pharmacology of chronic kidney disease

Question 1

what are some examples of statins

Answer 1

simvastatin

artovastatin

Question 2

what is the primary mechanism of action of statins

Answer 2

selective, competitive inhibitor of HMGCoa reductase which is enzymes responsible for converting hmgcoa to mevalonate in cholesterol synthesis pathway.
by reducing hepatic cholesterol synthesis, an upregulation of ldl receptors and increased hepatic uptake of ldl cholesterol from circulation occurs

Question 3

what is the drug target of statins

Answer 3

HMGcoa reductase

Question 4

what are the main side effects of statins

Answer 4

muscle toxicity can occur with all statins, however likelihood increases with higher doses and in certain patients at increased risk of muscle toxicity

constipation/ diarrhoea. and other gi symptoms

Question 5

extra info on statins

Answer 5

effective at reducing risk of adverse cardiac events in people
all patients should be regularly followed up to monitor for hyperkalaemia and acute renal failure

co administration with potent 3a4 inhibitors may result in increased statin serum concentrations

Question 6

what is the mechanism of action of statins

Answer 6

irreversible inactivation of cox enzyme. 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 and sensation and in brain decreases fever

Question 7

what is the target of aspirin

Answer 7

cyclooxygenase

Question 8

what are some side effects of aspirin

Answer 8

dyspepsia
haemorrhage
in elderly patients avoid doses >160mg daily and co adminiter with ppi if past history of peptic ulcer

Question 9

what dose of aspirin is most cost effective?

Answer 9

low dose aspirin - is most cost effective for prevention of secondary events of thrombosis

Question 10

why is stomach lining effected by aspirin

Answer 10

blockade of cox1 in gastric mucosal cells reduces mucus/bicarbonate production which can expose stomach lining to acid

Question 11

what is the mechanism of action of trimethoprim

Answer 11

direct competitor of enzyme dihydrofolate reductase. inhibits reduction of dihydrofolic acid to tetrahydrofolic acid, a necessary component for synthesising purines required for dna and protein production

Question 12

what is the target of trimethoprim

Answer 12

dihydrofolate reductase

Question 13

what are some side effects of trimethoprim

Answer 13

diarrhoea

skin reactions

Question 14

why is trimethoprim often administered with sulfamethoxazole

Answer 14

in combination they block 2 steps in bacterial biosynthesis of essential nucleic acids and proteins

Question 15

extra info on trimethoprim

Answer 15

need to monitor blood counts with long term use/in those at risk of folate deficiency.
also monitor serum electrolytes in patients at risk of developing hyperkalaemia

Question 16

what is the mechanism of action of gentamicin

Answer 16

binds to bacterial 30s ribosomal subunit disturbing translation of mrna leading to formation of dysfunctional proteins

Question 17

target of gentamicin

Answer 17

30s ribosomal subunit

Question 18

side effects of gentamicin

Answer 18

ototoxicity and nephrotoxicity

Question 19

why is gentamicin ineffective against anaerobic bacteria

Answer 19

an aminoglycoside antibiotic. can pass through gram neg cell membrane in an oxygen dependant manner

Question 20

how is gentamicin most likely administered

Answer 20

intravenously (in hospital) for endocarditis, septicaemia, meningitis, pneumonia or surgical prophylaxis