💊Pharmacology💊 - CKD Flashcards
What can CKD do to BP?
Cause hypertension
What effect does hypertension have on CKD?
Speeds up progression
What effect does having CKD have on the therapeutic objective of someone with hypertension?
Target BP becomes lower than what would otherwise be targeted
As a general rule, what is the approach to blood pressure in a patient with CKD?
TIGHT BP control
(slows CKD progression - regardless of underlying cause)
What can be given to a patient with Stage 2 hypertension who has CKD?
Amlodipine (L-type calcium channel blocker)
Atorvastatin as CVD risk >10%
Statins reduce cholesterol
What is the significance of proteinuria?
Marker of glomerular dysfunction
Damaging in its own right
What drugs/interventions improve proteinuria?
ACEi
ARBs
SGLT-2 inhibitors (e.g. dapagliflozin)
Salt restriction
What is key to note about using ACEi with amlodipine?
Amlodipine should be stopped if the addition of ACEi reduces blood pressure too much
When should aspirin be prescribed to someone with CKD and deemed at risk of CVD events?
Primary Prevention (no previous CVD events) → Generally avoid aspirin due to uncertain benefit and potential harm
Secondary Prevention (history of stroke, MI, or significant atherosclerosis) → Aspirin is justified as the benefits likely outweigh risks
What is the effect of trimethoprim on GFR calculations?
Trimethoprim inhibits the active secretion of creatinine
Trimethoprim breaks the link between creatinine and GFR
Explain the relationship between creatinine and GFR
What effect does ACEi have on GFR?
Reduces perfusion pressure in glomerulus - lower GFR
What effects does ibuprofen have?
Inhibits PG synthesis - reduces renal blood flow
Why does sepsis lower urine output?
Reduces perfusion pressure in glomerulus
What should be done to manage pain in a patient who also has CKD, and they are taking ibuprofen?
STOP ibuprofen
Start alternatives (e.g. paracetamol)
What should be done about ACEi with a patient with sepsis?
Pause while patient is acutely unwell
What is the risk of using gentamicin on someone with sepsis AND CKD?
It is highly nephrotoxic
Accumulates in renal proximal tubule cells, causing acute tubular necrosis (ATN)
Can continue but reduce frequency and be guided by blood gentamicin levels (Or choose alternative!)
What 2 things should be considered when prescribing a drug to a patient with reduced kidney function?
Might the drug damage the kidney and hence worsen the kidney injury
(e.g. ibuprofen)
Is the drug eliminated by the kidney, and hence will it accumulate in the blood if kidney function is impaired, and hence lead to side effects?
(e.g. morphine, metformin)
What is the primary mechanism of action of -statins?
HMG-CoA reductase inhibitor, reducing hepatic cholesterol synthesis
Increases hepatic uptake of LDL-cholesterol from the circulation
What is the primary mechanism of action of aspirin?
Irreversible inactivation of COX enzymes
Prevents oxidation of arachidonic acid to produce prostaglandins
Reduction of thromboxane A2 in platelets reduces aggregation
Reduction of PGE2 at sensory pain neurones reduces pain
What is the primary mechanism of action of trimethoprim?
Direct competitor of the enzyme dihydrofolate reductase. Inhibits the reduction of dihydrofolic cid to tetrahydrofolic acid (active form) – a necessary component for synthesising purines required for DNA and protein production
Used for proteinuria
What is the primary mechanism of action of gentamicin?
Binds to bacterial 30s ribosomal subunit
Formation of dysfunctional proteins
What is the drug target of -statins?
HMG-CoA reductase
What is the drug target of aspirin ?
Cyclo-oxygenase
What is the drug target of trimethoprim?
Dihydrofolate reductase
What is the drug target of gentamicin?
30s ribosomal subunit
What are the main side effects of -statins?
GI symptoms
Muscle toxicity (risk increases with higher doses)
What are the main side effects of aspirin?
Dyspepsia
Haemorrhage
In elderly no greater than 160mg daily
Gastritis (co-administer PPI in someone with pmx)
What are the main side effects of gentamicin?
Ototoxicity and nephrotoxicity
What are the main side effects of trimethoprim?
Diarrhoea
Skin reactions
