Pharmacology Flashcards
Why did FDA issue a black box warning against the use of SPS for treating hyperkalemia?
It can cause serious GI side effects such as colonic necrosis, colonic perforation.
The incidence of colonic perforation with SPS use has been estimated at 0.14%–1.8%, and a large retrospective cohort study showed a 1.9-fold higher risk of hospitalization for GI complications with SPS use compared with non-use.
SPS is contraindicated in patients with ____? (3)
Obstructive bowel disease, hypersensitivity to SPS, hypokalemia
SPS should be used in caution with ___? (3)
Gut dysmotility, constipation or those who cannot handle a large sodium load
What are causes of diuretic resistance? (7)
- nonadherence to salt and water restriction
- intestinal edema
- reduced tubular uptake in advanced CKD
- nephron adaptation by upregulation of sodium transporters
- RAAS activation
- NSAIDs
- low intravascular volume
what is the management for a patient who developed a standard infusion to rituximab?
Decrease the rate of rituximab at 50% of the initial rate
3 Drugs a/w retroperitoneal fibrosis (bonus: 7)
- Bromocriptine
- Beta blockers
- Hydralazine*
- Ergot alkaloids
- Methyldopa*
- Etanercept
- Infliximab
what is the antidote for anticholinergic overdose?
physostigmine
What is the antidote for warfarin toxicity?
Vitamin K or phytonadione
What is the antidote for unfractionated heparin?
Protamine sulfate
Antidote to DOAC toxicity
Andexanet alfa
Name 5 drugs that require dialysis when toxic levels are detected. (bonus: 12)
- methanol 2. lithium 3. salicylate 4. ethylene glycol
- isopropanol 6. theophylline 7. procainamide 8. phenobarbital 9. methaqualone 10. valproate 11. methotrexate 12. metformin
what is the treatment for BZD overdose?
Flumazenil (a BZD antagonist)
what is the treatment for acetaminophen overdose?
N-Acetylcysteine
What is the treatment for carbon monoxide poisoning?
hyperbaric oxygen
What is the treatment for digoxin toxicity?
specific Fab fragment (digibind or digoxin immune Fab)
what is used to reverse opiate overdose?
naloxone
What are the nephrotoxic effects of tenofovir? (3)
AKI, fanconi’s and nephrogenic DI
Nonoliguric AKI from aminoglycosides usually occur after how many days from exposure?
after 7-10 days
what is the pathophysiology of Bartter like syndrome related to aminoglycoside use?
Activation of the CaSR
A/w lower aminoglycoside use
What is the pathophysiology of Fanconi syndrome related to aminoglycoside use?
reduced expression of NHE expression
A/w higher aminoglycoside use
Ciprofloxacin is associated with AKI from various causes (4):
- AIN
- Necrotizing vasculitis
- ATN
- Crystalluria (starburst needle crystals)
Name 3 drugs that can cause pRTA or Fanconi syndrome?
Tenofovir, ifosfamide, cisplatin
What is the formula for modified maintenance dose in renal failure?
[patient GFR/120] x std maintenance dose
What is the formula for modified drug frequency for reduced kidney function?
[120/patient eGFR] x frequency (hrs)
Why do tacrolimus levels increase with diarrhea?
Tacrolimus is a P-glycoprotein substrate; P-glycoproteins help in drug secretion in the gut; P-glycoprotein activity is reduced during diarrhea, which explains why Tac levels increase during diarrhea
Is lipid amphotericin B used to treat fungal UTI?
No.
How does TMP cause hyperkalemia and metabolic acidosis?
TMP blocks ENaC.
How does cimetifine, dolutegravir and TMP increase serum creatinine?
It inhibits the tubular secretion of creatinine via OCT2
Are ARBS generally dialyzable or non-dialyzable?
Non-Dialyzable
Name 2 ACEi that are dialyzable?
Lisinopril, captopril
In general, are CCBs dialyzable or non-dialyzable?
Non-dialyzable
Name 4 BB that are non-dialyzable?
Carvedilol, labetalol, propanolol, timolol
Name 4 BB that are dialyzable
Metoprolol, atenolol, sotalol, nadolol (MASoN)
What is the mechanism of nephrotoxicity of ACEI/ARBS?
efferent vasodilation
What is the mechanism of nephrotoxicity of NSAIDs?
Afferent vasoconstriction, direct tubular toxicity, TIN,
What is the mechanism of nephrotoxicity of amphotericin?
