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Metabolic PPT Flashcards

1
Q

what helps predict the progression of AKI to CKD?

A

severity and duration of AKI

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2
Q

what are the 6 steps used to treat AKI?

A

1 - correction of hypovolaemia and restoration of haemodynamic status
2 - treatment of sepsis (sepsis 6)
3 - avoid nephrotoxic drugs
4 - adjust does of renally excreted drugs
5 - nutrition
6 - referral

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3
Q

whats used in the 1st step of AKI treatment?

A

crystalloid stat (hartmann’s solution)

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4
Q

what nephrotoxic drugs should be avoided in treatment of AKI/renally impaired patients?

A

NSAIDs, amphoterecin, aminoglycosides, iodinated contrast, ACE inhibitors

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5
Q

name some renally excreted drugs who’s dose should be adjusted in AKI

A

Digoxin, LMWH, opioids, penecillin

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6
Q

what are the 3 classes of drug that interfere with renal perfusion?

A

NSAIDs, ACEi, ARBs

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7
Q

give 2 examples of calcineurin inhibitors

A

tacrolimus, ciclosporin

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8
Q

whats the MOA of calcineurin inhibitors?

A

IL-2 productin inhibited which causes arrest of T cell division

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9
Q

whats are calcineurin inhibitors used for

A

immunosuppression

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10
Q

side effects of calcineurin inhibitors

A

1 - nephrotoxicity due to infrarenal vasocostriction
2 - hypertension
3 - hyperkalaemia
gum hypertrophy (ciclosporin)

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11
Q

name some anti-proliferative immunosuppressants

A

azathioprine, cyclophosphamide

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12
Q

whats the MOA of azathioprine

A

antagonizes purine synthesis, resulting in less DNA and RNA synthesis for white blood cell synthesis

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13
Q

side effects of azathioprine

A

leucopenia, thrombocytopenia, pancreatitis

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14
Q

when can azathioprine be used

A

immunosuppression for transplant

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15
Q

MOA of cyclophosphamide

A

an alkylating agent which can have 3 effects:
1 - alkyl group binds to DNA and prevents DNA synthesis and RNA transcription
2 - DNA damage via formation of crosslinks
3 - mispairing nucleotides leading to mutation

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16
Q

side effects of cyclophosphamide

A

1 -haemorrhagic cyst
2 - alopecia
3 - neutropenia

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17
Q

management plan for CKD

A

1 - lifestyle changes
2 - medication for underlying problems e.g. hypertension or high cholesterol
3 - dialysis (advanced ckd)
4 - kidney transplant (advanced ckd)

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18
Q

whats the MOA of quinolones

A

inhibit replication of bacterial DNA by blocking the ligase part of bacterial DNA

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19
Q

name some quinolones

A

ciprofloxacin, moxifloxacin

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20
Q

side effects of quinolones

A

1 - N&V
2 - dizziness
3 - ear pain

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21
Q

MOA of trimethoprim

A

antifolate antibacterial agent that inhibits an enzyme important in synthesis of bacterial DNA

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22
Q

side effects of trimethoprim

A

1 - itching and rash
2 - diarrhoea
3 - headaches

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23
Q

MOA of nitrofurantoin

A

antibiotic that is converted into an intermediate that inhibits citric acid cycle as well as DNA, RNA and protein synthesis

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24
Q

side effects of nitrofurantoin

A

1 -respiratory fibrosis
2 - headaches
3 - dizziness

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25
Q

name some drugs that are commonly used to treat simple UTIs

A

trimethoprim, nitrofurantoin

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26
Q

what 2 drugs are combined to make co-amoxiclav?

A

amoxicillin and clavulanic acid

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27
Q

MOA of co-amoxiclav

A

clavulanic acid is a beta lactamase inhibitor so prevents amoxicillin (a beta lactam) from being hydrolysed

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28
Q

what classes of drugs are the beta lactam subgroups

A

cephalosporins, penecillins, monobactams and carbepenems

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29
Q

MOA of beta lactams

A

bactericidal antibiotics that act by inhibiting the synthesis of peptidoglycan layer of bacterial cell walls

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30
Q

side effects of co-amoxiclav

A

1 - thrombocytopenia
2 - diarrhoea
3 - itching

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31
Q

what antibiotics can pyelonephritis commonly be treated with?

A

ciprofloxacin, co-amoxiclav

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32
Q

MOA of gentamicin

A

an aminoglycoside that inhibits protein synthesis

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33
Q

side effects of gentamicin

A

1 - nephrotoxicity

2 - ototoxicity (ear)

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34
Q

what drugs are used to treat incontinence and bladder instability?

