Renal - Drugs that alter urinary function and promote kidney function Flashcards
What are the major routes of drug excretion?
Intestine, bile (EHC), and kidneys.
Which organ is responsible for excreting all water-soluble substances?
The kidney.
Name the three fundamental processes of renal excretion.
Glomerular filtration, tubular reabsorption, and tubular secretion.
What factors affect renal excretion?
Blood flow to kidney, urinary pH, age, and disease.
Why is renal clearance significant for drugs?
It is important for drugs with a narrow therapeutic index to prevent toxicity.
What happens when renal clearance is impaired?
It increases the half-life of drugs, leading to potential toxicity.
What should be done to drug dosages in renal impairment?
Dosages need to be modified to avoid accumulation and toxicity.
What are the two ways of dose adjustment in renal impairment?
Prolong dosing intervals or decrease the dose without changing dosing intervals.
When is dose adjustment required for drugs?
When creatinine clearance is below 60 ml/min.
What is a minor dose adjustment in renal impairment?
When creatinine clearance is 30-60 ml/min.
What is a major dose adjustment in renal impairment?
When creatinine clearance is less than 15 ml/min.
Which antibiotics require dose adjustment in renal impairment?
Aminoglycosides, vancomycin, ceftazidime, cefepime, cephazolin, ciprofloxacin, piperacillin, imipenem, carbapenems, sulfamethoxazole.
Name antifungal drugs that require dose adjustment.
Fluconazole, itraconazole.
Which antiviral drugs require dose adjustment in renal impairment?
Acyclovir, famciclovir, valacyclovir.
List hypoglycemic agents that need dose adjustment in renal impairment.
Metformin, glibenclamide, glimepiride, gliptins, insulin.
Which cardiac drugs require dose adjustment?
Digoxin, atenolol, sotalol.
Name psychotropics and anticonvulsants requiring dose adjustment.
Lithium, gabapentin, levetiracetam, topiramate, vigabatrin, SSRIs.
Which NSAIDs and opioids require dose adjustment?
Aspirin, paracetamol, coxibs, morphine, codeine, pethidine.
List drugs for gout that need dose adjustment in renal impairment.
Allopurinol, colchicine.
Name anticoagulants that require dose adjustment in renal impairment.
Low molecular weight heparin (LMWH).
Which diuretics need dose adjustment in renal impairment?
Potassium-sparing diuretics, thiazide diuretics.
Which drugs do not require dose reduction in renal impairment?
Drugs mainly excreted into feces (e.g., ceftriaxone, doxycycline).
Define nephrotoxic drugs.
Medications that cause kidney injury, contributing to acute or chronic kidney injury.
What are the common mechanisms of drug-induced nephrotoxicity?
GFR alteration, tubular cell toxicity, interstitial nephritis, and crystal nephropathy.
Name some nephrotoxic antimicrobials.
Aminoglycosides, antiviral agents (acyclovir), amphotericin B, colistin, polymixin B, sulfadiazine, quinolones, vancomycin.
List nephrotoxic analgesics.
NSAIDs, selective COX-2 inhibitors, phenacetin, analgesic combinations.
Which chemotherapeutic agents are nephrotoxic?
Platins, ifosfamide, mitomycin, gemcitabine, methotrexate, interleukin-2 (high dose), anti-angiogenesis agents, immunotherapies.
Name nephrotoxic immunosuppressives.
Calcineurin inhibitors, sirolimus, everolimus.
List other nephrotoxic drugs.
ACE inhibitors, ARBs, renin inhibitors, SGLT-2 inhibitors, methoxyflurane, IVIg excipients, pamidronate, zolendronate, topiramate, zonisamide, orlistat, statins, mesalamine.
What are nephrotoxic diagnostic agents?
High osmolar, low osmolar, iso-osmolar radiocontrast, gadolinium (high dose), oral NaP solution.
Name some nephrotoxic environmental intoxicants.
Heavy metals (lead, mercury, cadmium, uranium, copper, bismuth), solvents (hydrocarbons), silicon, germanium.
What percentage of renal calculi are drug-induced?
1-2%.
What are the two main subtypes of drug-induced calculi?
Drug-containing calculi and metabolically induced calculi.
What is drug-containing calculi?
Stones where the medication or its metabolites are the primary constituents.
What are metabolically induced calculi?
Stones formed due to medications causing metabolic abnormalities that facilitate stone formation.
List drugs that can cause calcium oxalate or calcium phosphate stones.
Loop diuretics, carbonic anhydrase inhibitors, antiepileptics (topiramate, zonisamide).
Which type of stone is caused by urinary tract infections?
Struvite stones.
What are some rare types of renal stones?
Uric acid stones and cystine stones.
Name drugs that can cause ammonium acid urate stones when abused.
Laxatives.
Which antacids can lead to silica stones?
Magnesium trisilicate.
List antibiotics that can cause drug-induced renal calculi.
Quinolones (ciprofloxacin), sulfonamides (sulfadiazine).
Name potassium-sparing diuretics that can cause renal stones.
Triamterene.
Which protease inhibitors can lead to drug-induced renal calculi?
Indinavir, atazanavir.
What is the radiographic status of ciprofloxacin-induced stones?
Radiolucent.
What is a key risk factor for drug-induced nephrolithiasis?
High doses and/or chronic drug use.