Afferent vasoconstriction, direct tubular toxicity
What is the mechanism of nephrotoxicity of CNIs?
Afferent vasoconstriction
Drugs that can crystallize and cause obstructive uropathy
- Methotrexate
- Acyclovir
- Sulfadiazine
- Indinavir, nelfinavir
- Acetazolamide
- Topiramate
- Triamterene
- Zonisamide
- Methoxyflurane
- Ciproflaxin
- Sodium phosphate bowel prep
3 drugs that cause drug-induced ANCA vasculitis
- Hydralazine
- PTU
- cocaine
Others: methimazole, allopurinol, TNF-alpha inhibitors (e.g. infliximab, etanercept, adalimumab)
Rhabdomyolysis seen with TAC and statin therapy is seen only with concomitant ____ use?
Diltiazem
CsA + ____ = high risk for rhabdomyolysis
gemfibrozil
Most common electrolyte disorder associated with cisplatin?
Hypomagnesemia
What are the top 4 side effects of cyclophosphamide?
hyponatremia, hemorrhagic cystitis, premature ovarian failure, bladder cancer
what is the max lifetime cumulative dose of cyclophosphamide to minimize malignancy risk?
< 36g
What is the max lifetime cumulative dose of cyclophosphamide for those who wish to conceive?
< 10g
What is given with cyclophosphamide to detoxify acrolein and reduce the risk of hemorrhagic cystitis?
MESNA
What are the 4 renal side effects of ifosfamide?
pRTA, fanconi syndrome, nephrogenic DI, ATN
What is the max cumulative lifetime dose of ifosfamide?
< 90g
High dose of ____ has shown to reduce the nephrotoxicity of Methotrexate
folinic acid
Cetuximab and panitumumab is associated with what electrolyte disorder?
Hypomagnesemia
Cranberry can cause ____?
Nephrolithiasis, oxaluria
Bladder wrack (brown algae) from Japan can cause?
chronic interstitial nephritis
Cat claw can cause
Acute interstitial nephritis
Chaparral tea, from a native american shrub, can cause
Renal cysts and renal cell carcinoma
Djenkol can cause
Nephrolithiasis
Aristolochic acid/chinese herbal tea can cause
Chronic interstitial nephritis, renal cell carcinoma, fanconi syndrome
Black licorice can cause
hypertension; hypokalemia;
Yohimbe can cause
Lupus nephritis
Star fruit, rhubarb leaves can cause
Nephrolithiasis, interstitial nephritis
Ma huang (ephedra) can cause
HTN, nephrolithiasis
Willowbark can cause
renal papillary necrosis
Wormwood oil can cause
Rhabdomyolysis
Chronic lead exposure can cause a triad of?
CKD, gout, hypertension
Accumulation of allopurinol can cause
tubulointerstitial nephritis
Accumulation of meperidine can cause
Seizures
Accumulation of morphine can lead to
Seizure
Accumulation of nitroprusside can lead to
Cyanide toxicity
Accumulation of tramadol can lead to
Seizures, altered mentation
Venlafaxine accumulation can lead to
Prolonged QT, orthostatic hypotension, accelerated HTN, altered mentation
Given to reverse alcohol poisoning
Fomepizole
It inhibits alcohol dehydrogenase
HD is indicated at what level of alcohol?
alcohol > 50 mg/dL in the setting of severe metabolic acidosis or end-organ damage
Note: use large surface area dialyzer (> 1.5m2) and high Qb > 300 ml/min
In methanol poisoning, what is given to convert formic acid to CO2 and water?
Folinic acid
HD is indicated in isopropyl alcohol poisoning at what level of alcohol and what level of osmolal gap?
Alcohol > 500 mg/dL and osmolal gap of > 100
HD is indicated at what lithium level?
Lithium is > 3.5 mmol/L OR
Lithium > 2.5 but with CNS issues, hemodynamically unstable, or AKI
What is the acid-base disorder of salicylate overdose?
Combined HAGMA + respiratory alkalosis
Should we alkalinize or acidify the urine in salicylate (aspirin) poisoning?
Alkanize the urine (pH > 7.5) to ionize salicylate and promote excretion
What are the indications of HD in salicylate poisoning?
- Levels > 90 mg/dL
- Arterial pH < 7.2
- Noncardiogenic pulmonary edema
- Neuro (seizures, altered mentation, hyperthermia)
Digoxin is not dialyzable but HD is indicated of this is present
Hyperkalemia
