toxic effect

Answer 20

Acute kidney injury

Question 21

Type of antiretroviral with toxic effect

Answer 21

Tenofovir
Protease inhibitor (indinavir)

Question 22

Antifungal agents with nephrotoxic effects

Answer 22

Amphoterecin B

Question 23

Who has better renal safety
liposomal AmB
Or conventional AmB

Answer 23

LiposomalAmB

Question 24

AmB MOA in toxicity

Answer 24

Alter membrane permeability of normal renal tubular cells

Question 25

Chemotherapeutic agents with nephrotoxic effects

Answer 25

Cisplatin
Ifosfamide
Methotrexate

Question 26

Cisplatin nephrotoxic effects

Answer 26

Acute kidney injury
Hypocalcemia
Hyponatremia

Question 27

Management of cisplatin administration

Answer 27

Hypertonic Saline and sodium thosulfate

Kidney function and electrolyte serum monitoring

Question 28

toxic form of ifosfamide

Answer 28

Chloroacetaldehyde

Question 29

Methotrexate MOA of toxicity

Answer 29

Crystallization at high IV dose in rénale tubules and direct tubular toxicity

Question 30

Management of methotrexate administration

Answer 30

High urine output

Urinary alaklization