A

muscarinic receptor antagonists e.g. oxybutinin, tolterodine

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35
Q

how are most drugs eliminated from the body?

A

hepatic metabolism. Only water soluble drugs are mainly eliminated by the kidneys

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36
Q

MOA of oxybutinin

A

selective antagonist of M1 and M3 receptors, acting as a competitive inhibitor of Ach and promoting bladder relaxation

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37
Q

MOA of tolterodine

A

non-selective antagonist of muscarinic receptors, acting as a competetive inhibitor of Ach, which promotes bladder relaxation

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38
Q

side effects of oxybutinin

A

can cross the blood-brain barrier producing; sedation, insomnia and confusion. Blockage of M3 leads to dry mouth

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39
Q

side effects of tolterodine

A

dry mouth, abdominal pain, constipation

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40
Q

name some alpha-1 adrenoceptor antagonists

A

doxazosin, tamsulosin

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41
Q

MOA of alpha-1 adrenoceptor antagonists

A

inhibit contraction of hypertrophied smooth muscle in prostatic tissue and the internal urethral sphincter without affecting detrusor. this improve urinary flow rate and other symptoms

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42
Q

name some 5-alpha reductase inhibitors

A

dutasteride, finasteride

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43
Q

MOA of 5-alpha reductase inhibitors

A

inhibition of 5-alpha reductase reduces enzymatic conversion of testosterone into dihydrotestosterone in prostatic cells. This helps reduce prostatic volume as DHT is involved in prostatic growth

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44
Q

side effects of alpha-1 adrenoceptor antagonists and 5-alpha reductase inhibitors

A

postural hypotension, dizziness, syncope

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45
Q

what drugs can be used to treat BPH or lower urinary tract symptoms?

A

5-alpha reductase inhibitors, alpha-1 adrenoceptor antagonists

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46
Q

cisplatin moa

A

binds to nuclear DNA and interferes with transcription and replication, killing the fastest proliferating cells

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47
Q

side effects of cisplatin

A

nephrotoxicity, neurotoxicity, N&V

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48
Q

moa of sunitinib

A

blocks multiple tyrosine kinase receptors which are involved in growth of cancer cells

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49
Q

moa of bevacuzimab

A

monoclonal antibody that binds to and neutralises activity of a growth factor. this reduces vascularisation of tumours and inhibits their growth

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50
Q

side effects of bevacuzimab

A

black tarry stools, bleeding gums, aches and pains

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51
Q

side effects of sunitinib

A

neutropenia, vomiting, aching

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52
Q

moa of goserelin

A

inhibits pituitary gonadotropin release, resulting in suppression of LH and testosterone

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53
Q

side effects of goserelin

A

hot flushes, decreased libido, gynaecomastia

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54
Q

moa of cyproterone acetate

A

anti androgen that blocks the binding of dihydrotestosterone to prostatic cancer cells

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55
Q

side effects of cyproterone acetate

A

decreased libido, hot flushes, headaches

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56
Q

name some PDE5 inhibitors

A

sildenafil, tadanafil

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57
Q

MOA of PDE5 inhibitors

A

selectively inhibit PDE5 so inhibit degradation of cGMP, which helps relax penile muscle and allow blood to flow in

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58
Q

name a prostaglandin E1 analogue

A

alprostadil

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59
Q

MOA of alprostadil

A

acts on smooth muscle cell receptors to increase intracellular cAMP, which reduces intracellular calcium and causes vasodilation

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60
Q

side effects of PDE5 inhibitors

A

headaches, dizziness, alopecia

61
Q

side effects of alprostadil

A

dizziness, painful erection, bleeding

62
Q

what can be used to treat iron deficiency anaemia

A

ferrous sulfate, iron sucrose

63
Q

what can be used to treat megaloblastic anaemia

A

folic acid, hydroxocolabamin (vit B12 preparation)

64
Q

side effects of iron preparations

A

N&V, black stools, rash

65
Q

side effects of folic acid

A

anorexia, abdominal distention (side effects rare)

66
Q

side effects of EPOs

A

N&V, headaches, hypertension

67
Q

side effects of hydroxocolabmin

A

N&V, diarrhoea, headaches

68
Q

what can be used to treat renal anaemia

A

epoetins e.g. darbepoetin

69
Q

name a human quick acting insulin

70
Q

name an analogue quick acting insulin

A

humalog, novorapid

71
Q

name a human biphasic insulin

A

humulin M3

72
Q

name a human isophane insulin

73
Q

name an anaolgue biphasic insulin

A

humalog mix, novomix

74
Q

name an analogue long acting insulin

A

insulin gargine, insulin degludec

75
Q

name a biguanide

76
Q

whats the MOA of metformin

A

not fully understood.
increases insulin sensitivity
decreases glycogenolysis
increases glucose uptake

