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HEME PHARM > Kidney Toxicity > Flashcards

Kidney Toxicity Flashcards

1
Q

Pre-Renal

A

Diuretics

ACEIs and ARBs
Antihypertensives

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2
Q

Vasoconstriction

A

NSAIDS

radiocontrast agents
cyclosporine
Tacrolimus
amphotericin B

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3
Q

Crystalluria

A

Sulfonamides

Methotrexate
acyclovir
triamterene
protease inhibitors

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4
Q

Tubular toxicity

A

Aminnoglycosides

cisplatin
vvancomycin
pentamidine
radiocontrast dyes

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5
Q

Endothelial injuries

A

cyclosporine

mitomycin C
Tacrolimus
Cocaine

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6
Q

Glomerulopathy

A

Penicillamine

NSAIDS

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7
Q

Interstitial nephritis

A

Antibiotics

NSAIDS
Diuretics

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8
Q

Acetaminophen

A

proximal tubular necrosis
increase BUN and ser creatinine
decrease GFR

MOA:
Cyp activation? Glutathione conjugates?

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9
Q

NSAIDs

A

3 mechanisms

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10
Q

1st NSAID mechanism

A

inhibit prostaglandin synthesis…decreased RBF and ischemia

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11
Q

2nd NSAID mechanism

A

chronic comsumption…analgesic nephropathy!

  • -chronic interstitial nephritis and papillary necrosis
  • -under hypoxic conditions…generation of reactive itnermediate binds to cellular macromoleculles
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12
Q

3rd NSAID mechanism

A

interstitial nephritis…more rare form of toxicity

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13
Q

Aminoglycosides

A

increase in number and size of lysosomes (which contain phospholipid)
…due to inhibition of sphingomyelinase and phospholipases

rupture of lysosomes exposes the cytoplasm to contents…toxic!

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14
Q

Amphotericin B

A

impaires functional integrity of glomerulus, proximal and distal tubules
decrease RBF and decrease GFR

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15
Q

Cyclsporine

A

produces acute reversible renal dysfunctionand acute vasculopathy
……mediated by thromboxane-induced vasoconstriction, reduced vasodilatory prostaglandins, aniotensin II, endothelium platelet activating factor, or reduced endothelium-dependent relaxation factors

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16
Q

Cisplatin

A

may produce renal toxicity through its MOA
…inhibition of DNA synthesis and transport functions
–focal necrotic lesions arise in nephron
–glomerulus usually unaffected
pts treated w/ this permanently lose 10-30% of their renal function

17
Q

Radiocontrast agents

A

acute vasoconstrictive response
cellular generation of ROS
(IOTROL or IOPAMIDOL have incidence of 0-10% in pts w/ normal renal function, but w/ risk factors incidence 12-50%)

HEME PHARM (10 decks)

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