Pharmacology Flashcards
7 factors that influence prescribing decisions
indication/diagnosis recommended drug contraindications/special circumstances product licence patient expectations cost effectiveness follow up
___ is an absolute contraindication to ACEIs
bilateral renal artery stenosis
warfarin is/isnt contraind in preg
is
COCP is contraindicated if there is a FH of __
thrombophilia
___ should not be given with warfarin as increases risk of GI bleed
naproxen
avoid trimethoprim in ___ of preg
1st trimester
can / cant give ciprofloxacin in preg
cant
can give nitrofuratoin for ___ in 1 st trimester
but avoid at term because causes ___
cystitis
haemolysis
___ is the ACEI of choice in hepatic impairment as the others are ___
lisinopril
prodrugs
anxiolytics and sedatives eg diazepam may cause ___ in hepatically impaired
coma
t1/2 of amlodipine __ in patients with hepatic impairment so what do you do to their dosage?
increases
decrease dose
___ isnt licensed for but is 1st line in treatment of migrain
amitryptyline
2 drugs secreted into prox tubule by OAT
thiazides and loop diuretics
2 drugs secreted into prox tubule by OCT
triamterene and amiloride
___ is secreted into proximal tubule by OAT and so if use __/___ diuretics which also use OAT then its secretion is decreased
uric acid
thiazides/loops
act at proximal tubule to inhibit HCO3- reabsorption = ___ eg.
carbonic anhydrase inhibitors
acetazolamide
loop diuretics act on ____ in the ___
Na/K/2Cl cotransporter
thick ascending loop of Henle
thiazides act on __ in the __
Na/Cl transporter
distal convoluted tubule
loop diuretics cause reabsorption of +++ to be decreased
Na, K, Ca, Mg
loop diuretics have an indirect ___ action acutely which is beneficial in ___
venodilator
pulmonary oedema
loop diuretics are/arent effective in severe renal failure
are
indications for loop diuretics
acute pulmonary oedema CKD ascites CCF nephrotic syndrome hyperCa2+/renal stones increase urine volume in AKI
adverse affects of loops and thiazides usually occur within ___ if they are going to happen
2 wks
complications of loop diuretics
hypoK metabolic alkalosis (H+ loss) hypovolaemia and lbp hypoCa2+ and Mg+ hyperglycaemia hyperuricaemia hearing loss - dose dependent
thiazides: increased __ load to collecting tubule => __ loss => ___ reabs increased in distal tubule
Na
K
Ca2+
thiazides have an indirect ___ action and so are useful in __
venodilator
hbp
indications for thiazides
mild HF hbp severe resistant oedema (w a loop) nephrolithiasis nephrogenic DI
thiazides don’t work if ___
eGFR <30ml/min
thiazide that can be used if GFR <30ml/min
is used in combo with a loop for diuresis
metolazone
adverse affects of thiazides
postural hypotension metabolic alkalosis hypoK,Na and Mg hyperCa2+ hyperglycaemia and lipidaemia gout
loops or thiazides cause a greater K+ loss
thiazides
thiazides and loops, because they cause Na+ loss can cause activation of __ leading to further __ loss
RAAS
K+ loss
amiloride and triamterene block ___
apical Na+ channel => Na reabs
spironolactone and eplerenone compete with __ for intracellular receptors => decreased gene expression and synth of protein that activates ___
also decreases no of ___
aldosterone
Na+ apical channels
NaKATPase on basolateral membrane
amiloride and triamterene enter nephron via ___ in prox tubule
more potent one =
better gut absorption =
OCT
amil
triam
spironolactone is rapidly metabolised in ___ to __ = 50-66.6% of the drugs action
liver
canrenone
uses of K+ sparing diuretics
mod-severe CCF
2ndry hyperaldosteronism
Conns
resistant essential hbp
carbonic anhydrase is present in +++++
prox tubule gastric mucosa pancreas eye brain RBC
adverse effects of acetazolamide
alkaline diuresis, hypoK
metabolic acidosis
extrarenal uses of carbonic anhydrase inhibitors
glaucoma
acute mountain sickness
alkalinise urine (UTI/dysuria)
some infant epilepsies
osmotic diuretic =
mannitol
major site of action for osmotic diuretics eg mannitol =
prox tubule - where iso-osmotic reabs of H2O occurs
mannitol is given as a __
10-20% IV solution - there is no gut absorption
use of osmotic diuretics eg mannitol =
acute raised ICP and IOP and to prevent impending acute renal failure - maintains GFR and urine flow