77
Q

side effects of metformin

A

N&V, diarrhoea, lactic acidosis

78
Q

name some sulfonylureas

A

gliclazide, tolbutamine, glibenclamide

79
Q

MOA of sulfonylureas

A

inhibit K+ transporter so that there’s not an efflux of K+. This depolarises the beta cells and allow the vesicles to release insulin

80
Q

side effects of sulfonylureas

A

weight gain, hypoglycaemia, N&V

81
Q

name a thiazolidinedione

A

pioglitazone

82
Q

MOA of thiazolidinediones

A

activation of peroxisome proliferator activated receptor gamma (PPAR gamma). This decreases peripheral insulin resistance, prevents the release of free fatty acids from adipose tissue

83
Q

side effects of thiazolidinediones

A

weight gain, fractures, bladder cancer

84
Q

thazolidinediones are contraindicated for what diseases

A

congestive heart failure, liver failure, DKA

85
Q

name an alpha glucosidase inhibitor

86
Q

MOA of acarbose

A

Inhibits the enzyme glucosidase, present on the apical surface of enterocytes and so prevents glucose absorption, leading to decreased blood glucose

87
Q

side effects of acarbose

A

flatulence, cramps, diarrhoea

88
Q

for what disease is acarbose contraindicated

89
Q

name some GLP-1 mimetics

A

liraglutide, semaglutide

90
Q

MOA of GLP-1 mimetics

A

bind to GLP-1 receptors on the pancreas which both stimulates insulin secretion and suppresses glucagon secretion. Also slows gastric emptying (reduces rate at which glucose is absorbed into blood)

91
Q

side effects of GLP-1 mimetics

A

pancreatitis, D&V, dyspepsia

92
Q

name some SGLT-2 inhibitors

A

canaglifozin, empaglifozin, dopaglifozin

93
Q

MOA of SGLT-2 inhibitors

A

Inhibits SGLT-2 in the renal pct, which prevents reabsorption of glucose and instead excretes it in urine

94
Q

side effects of SGLT-2 inhibitors

A

UTIs, hypoglycaemia, perineal gangrene

95
Q

name some dipeptidyl peptide 4 (DPP4) inhibitors

96
Q

MOA of DPP 4 inhibitors

A

inhibits DPP 4 which usually rapidly degrades insulin. This results in higher incretin levels after food. Incretins stimulate insulin release and suppress glucagon release

97
Q

side effects of DPP 4 inhibitors

A

N&V, pancreatitis, hypoglycaemia (when in combo)

98
Q

name a meglitinide

A

repaglinide

99
Q

MOA of meglitinides

A

inhibit K+ channels in beta cells (same mechanism as sulfonylureas but have weaker binding and dissociate quicker)

100
Q

side effects of meglitinides

A

weight gain, hypoglycaemia

101
Q

What drugs are used in management of DKA

A

IV fluids, IV insulin, potassium replacement. The doses are dependent on the bodyweight of the patient, how much fluid they have lost and how far into DKA they are.

102
Q

whats the management of hyperosmolar hyperglycaemic state

A

IV fluids, IV insulin, catheter, anticoagulation (e.g. LMWH)

103
Q

what can be used to treat hypoglycaemia

A

oral/IV glucose, glucagon

104
Q

what concentrations of glucose are used to treat hypoglycaemia

A

10,20 or 50% concentrations

105
Q

side effects of oral/IV glucose

A

hyperglycaemia, irritates veins causing phlebitis or thrombosis

106
Q

sick day treatment for diabetics

A

dose of insulin should be increased (with blood glucose monitoring) to counteract the hyperglycaemic action of hormones released during stress reactions

107
Q

diabetic treatment prior to surgery

A

during and immediately after surgery, 10% IV glucose should be given until the person is able to eat and drink again where they can restart normal treatment

108
Q

what class of drugs can be used to treat hyperthyroidism

A

thionamides (carbimazole, propylthiouracil), beta blockers, radioiodine, oral iodine

109
Q

name some thionamides

A

carbimazole, propylthiouracil

110
Q

MOA of thionamides

A

inhibit thyroid peroxidase, reducing production of iodine which is needed for T3 and T4. may take 3-4 weeks to notice effect as T4 has a long half life so can stay in the body longer

