Pharmacology - Renal Stones Flashcards
What are the four imbalances in the urine that can lead to calcium stone formation
Hypercalciuria (calcium)
Hyperoxaluria (oxalate)
Hyperuricosuria (uric acid)
Hypocitraturia (citric acid)
Identify the NSAID and narcotic analgesic of choice for the management of pain for renal colic
NSAID - ketorolac
Narcotic agent - morphine sulfate
What calcium channel blocker is given to aid in the passage of a kidney stone
Nifedipine
What is the mechanism of nifedipine
Suppress smooth muscle contraction and reduce ureteral spasm
What two alpha blockers are given to aid in the passage of a kidney stone
Tamsulosin
Terazosin
What is the mechanism of tamulosin and terazosin
Decrease ureteral smooth muscle tone and frequency and force of peristalsis
What is the treatment for hypercalciuria
Thiazide
What is the mechanism of thiazides
Inhibit Na/Cl transport –> increases Ca reabsorption
What are adverse effects of thiazides
Hypokalemic metabolic alkalosis
Hyperuricemia and gout
Hyperglycemia
Hyperlipidemia
How can you prevent hypokalemia with thiazides
Combine with amiloride
Why cant you combine thiazide with triamterene to prevent hypokalemia
Triamterene is highly insoluble in urine and may increase incidence of stone formation
How do you alkalize the urine
Potassium citrate
What kidney stones is allopurinol indicated for
Calcium stones
Uric acid stones
What is the mechanism of allopurinol
Inhibits xanthine oxidase the enzyme that synthesizes uric acid from hypoxanthine
Reduces uric acid formation
What type of stones is tiopronin and d-penicillamine used for
Cystine stones
What is the mechanism of tiopronin and d-penicillamine
Cystine is a dimer of cysteine linked by disulfide bridge
Tiopronin and penicillamine break the disulfide bridge and form a complex with cysteine
What are the side effects of tiopronin and d-penicillamine
Gastrointestinal side effects
Dermatological complications
Hematologic abnormalities
Neurologic complications
What are the hematologic abnormalities of tiopronin and d-penicillamine
bleeding anemia leukopenia thrombocytopenia eosinophilia
What is the neurologic complication of tiopronin and d-penicillamine
Myasthenic syndrome
