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RenalJaz > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

7 factors that influence prescribing decisions

A 
indication/diagnosis
recommended drug
contraindications/special circumstances
product licence
patient expectations
cost effectiveness
follow up
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2
Q

___ is an absolute contraindication to ACEIs

A

bilateral renal artery stenosis

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3
Q

warfarin is/isnt contraind in preg

A

is

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4
Q

COCP is contraindicated if there is a FH of __

A

thrombophilia

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5
Q

___ should not be given with warfarin as increases risk of GI bleed

A

naproxen

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6
Q

avoid trimethoprim in ___ of preg

A

1st trimester

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7
Q

can / cant give ciprofloxacin in preg

A

cant

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8
Q

can give nitrofuratoin for ___ in 1 st trimester

but avoid at term because causes ___

A

cystitis

haemolysis

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9
Q

___ is the ACEI of choice in hepatic impairment as the others are ___

A

lisinopril

prodrugs

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10
Q

anxiolytics and sedatives eg diazepam may cause ___ in hepatically impaired

A

coma

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11
Q

t1/2 of amlodipine __ in patients with hepatic impairment so what do you do to their dosage?

A

increases

decrease dose

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12
Q

___ isnt licensed for but is 1st line in treatment of migrain

A

amitryptyline

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13
Q

2 drugs secreted into prox tubule by OAT

A

thiazides and loop diuretics

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14
Q

2 drugs secreted into prox tubule by OCT

A

triamterene and amiloride

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15
Q

___ is secreted into proximal tubule by OAT and so if use __/___ diuretics which also use OAT then its secretion is decreased

A

uric acid

thiazides/loops

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16
Q

act at proximal tubule to inhibit HCO3- reabsorption = ___ eg.

A

carbonic anhydrase inhibitors

acetazolamide

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17
Q

loop diuretics act on ____ in the ___

A

Na/K/2Cl cotransporter

thick ascending loop of Henle

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18
Q

thiazides act on __ in the __

A

Na/Cl transporter

distal convoluted tubule

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19
Q

loop diuretics cause reabsorption of +++ to be decreased

A

Na, K, Ca, Mg

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20
Q

loop diuretics have an indirect ___ action acutely which is beneficial in ___

A

venodilator

pulmonary oedema

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21
Q

loop diuretics are/arent effective in severe renal failure

A

are

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22
Q

indications for loop diuretics

A 
acute pulmonary oedema
CKD
ascites
CCF
nephrotic syndrome
hyperCa2+/renal stones
increase urine volume in AKI
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23
Q

adverse affects of loops and thiazides usually occur within ___ if they are going to happen

A

2 wks

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24
Q

complications of loop diuretics

A 
hypoK
metabolic alkalosis (H+ loss)
hypovolaemia and lbp
hypoCa2+ and Mg+
hyperglycaemia
hyperuricaemia
hearing loss - dose dependent
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25
Q

thiazides: increased __ load to collecting tubule => __ loss => ___ reabs increased in distal tubule

A

Na
K
Ca2+

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26
Q

thiazides have an indirect ___ action and so are useful in __

A

venodilator

hbp

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27
Q

indications for thiazides

A 
mild HF
hbp
severe resistant oedema (w a loop)
nephrolithiasis
nephrogenic DI
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28
Q

thiazides don’t work if ___

A

eGFR <30ml/min

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29
Q

thiazide that can be used if GFR <30ml/min

is used in combo with a loop for diuresis

A

metolazone

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30
Q

adverse affects of thiazides

A 
postural hypotension
metabolic alkalosis
hypoK,Na and Mg
hyperCa2+
hyperglycaemia and lipidaemia
gout
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31
Q

loops or thiazides cause a greater K+ loss

A

thiazides

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32
Q

thiazides and loops, because they cause Na+ loss can cause activation of __ leading to further __ loss

A

RAAS

K+ loss

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33
Q

amiloride and triamterene block ___

A

apical Na+ channel => Na reabs

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34
Q

spironolactone and eplerenone compete with __ for intracellular receptors => decreased gene expression and synth of protein that activates ___
also decreases no of ___

A

aldosterone
Na+ apical channels
NaKATPase on basolateral membrane

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35
Q

amiloride and triamterene enter nephron via ___ in prox tubule
more potent one =
better gut absorption =

A

OCT
amil
triam

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36
Q

spironolactone is rapidly metabolised in ___ to __ = 50-66.6% of the drugs action

A

liver

canrenone

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37
Q

uses of K+ sparing diuretics

A

mod-severe CCF
2ndry hyperaldosteronism
Conns
resistant essential hbp

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38
Q

carbonic anhydrase is present in +++++

A 
prox tubule
gastric mucosa
pancreas
eye
brain
RBC
39
Q

adverse effects of acetazolamide

A

alkaline diuresis, hypoK

metabolic acidosis

40
Q

extrarenal uses of carbonic anhydrase inhibitors

A

glaucoma
acute mountain sickness
alkalinise urine (UTI/dysuria)
some infant epilepsies

41
Q

osmotic diuretic =

A

mannitol

42
Q

major site of action for osmotic diuretics eg mannitol =

A

prox tubule - where iso-osmotic reabs of H2O occurs

43
Q

mannitol is given as a __

A

10-20% IV solution - there is no gut absorption

44
Q

use of osmotic diuretics eg mannitol =

A

acute raised ICP and IOP and to prevent impending acute renal failure - maintains GFR and urine flow