111
Q

side effects of thionamides

A

GI upset, allergic reactions, bone marrow suppression (agranulocytosis)

112
Q

MOA of radioactive iodine

A

Once absorbed from the gut it can be taken up by thyroid follicles in the thyroid gland. It emits beta particles which destroy follicular cells

113
Q

side effects of radioactive iodine

A

short term - dry mouth, swollen neck

long term - infertility, inflammation of salivary glands

114
Q

treatment of hypothyroidisim

A

levothyroxine, surgery

115
Q

MOA of levothyroxine

A

levothyroxine is synthetic T4 and so has the same actions

116
Q

side effects of levothyroxine

A

D&V, headaches, palpitations

117
Q

name some glucocorticoids

A

hydrocortisone, prednisolone, dexamethasone

118
Q

what can be used to treat hypopituitarism and adrenal insufficiency

A

glucocorticoids

119
Q

MOA of glucocorticoids

A

bind to cytosolic glucorticoid receptors which then translocate to the nucleus when they can regulate gene expression

120
Q

name an important mineralocorticoid

A

fludrocortisone

121
Q

what can be used to treat growth hormone deficiency in children

A

somatropin - synthetic growth hormone

122
Q

side effects of somatropin

A

carpal tunnel, fluid retention, parasthesia

123
Q

what class of drug is used to treat galactorrhoea and hyperprolactinaemia

A

dopamine D2 agonists

124
Q

whats the MOA of dopamine D2 agonists

A

potent and long acting agonist of D2 receptors, also has inhibitory effect on pituitary cells

125
Q

side effects of dopamine D2 agonists

A

N&V, sleep disturbances, postural hypotension

126
Q

name dopamine D2 agonist

A

carbergoline, bromocriptine

127
Q

what can male hypogonadism be treated with

A

testogel, sustanon

128
Q

MOA of testogel or sustanon

A

these contain testosterone esters which have the same effect on the body as testosterone

129
Q

side effects of testosterone esters

A

irritability, weight gain, body and facial hair

130
Q

name some bisphosphonates

A

alendronic acid, zolendronic acid, risendronate

131
Q

MOA of bisphosphonates

A

pyrophosphate analogues that bind to crystals in the bone matrix. They are deposited under osteoclasts and stop their resorptive action on bone

132
Q

side effects of bisphosphonates

A

N&V, headaches, osteonecrosis of jaw

133
Q

what can bisphosphonates be used to treat

A

hypercalcaemia, menopause, osteoporosis prevention

134
Q

what can vitamin D compounds be used to treat

A

hypocalcaemia (if irreversible pathology), vitamin D deficiency, hypoparahtyroidism, renal bone disease

135
Q

name some vitamin D compounds

A

alfacalcidol. calcitriol, ergocaliferol, colecalciferol

136
Q

MOA of vitamin D compounds

A

Act as synthetic vitamin D. They increase absorption of Ca2+ and phosphate from the gut, and at high conc they stimulate bone resorption.

137
Q

side effects of vitamin D compounds

A

hypercalcaemia, if mother takes them whilst breastfeeding the infant could be hypercalcaemic

138
Q

treatment of acute severe hypocalcaemia

A

IV calcium gluconate, folowed by oral calcium supplements

139
Q

how can mild hypocalcaemia be treated

A

oral calcium supplements between meals

140
Q

how is chronic hypocalcaemia usually treated

A

vitamin D and oral calcium supplements

141
Q

name some vasopressin analogues

A

desmopressin, terlipressin

142
Q

MOA of vasopressin analogues

A

they bind to V2 receptors and stimulate expression of aquaporin-2 channels which allows water reabsorption. Desmopressin is longer acting, more potent and increases clotting factor VIII conc compared to terlipresssin

143
Q

side effects of vasopressin analogues

A

hyponatraemia, fluid retention, headaches

144
Q

what can desmopressin be used to treat

A

mild/moderate bleeding in haemophilia A, diabetes insipidus

145
Q

what can terlipressin be used to treat

A

oesophageal varices

146
Q

name a vasopressin V2 receptor antagonist

147
Q

MOA of tolvaptan (vasopressin 2 receptor antagonist)

A

competitive inhibitor of the V2 receptor on renal collecting ducts, so prevents reabsorption of water

148
Q

uses of tolvaptan

A

treat hyponatraemia caused by syndrome of inappropriate ADH secretion (SIADH), treat diuretic induced hyponatraemia

149
Q

side effects of tolvaptan

A

hypernatraemia, thirst, hyperglycaemia, acute liver failure

year 3 drug list (4 decks)

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