Renal Disease Flashcards
afferent arteriole
delivers the blood
efferent arteriole
blood exists
proximal tubule
SGLT2 inhibitors work here
Loop of Henle
- Na CL ions are reabsorbed back into the blood, water is not. Unless antidiuretic hormone (ADH) is present, water passes through the wall and is reabsorbed. ADH is also known as vasopressin
- loop diuretics inhibit the Na-K pump (less NA is reabsorbed), also cause less Ca reabsorption back into the blood (SE decrease bone density)
Distal convoluted tubules
thiazide diuretics inhibit the Na-Cl pump. increase in Ca reabsorption
collecting duct
potassium sparring diuretics- including aldosterone antagonists (spironolactone, eplerenone),
ultimately decrease Na and increase K
select drugs that cause kidney disease
Aminoglycosides
Amphotericin B
Cisplatin
Cyclosporine
Loop diuretics
NSAIDs
Polymyxins
Radiographic contrast dye
tacrolimus
vancomycin
cockcroft-gault equation
ACE inhibitors and ARBs for albuminuria
prevent kidney disease progression,
RAAS causes efferent arteriolar dilation
by reducing pressure in the glomerulus, decreasing albuminuria, cardio protection
CKD
GFR <60 and/or albuminuria (ACR or AER >=30)
ACE/ARB increase
K, so monitor
metformin and SGLT2 inhibitors
for pt with CKD, type 2 diabetes, and GFR> 30
SGLT2- specifically canagliflozin, dapagliflozin, and empagliflozin- demonstrated reduction in cardo event and CKD progression
key drugs that require dose reduction or interval increase in CKD
anti-infectives
Aminoglycosides (increase dose interval primarily)
Beta-lactam (except antistaphylococcal and ceftriaxone)
Fluconazole
Quinolones (except moxifloacin)
Vancomycin
key drugs that require dose reduction or interval increase in CKD
cardio drugs
LMWHs (enoxaparin)
Rivaroxaban* (for AF)
Apixaban* (for AF)
Dabigatran* (for AF)
key drugs that require dose reduction or interval increase in CKD
GI
H2RAs (famotidine, ranitidine)
Metoclopramide
key drugs that require dose reduction or interval increase in CKD
others
bisphosphonates
lithium
Key drugs contra
CrCl <60
nitrofurantoin
Key drugs contra
CrCl<50
Tenofovir disoproxil fumarate
Products include atripla, complera, delstrigo, stribild (don’t start if less the<70), symfi
vorconazole IV (due to vehicle)
Key drugs contra
CrCl<30
tenofovir alafenamide
products include biktarvy, descovy, genvoya, odefsay, symtuza
Key drugs contra
GFR<30
SGLT2 inhibitors
Metformin - dont start if GFR<45
provide overview of Ca, PO4, vitamin D in CKD system EPO too
Aluminum Hydroxide suspension
TID w/meals
SE: “Dialysis dementia”
Aluminum-based: potent phosphate binders, rarely used due to the risk of aluminum accumulation (which can cause nervous system and bone toxicity). tx max… 4 weeks
- phosphate binder
calcium acetate
phoslyra, PhosLo
TID w/meals
SE: Hypercalcemia- monitor Ca avoid with vitamin D..
- calcium-based: first line phosphate binder
calcium carbonate
tums, TID w/meals
SE: hypercalcemia- monitor Ca, avoid with vitamin D..
- calcium-based: first line phosphate binder
sucroferric oxyhydroxide
velphoro
TID w/meals
SE: black feces
- aluminum-free, calcium-free
Ferric citrate
auryxia
iron absorption with ferric citrate monitor TSAT
SE: black feces
- aluminum-free, calcium-free phosphate binder
Lanthanum carbonate
Fosrenol
TID w/meals
must chew thoroughly…
Avoid in GI obstruction fecal impaction ileus pts
SE. N/v, diarrhea, constipation….
- aluminum-free, calcium-free phosphate binder
Sevelamer carbonate
sevelamer hydrochloride
Sevelamer carbonate- renvela
sevelamer hydrochloride- renagel
contra: bowel obstructions
can lower TC and LDL
- non-calcium, non-aluminum based phosphate binder that is not systemically absorbed
phosphate binders DI:
separate admin from levo and antibiotics that chelate
Calcitriol
Rocaltrol
- vitamin D analogs: increase absorption of Ca, which provides a negative feed back to the parathyroid gland
Calcifediol
Rayaldee
- vitamin D analogs: increase absorption of Ca, which provides a negative feed back to the parathyroid gland
Doxercalciferol
Hectorol
- vitamin D analogs: increase absorption of Ca, which provides a negative feed back to the parathyroid gland
Paricalcitol
Zemplar
- vitamin D analogs: increase absorption of Ca, which provides a negative feed back to the parathyroid gland
Cinacalcet
Sinsipar
SE: Hypocalcemia
-Calcimimetic: increases sensitivity of the calcium-sensing receptors on the parathyroid gland, which causes decrease PTH and decrease Ca and decrease PO4
Etelcalcetide
Parsabiv
SE: hypocalcemia, muscle spasms, paresthesia
-Calcimimetic: increases sensitivity of the calcium-sensing receptors on the parathyroid gland, which causes decrease PTH and decrease Ca and decrease PO4
EPO
kindy function declines, EPO production decreases, ESAs produce more RBCs
ESA include epoetin alfa (procrit, epogen, Retacrit)… long lasting formula, darbepoetin alfa (arnesp)
only used when hemoglobein <10g/dL
select drugs that raise K levels
ACE inhibitors
Aldosterone receptor antagonists
Aliskiren
ARBs
Canagliflozin
Drospirenone-containing COCs
PN- IV fluids containing K
Potassium supplements
Sulfamethoxazole/Trimethoprim
Transplant drugs (cyclosporine, everolimus, tacrolimus)
Sodium polystyrene sulfonate
SPS, kayexalate
warning: GI necrosis (increased risk with sorbitol)
can bind to other meds… check
monitor K, Na, Mg, Ca
oral and rectal
- tx of hyperkalemia
Patiromer
Veltassa
Warning: worsen GI motality, hypoMg
binds to oral drugs, at least 3 hrs before and 3 hr after
monitor K, Mg
delayed onset of action…
- tx of hyperkalemia
Sodium zirconium cyclosilicate
Lokelma
binds other drugs, separate by 2 hrs before and after
fast onset of action
