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Nephrology > Medicines and the Kidney > Flashcards

Medicines and the Kidney Flashcards

1
Q

Where might drugs become highly concentrated? And what might this cause?

A

Loop of Henle

Tubular toxicity

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2
Q

What does drug elimination depend on?

A
  1. Glomerular filtration
  2. Tubular secretion
  3. Diffusion (non-ionic)
  4. Protein-binding
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3
Q

How are weak acid drugs eliminated?

A

Actively secreted into PCT

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4
Q

What is the effect of impaired renal function on drug therapy?

A
  1. Toxicity - drug not excreted and reaches toxic levels

2. Ineffective treatment - e.g. UTI antibiotic not reaching place of action

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5
Q

Define loading dose

A

A loading dose is an initial higher dose of a drug that may be given at the beginning of a course of treatment before dropping down to a lower maintenance dose

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6
Q

How is kidney function measured? What is taken into account?

A 
eGFR
MDRD formula
- age
- female
- black ethnicity
- creatinine
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7
Q

Define trough concentration

A

Trough concentration is the lowest concentration reached by a drug before the next dose is administered, often used in therapeutic drug monitoring.

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8
Q

What happens if you increase dose interval?

A

Decrease trough concentration

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9
Q

What happens if you decrease drug dosage?

A

Decrease peak concentration

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10
Q

How are opioids and their metabolites excreted?

A

Renally

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11
Q

What kind of drug an gentamicin? What effect does it have on the kidney

A

Aminoglycoside
Antibiotics

Causes nephrotoxicity and make kidney function worse

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12
Q

How do ACEi work?

And what is their outcome?

A

Decrease Ang II
Cannot vasoconstrict efferent arteriole to maintain glomerular capillary pressure
- decrease kidney function in setting of hypovolaemia

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13
Q

What do NSAIDs do with respect to kidney function?

A

Inhibit prostaglandins

- afferent arteriole dilation

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14
Q

What is the main effect of diuretics?

A

Increase urine volume

- Natriuresis (Na+ excretion) + water.

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15
Q

List the different types of diuretics and where they act

A
  1. Loop diuretics inhibit NKCC on TALH
    - E.g.: Furosemide and bumetanide
    - Most powerful diuretics, account for 15%
  2. Thiazides inhibit Na/Cl co-transporter (NCC) on DCT
    - E.g.: bendro-flu-methi-azide and hydrochloro-thiazide
    - Better tolerated than loop diuretics but are less powerful
  3. K-Sparing inhibit Na+/K+-ATPase pump on DCT/CD
    - E.g. Spironolactone and eplerenone
    - limited action, account for only 2%
  4. Aldosterone antagonists inhibit aldosterone receptors and in turn blocking ENaC on CD. Also act on DCT
    - Decrease potassium excretion (can be used in hypokalaemia)
    - E.g.: Amiloride
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16
Q

Which is the most powerful diuretic?

A

Loop diuretic

E.g. furosemide

17
Q

Which diuretic inhibits NKCC?

A

Loop diuretic

E.g. furosemide

18
Q

Which diuretic inhibits Na+/K+-ATPase?

A

K-sparing

e.g. spironolctone

19
Q

Which drug indirectly acts to reduced ENaC Action

A

Amiloride

Aldosterone antagonist

20
Q

Which diuretic can help retain potassium

A

K-sparing diuretics
or
Amerloride

21
Q

Where do thiazides work?

A 
DCT
inhibit NCC (Na/Cl co-transporters)
22
Q

Give 2 examples of thiazide drugs

A

Hydrochlorothiazide

Bendroflumethithiazide

23
Q

Give 2 examples of loop diuretics

A

Furosemide

Bumetanide

24
Q

Give 2 examples of K-sparing diuretics

A

Spironolactone

eplerenone

25
Q

Give 2 common conditions where you would prescribe a diuretic

A

Oedema

Hypertension

26
Q

Which diuretic cannot be prescribed in kidney dysfunction?

A

K-sparing

Patient already cannot excrete adequate K+
= risk of hyperkalaemia

27
Q

Which diuretic is best prescribed to kidney dysfunction patients?

A

Loop diuretics

28
Q

Which diuretic carries risk of ototoxicity at high doses?

A

Loop diuretics

29
Q

Where do spironolactones act?

A

K-sparing drugs

- MR antagonist

30
Q

Which diuretic can be useful for hyperaldosterone states?

A

Aldosterone = mineralocoritoid

Use spironolactone to inhibit MR

31
Q

How does amiloride work?

A

Blocks ENaC in CD

Nephrology (6 decks)

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