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Pharmacokinetics > Renal Disease and Drug Handling > Flashcards

Renal Disease and Drug Handling Flashcards

1
Q

What is the definition of clearance?

A

The volume of plasma cleared entirely of drug per unit time (ml/min).

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2
Q

What (in terms of renal function) decreases with age?

A

Renal Blood Flow
Renal Blood Filtration
Renal Mass

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3
Q

What is Acute Kidney Injury (AKI)?

A

Sudden episode of kidney failure which happens within a few hours // days.
Lasts for 7 days or less.

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4
Q

What is Chronic Kidney Disease (CKD)?

A

Deteriorating kidney function over a long period of time.

Lasts for >90 days.

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5
Q

What are the 3 stages in AKI?

A

Pre - Renal
Intrinsic
Post - Renal

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6
Q

Out of AKI and CKD, which one is reversible?

A

AKI is reversible.

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7
Q

What are the 3 main causes of CKD?

A

Glomerular Disease
Hypertension
Diabetes

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8
Q

What are the risk factors for kidney disease?

A 
Age 
Obesity 
Smoking
Heart Disease
African - American ethnicity 
Hypertension 
Diabetes
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9
Q

What are the outcomes for kidney disease?

A

Cardiovascular Disease
Kidney Events
Disability
Death

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10
Q

What is glomerular disease?

A

Autoimmune Disease in which the glomeruli is damaged.

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11
Q

What are the main causes of glomerular disease?

A
  • Immunologically mediated inflammatory injury.
  • Secondary mechanisms ( fibrin // deposition // platelet aggregation ).
  • Haemodynamic Changes.
  • Generalised Disease. (Lupus // Diabetes)
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12
Q

What is Lupus?

A

A long term autoimmune disease in which healthy tissue is attacked.

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13
Q

What does haemodynamic changes mean?

A

Changes to the dynamics of blood flow.

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14
Q

What are 2 terms used to describe glomerular disease?

A

Nephrotic

Nephritic

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15
Q

What is nephrotic kidney disease?

A

Kidney disease which causes body to pass TOO MUCH protein in your urine.

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16
Q

What is nephritic kidney disease?

A

Kidney disease which causes body to pass BLOOD in the urine due to inflammation.

17
Q

How can hypertension affect kidney functioning?

A

There is narrowing in the arteries which delivers blood to the kidney -> Causes damage and thus, weakens the kidney vessels.

18
Q

Why does hypertension damage the kidney?

A

The waste and extra fluids CAN’T be removed and therefore, they build up in the vessels = damaging them.

19
Q

How can diabetes affect the kidney?

A

Damage the kidney.

Damage the nerves in the kidney.

20
Q

Explain further regarding the damage done to the kidney.

A

Waste and fluids build up in the blood instead of leaving the blood.
The body retains more SALT and WATER -> leads to weight gain alongside swelling of the ankles.

21
Q

Explain further regarding the damage done to the kidney nerves.

A

Leads to difficulty in emptying the bladder and thus, pressure builds up -> injuring the kidney.

22
Q

How can you measure kidney function?

A 
Serum Urea
Serum Creatinine 
Albumin to Creatinine ratio 
Creatinine Clearance 
Insulin Clearance
23
Q

What is an indicator of severe risk of disease progression?

A

As kidney failure progress and the urine protein levels increase -> High risk of disease progression.

24
Q

What are the ways of measuring GFR?

A

Cockcroft - Gault Equation.

Measuring amount of creatinine present in sample of urine collected over 24hrs.

25
Q

What is the normal creatinine clearance?

A 
MEN = 97 / 123 mL / min  
WOMEN = 88 / 128 mL / min
26
Q

What factors are taken into consideration when using the Cockcroft - Gault equation?

A

Sex // Age // Height // Creatinine // Height

27
Q

What is an eGFR?

A

This is a calculated estimate of the actual glomerular filtration rate. This is based on blood creatinine level with age // sex // race.

28
Q

What are the issues with impaired renal function and drugs?

A

Causes toxicity.
Side effects are poorly tolerated.
Effectivity is reduced.
Sensitivity is reduced.

29
Q

Why should nephrotoxic drugs be avoided in pattens with renal impairment?

A

Can cause renal damage -> as it can cause acute kidney injury due to renal under - perfusion : known as PRERENAL AZOTEMIA.

30
Q

What is Prerenal Azotemia?

A

This is when little // no urine is produced despite the kidney working.

31
Q

What are the 2 classes of drugs which can damage the kidney?

A

NSAIDS.

ACE Inhibitors.

32
Q

How can NSAIDS damage the kidney?

A

They block the synthesis of afferent arteriole vasodilation = Causes vasoconstriction and thus, reduces GFR.

33
Q

How can ACE Inhibitors damage the kidney?

A

They block efferent vasoconstriction -> can cause acute renal failure.

Pharmacokinetics (18 decks)

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