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Y4R3 - Medicine II 🩺 > L9: Kidney & Drugs > Flashcards

L9: Kidney & Drugs Flashcards

1
Q

Effect of CKD on Meds
(Pharmacokinetics)

A

(ABSORPTION – DISTRIBUTION – METABOLISM – ELIMINATION)

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2
Q

Effect of CKD on Drug Absorbtion

A
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3
Q

Effect of CKD on Drug Distribution

A
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4
Q

Effect of CKD on Drug Metabolism

A
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5
Q

Effect of CKD on Drug Elimination

A
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6
Q

Effect of Meds on Kidney

A
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7
Q

Mechanisms of medication-induced nephrotoxicity

A

① Functional/Hemodynamic effect: Afferent VC or Efferent VD.

② Glomerular injury.

③ Tubulointerstitial injury: AIN + Analgesic nephropathy + Crystal Nephropathy

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8
Q

Functional/Hemodynamic effect of Meds on Kidney

A
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9
Q

Functional/Hemodynamic effect of Meds on Kidney

  • Mechanism
A

These drugs alter renal blood flow → Decreased GFR

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10
Q

Functional/Hemodynamic effect of Meds on Kidney

  • Examples
A
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11
Q

Medication-induced glomerular disease

A
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12
Q

Medication-induced glomerular disease

  • Direct Cellular Injury
A
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13
Q

Drugs Causing Direct Cellular Injury

  • Epithelial (Podocyte) Cells
A
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14
Q

Drugs Causing Direct Cellular Injury

  • Endothelial Cells
A
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15
Q

Drugs Causing Direct Cellular Injury

  • Mesengial Cells
A
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16
Q

Drugs Causing Immune Mediated Injury

A
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17
Q

Drugs Causing Immune Mediated Injury

  • Immune Complex Diseaeses
A
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18
Q

Drugs Causing Immune Mediated Injury

  • Small vessel vasculitis (ANCA related)
A
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19
Q

Tubulointerstitial injury by Drugs

A
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20
Q

AIN by Drugs

A
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21
Q

AIN by Drugs

  • Antibiotics
A

▪ Penicillins
▪ Cephalosporins
▪ Sulfonamides
▪ Isoniazid
▪ Rifampin

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22
Q

AIN by Drugs

  • Ananlgesics
A

NSAIDs

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23
Q

AIN by Drugs

  • Diuretics & Antihypertensives
A

▪ Furosemide
▪ Thiazides
▪ Triamterene
▪ Amlodipine
▪ Diltiazem

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24
Q

AIN by Drugs

  • PPI
A

Omeprazole

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25
Q

AIN by Drugs

  • H2 Blockres
A

▪ Famotidine ▪ Ranitidine

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26
Q

AIN by Drugs

  • Anticonvulsants
A

▪ Phenytoin ▪ Carbamazepine

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27
Q

AIN by Drugs

  • Others
A

▪ Allopurinol

▪ Immune Checkpoint Inhibitors (i.e., PD-L1 inhibitors)

28
Q

Analgesic Nephropathy by Drugs

29
Q

Def of Analgesic Nephropathy

A

A kidney disease characterized by papillary necrosis & chronic interstitial nephritis.

30
Q

Etiology of Analgesic Nephropathy

A
  • When combination analgesics (e.g., NSAIDs + Paracetamol) are used in large cumulative doses.
31
Q

Pathogensis of Analgesic Nephropathy

32
Q

Def of Crystal Nephropathy

33
Q

Etiology of Crystal Nephropathy

34
Q

Etiology of Crystal Nephropathy

  • Hypercalcemia
35
Q

Etiology of Crystal Nephropathy

  • Excess Vit C
A

Vit c is converted to oxalate & excreted in the urine → allows calcium oxalate crystals to form.

36
Q

Etiology of Crystal Nephropathy

  • Hyperuricemia
37
Q

Contributing Factors for Crystal Nephropathy

38
Q

Meds Usage in renal Disease

A

① Medications commonly used in renal patients.

② Medications that should be deprescribed in renal patients.

③ Medications that should be monitored closely in renal patients.

39
Q

Medications commonly used in renal patients

40
Q

Benefits of Diuretics in CKD

A

For natriuresis & BP control with a reduced GFR.

41
Q

Risks if Diuretics in CKD

42
Q

Risks if Diuretics in CKD

  • Specific to loop & Thiazides
A

② A range of electrolyte disturbances including dec, k+ & dec. Mg2+

③ Hypochloremic metabolic alkalosis

④ Hyperuricemia

⑤ At higher doses of thiazides → glucose intolerance, and hyperlipidemia

43
Q

Risks if Diuretics in CKD

  • Specific to K Sparring Diuretics
A

(MRA, Amiloride)

  • Hyperkalemia
44
Q

MOA of RAAS Blockers

45
Q

RAAS blockers Double-Edged Sword in CKD

  • Explain
46
Q

Mechanism of RAAS-Induced Hyperkalemia

47
Q

RF for RAAS-Induced Hyperkalemia

48
Q

Mechanism of RAAS-Induced AKI

49
Q

RF for RAAS-Induced AKI

50
Q

Usage of Anti-Hyperglycemia Drugs in Kidney Disease

51
Q

Medications that should be deprescribed in renal patients

52
Q

Risks of NSAIDs in Kidney Disease

53
Q

Cautions While Using NSAIDs in Kidney Disease

54
Q

Risk of Iodinated Contrast in Kidney Disease

A

Contrast-induced nephrotoxicity

55
Q

Caustions while Using Iodinated Contrast in Kidney Disease

56
Q

OTC Meds with Kidney Diseases

A

Unneeded OTC medications & dietary supplements:
① Herbal supplements
② Non-herbal supplements
③ Vitamins

57
Q

Licorice with Kidney Diseases

A

increase Risk of sodium and water retention, hypokalemia.

58
Q

PPI with Kidney Diseases

A
  • Growing evidence indicates potential kidney and non-kidney-related harm with prolonged usage.
59
Q

Medications that should be monitored closely in renal patients

60
Q

Medications that should be monitored closely in renal patients.

  • Examples
61
Q

Approach to Safe Medication Prescription in Renal Patients

62
Q

Approach to Safe Medication Prescription in Renal Patients

  • Assess Kidney Function
63
Q

Approach to Safe Medication Prescription in Renal Patients

  • Meds History
A
  • The medication list should include all prescriptions, OTC, and dietary supplements.
  • Ask for history of drug allergies/sensitivities
64
Q

Approach to Safe Medication Prescription in Renal Patients

  • Meds Review
65
Q

Approach to Safe Medication Prescription in Renal Patients

  • Adjust regimen
A

Adjust the dose based on patient’s eGFR and drug pharmacokinetics (Avoid renally cleared medications)

66
Q

Approach to Safe Medication Prescription in Renal Patients

  • Drug Therapy Monitoring
A

Monitor the following:
▪ Drug efficacy (Response).
▪ Drug toxicity.
▪ Drug level “If available/applicable”

67
Q

Done

Y4R3 - Medicine II 🩺 (35 decks)

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