Pharmacology of Renal Failure Flashcards
_____ are the recommended first line treatments for HTN.
Thiazide diuretics
Name 4 drugs types that may cause hyperkalemia.
- K+ sparing diuretics
- ACE inhibitors
- Angiotensin receptor blockers
- Digoxin
Which drugs and physiologic mediators increase constriction of the afferent arterioles, thereby decreasing GFR?
- Angiotensin II
- NE
- adenosine
- NSAIDs
____ is the most common cause of resistance to EPO therapy.
Iron deficiency
Although the majority of drug metabolism occurs in the liver, up to 20% of _____ reactions occur in the kidney.
phase I CYP450
This drug is a vitamin D compound indirectly used to decrease PTH secretion.
calcitriol (Rocaltrol)
What is Cinacalet (Sensipar)?
a calcimimetic drug that directly reduces release of PTH
As kidney disease progresses, the serum concentration of EPO decreases and _____ results.
anemia
Although the majority of drug metabolism occurs in the liver, up to ____% of phase I CYP450 reactions occur in the kidney.
20
This is a calcimimetic drug that directly reduces release of PTH.
Cinacalet (Sensipar)
What is the definitive treatment for hyperkalemia?
hemodialysis
By the time pts reach stage 5 kidney disease, they are typically taking an average of ____ medications daily.
11
There are 5 stages of chronic kidney disease, from 1 to 5. In which stages are the doses of renally eliminated drugs adjusted?
3, 4, 5
What is sodium polystyrene sulfonate (Kayexalate)?
a cation exchange resin that exchanges K+ for Na+ in the intestines- used to treat chronic, asymptomatic hypercalcemia
Which drugs and physiologic mediators decrease dilation of the efferent arterioles, thereby decreasing GFR?
- ACE-inhibitors
- ARBs
Which drugs and physiologic mediators reduce dilation of the afferent arterioles, thereby increasing GFR?
- NO
- PGE2/PGE1
- dopamine
- caffeine (adenosine antagonist)
What is the tx for chronic, asymptomatic hyperkalemia?
sodium polystyrene sulfonate (Kayexalate)
Which drugs and physiologic mediators increase constriction of the efferent arterioles, thereby increasing GFR?
- Angiotensin II
- NE
This drug is a cation exchange resin that exchanges K+ for Na+ in the intestines- used to treat chronic, asymptomatic hypercalcemia.
sodium polystyrene sulfonate (Kayexalate)
In diabetic pts without CKD, renal metabolism is responsible for the removal of ___% of an insulin dose.
30
How can diuretic resistance from late stage CKD be overcome?
the use of synergistic combos of diuretics that act upon different sites in the nephron
Name 5 temporizing therapies for acute hyperkalemia.
- IV calcium gluconate
- insulin
- glucose
- sodium bicarbonate
- beta-2 agonists (nebulized albuterol)
What is calcitriol (Rocaltrol)?
a vitamin D compound indirectly used to decrease PTH secretion
What are phosphate binding agents used for?
to decrease PO4- absorption and thereby decrease serum levels
Which hyperlipidemia drugs need dose adjustments in stage 3+ CKD?
the fibrates (only use gemfibrozil in CKD stage 5)
Dosing reductions are generally not recommended until GFR falls below _____ (stage 3 to stage 5).
50mL/min/1.73m3
How does CKD affect phenytoin (Dilantin)?
Causes:
- greater levels of free drug
- greater ability to distribute outside of the plasma
- greater potential for toxicity
What are calcium acetate (PhosLo), sevelamer HCl (Renagel), and sevelamer bicarbonate (Renvela)?
phosphate binding agents
What is stage 5 kidney disease?
kidney failure
Which diabetes drugs need dose adjustments in stage 3+ CKD? Why?
- glyburide (half life is prolonged)
- metformin (NOT recommended if Scr>1.5)
- insulin (half life prolonged)
Which HTN drugs need dose adjustments in stage 3+ CKD and why?
- thiazides (lose effectiveness with dz progression)
- atenolol (half life prolonged)
- ***DON’T USE K+ sparing diuretics in CKD
- *** monitor K+ and Scr when using ACEs and ARBs
What are Alfa (Epogen) and Darbepoeitin Alfa (Aranesp)?
pharmacological glycoproteins with biologic activity identical to EPO
In pts with CKD, any given dose of Digoxin will result in a higher ____ due to a smaller Vd.
plasma concentration (Cp)