45
Q

adverse affect that is common with mannitol (osmotic diuretics)

A

hyponatraemic headache

46
Q

ADH receptors:
V1a+b =
V2 =

A

vasoconstriction

more sensitive, vasodilatory, AQP2 insertion in collecting duct

47
Q

vasopressin analogues =

A 
terlipressin 
desmopressin (more potent and longer action)
48
Q

neurogenic DI Rx =

A

desmopressin

49
Q

causes of nephrogenic DI

Rx =

A

recessive X-linked mutations in V2 ADH receptor gene / lithium / demeclocycline
thiazide (paradoxical effect)

50
Q

Rx for bedwetting / enuresis in >10yo kids

A

PO/ intranasal desmopressin

51
Q

aquaretics/vaptans effects =

A

increase serum Na
decrease urine osmolarity
electrolyte free aquaresis

52
Q

aquaretics/vaptans indications for use =

A

excess AD:H to correct hypoNa - SIADH, CCF and cirrhosis

53
Q

nonselective (V2 and 1a ADH receptor antagonist) aquaretics/vaptans =

A

conivaptan IV only

54
Q

oral and V2 receptor selective vaptans

A

tolvaptan, lixivaptan, satavaptan

55
Q

____ protects the myocardium from hyperkalaemia

A

calcium gluconate

56
Q 
most important prostaglandins in the kidney
function =
A

PGE2 + I2
vasodilatory of afferent arteriole - increase RBF and GFR
diuretic effect - h20 K+ and Na+ excretion

57
Q

in volume depleted state need ___ to maintain GFR and RBF so can precipitate AKI if then give ___

A

PGs - I2+E2

NSAIDS

58
Q

uricosuric agents egs

A

probenecid
sulfinpyrazone
benzbromarone ( can be used in mild renal failure)

59
Q

block the active transport of organic acids => reduced net absorption of urate =

A

uricosuric agents

60
Q

uricosuric agents arent suitable in __/Hx of

A

renal impairment

stones

61
Q

___ antagonise uricosuric agents in the prox tubule

A

aspirin/salicylates

62
Q

SGLT that reabsorbs 90% of glucose and where is it

A

2

S1 of proximal tubule

63
Q

minimum amount of haemodialysis per week

A

4hrs 3x/wk

64
Q

restrictions on ptnts on dialysis

A

low salt and potassium diet
phosphate binders
1l fluid restrict

65
Q

gold standard for vascular access in haemodialysis

A

AV fistula

66
Q

how long does it take for a AV fistula to mature for haemodialysis

A

6wks

67
Q

vascular access method for haemodialysis that can be used immediately

A

tunneled venous catheter

68
Q

treat infection of a tunneled venous catheter for haemodialysis with

A

vancomycin

remove/exchange

69
Q

process for continuous peritoneal dialysis

A

4 days/day = 30 min per bag = 2hrs total

70
Q

process for automated peritoneal dialysis

A

1 bag fluid overnight for 9-10hrs

71
Q

why don’t you correct urea levels too quickly when starting dialysis?

A

urea has built up in brain

remove fast => seizures+cerebral oedema = disequilibrium syndrome

72
Q

mechanism for hyperacute transplant rejection

A

+ve cross match = preformed Igs to transplant tissue

73
Q

mechanism for acute transplant rejection

A

T/B cell mediated

Rx = increase IS

74
Q

mechanism for chronic transplant rejection

A

immunological and vascular deterioration

75
Q

IS used for induction in transplant ptnts

A

steroids, MMF, CyA, tacrolimus, antibodies

76
Q

calcineurin inhibitor egs

A

tacrolimus

cyclosporin

77
Q

immunoogical effect of calcineurin inhibitors

A

inhibit Th activation

78
Q

SE of calcineurin inhibitors

A

renal dysfunction
hbp
diabetes
tremors

79
Q

azathioprine should not be given with which drug

A

allopurinol

80
Q

azathioprine and mycophenolate are ___ that block ___

A

antimetabolites

purine synthesis

81
Q

steroids affect which immunological cells

A

decrease T cell activity and B cell proliferation

82
Q

absolute contraindications to transplanting kidney

A 
malignancy - current or solid tumour in last 2-5yrs
untreated tb
severe IHD not amenable to Sx
severe airway disease
active vasculitis
severe PVD
83
Q

transplant can have delayed function due to __
lasts __ so put on ___ in meantime
use ___ to detect rejection

A

ATN
10-30days
dialysis
biopsy

84
Q

if dehydrated and don’t stop ___ can cause AKI

A

ACEI

85
Q

how to decide if need Rx for hyperkalaemia

A

ECG

86
Q

1st ECG sign of hyperkalaemia

A

tall peaked T waves

87
Q

drugs that can cause pre renal AKI

A

diuretics

ACEI/ARB

88
Q

drugs that can cause renal AKI

A

gentamicin
sulfonamides
aspirin

89
Q

drugs that can cause post-renal AKI

A

methylsergide

chemo

90
Q

10 drugs with narrow therapeutic index

A 
theophylline
warfarin
lithium
gentamicin
digoxin
vancomycin
phenytoin
cyclosporin
carbamazepine
levothyroxine
91
Q

B adverse drug reactions are

A

bizarre - dose independent and unpredictable

92
Q

drug-drug interactions of statins

A

fibrates

macrolides

93
Q

herbal remedies that affect anticoagulation medication

A

gingko biloba
saw palmetto
glucosamine

RenalJaz (10 decks)

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