adverse affect that is common with mannitol (osmotic diuretics)
hyponatraemic headache
ADH receptors:
V1a+b =
V2 =
vasoconstriction
more sensitive, vasodilatory, AQP2 insertion in collecting duct
vasopressin analogues =
terlipressin desmopressin (more potent and longer action)
neurogenic DI Rx =
desmopressin
causes of nephrogenic DI
Rx =
recessive X-linked mutations in V2 ADH receptor gene / lithium / demeclocycline
thiazide (paradoxical effect)
Rx for bedwetting / enuresis in >10yo kids
PO/ intranasal desmopressin
aquaretics/vaptans effects =
increase serum Na
decrease urine osmolarity
electrolyte free aquaresis
aquaretics/vaptans indications for use =
excess AD:H to correct hypoNa - SIADH, CCF and cirrhosis
nonselective (V2 and 1a ADH receptor antagonist) aquaretics/vaptans =
conivaptan IV only
oral and V2 receptor selective vaptans
tolvaptan, lixivaptan, satavaptan
____ protects the myocardium from hyperkalaemia
calcium gluconate
most important prostaglandins in the kidney function =
PGE2 + I2
vasodilatory of afferent arteriole - increase RBF and GFR
diuretic effect - h20 K+ and Na+ excretion
in volume depleted state need ___ to maintain GFR and RBF so can precipitate AKI if then give ___
PGs - I2+E2
NSAIDS
uricosuric agents egs
probenecid
sulfinpyrazone
benzbromarone ( can be used in mild renal failure)
block the active transport of organic acids => reduced net absorption of urate =
uricosuric agents
uricosuric agents arent suitable in __/Hx of
renal impairment
stones
___ antagonise uricosuric agents in the prox tubule
aspirin/salicylates
SGLT that reabsorbs 90% of glucose and where is it
2
S1 of proximal tubule
minimum amount of haemodialysis per week
4hrs 3x/wk
restrictions on ptnts on dialysis
low salt and potassium diet
phosphate binders
1l fluid restrict
gold standard for vascular access in haemodialysis
AV fistula
how long does it take for a AV fistula to mature for haemodialysis
6wks
vascular access method for haemodialysis that can be used immediately
tunneled venous catheter
treat infection of a tunneled venous catheter for haemodialysis with
vancomycin
remove/exchange
process for continuous peritoneal dialysis
4 days/day = 30 min per bag = 2hrs total
process for automated peritoneal dialysis
1 bag fluid overnight for 9-10hrs
why don’t you correct urea levels too quickly when starting dialysis?
urea has built up in brain
remove fast => seizures+cerebral oedema = disequilibrium syndrome
mechanism for hyperacute transplant rejection
+ve cross match = preformed Igs to transplant tissue
mechanism for acute transplant rejection
T/B cell mediated
Rx = increase IS
mechanism for chronic transplant rejection
immunological and vascular deterioration
IS used for induction in transplant ptnts
steroids, MMF, CyA, tacrolimus, antibodies
calcineurin inhibitor egs
tacrolimus
cyclosporin
immunoogical effect of calcineurin inhibitors
inhibit Th activation
SE of calcineurin inhibitors
renal dysfunction
hbp
diabetes
tremors
azathioprine should not be given with which drug
allopurinol
azathioprine and mycophenolate are ___ that block ___
antimetabolites
purine synthesis
steroids affect which immunological cells
decrease T cell activity and B cell proliferation
absolute contraindications to transplanting kidney
malignancy - current or solid tumour in last 2-5yrs untreated tb severe IHD not amenable to Sx severe airway disease active vasculitis severe PVD
transplant can have delayed function due to __
lasts __ so put on ___ in meantime
use ___ to detect rejection
ATN
10-30days
dialysis
biopsy
if dehydrated and don’t stop ___ can cause AKI
ACEI
how to decide if need Rx for hyperkalaemia
ECG
1st ECG sign of hyperkalaemia
tall peaked T waves
drugs that can cause pre renal AKI
diuretics
ACEI/ARB
drugs that can cause renal AKI
gentamicin
sulfonamides
aspirin
drugs that can cause post-renal AKI
methylsergide
chemo
10 drugs with narrow therapeutic index
theophylline warfarin lithium gentamicin digoxin vancomycin phenytoin cyclosporin carbamazepine levothyroxine
B adverse drug reactions are
bizarre - dose independent and unpredictable
drug-drug interactions of statins
fibrates
macrolides
herbal remedies that affect anticoagulation medication
gingko biloba
saw palmetto
glucosamine
