Renal - Drugs that alter urinary function and promote kidney function

Question 1

What are the major routes of drug excretion?

Answer 1

Intestine, bile (EHC), and kidneys.

Question 2

Which organ is responsible for excreting all water-soluble substances?

Answer 2

The kidney.

Question 3

Name the three fundamental processes of renal excretion.

Answer 3

Glomerular filtration, tubular reabsorption, and tubular secretion.

Question 4

What factors affect renal excretion?

Answer 4

Blood flow to kidney, urinary pH, age, and disease.

Question 5

Why is renal clearance significant for drugs?

Answer 5

It is important for drugs with a narrow therapeutic index to prevent toxicity.

Question 6

What happens when renal clearance is impaired?

Answer 6

It increases the half-life of drugs, leading to potential toxicity.

Question 7

What should be done to drug dosages in renal impairment?

Answer 7

Dosages need to be modified to avoid accumulation and toxicity.

Question 8

What are the two ways of dose adjustment in renal impairment?

Answer 8

Prolong dosing intervals or decrease the dose without changing dosing intervals.

Question 9

When is dose adjustment required for drugs?

Answer 9

When creatinine clearance is below 60 ml/min.

Question 10

What is a minor dose adjustment in renal impairment?

Answer 10

When creatinine clearance is 30-60 ml/min.

Question 11

What is a major dose adjustment in renal impairment?

Answer 11

When creatinine clearance is less than 15 ml/min.

Question 12

Which antibiotics require dose adjustment in renal impairment?

Answer 12

Aminoglycosides, vancomycin, ceftazidime, cefepime, cephazolin, ciprofloxacin, piperacillin, imipenem, carbapenems, sulfamethoxazole.

Question 13

Name antifungal drugs that require dose adjustment.

Answer 13

Fluconazole, itraconazole.

Question 14

Which antiviral drugs require dose adjustment in renal impairment?

Answer 14

Acyclovir, famciclovir, valacyclovir.

Question 15

List hypoglycemic agents that need dose adjustment in renal impairment.

Answer 15

Metformin, glibenclamide, glimepiride, gliptins, insulin.

Question 16

Which cardiac drugs require dose adjustment?

Answer 16

Digoxin, atenolol, sotalol.

Question 17

Name psychotropics and anticonvulsants requiring dose adjustment.

Answer 17

Lithium, gabapentin, levetiracetam, topiramate, vigabatrin, SSRIs.

Question 18

Which NSAIDs and opioids require dose adjustment?

Answer 18

Aspirin, paracetamol, coxibs, morphine, codeine, pethidine.

Question 19

List drugs for gout that need dose adjustment in renal impairment.

Answer 19

Allopurinol, colchicine.

Question 20

Name anticoagulants that require dose adjustment in renal impairment.

Answer 20

Low molecular weight heparin (LMWH).

Question 21

Which diuretics need dose adjustment in renal impairment?

Answer 21

Potassium-sparing diuretics, thiazide diuretics.

Question 22

Which drugs do not require dose reduction in renal impairment?

Answer 22

Drugs mainly excreted into feces (e.g., ceftriaxone, doxycycline).

Question 23

Define nephrotoxic drugs.

Answer 23

Medications that cause kidney injury, contributing to acute or chronic kidney injury.

Question 24

What are the common mechanisms of drug-induced nephrotoxicity?

Answer 24

GFR alteration, tubular cell toxicity, interstitial nephritis, and crystal nephropathy.

Question 25

Name some nephrotoxic antimicrobials.

Answer 25

Aminoglycosides, antiviral agents (acyclovir), amphotericin B, colistin, polymixin B, sulfadiazine, quinolones, vancomycin.

Question 26

List nephrotoxic analgesics.

Answer 26

NSAIDs, selective COX-2 inhibitors, phenacetin, analgesic combinations.

Question 27

Which chemotherapeutic agents are nephrotoxic?

Answer 27

Platins, ifosfamide, mitomycin, gemcitabine, methotrexate, interleukin-2 (high dose), anti-angiogenesis agents, immunotherapies.

Question 28

Name nephrotoxic immunosuppressives.

Answer 28

Calcineurin inhibitors, sirolimus, everolimus.

Question 29

List other nephrotoxic drugs.

Answer 29

ACE inhibitors, ARBs, renin inhibitors, SGLT-2 inhibitors, methoxyflurane, IVIg excipients, pamidronate, zolendronate, topiramate, zonisamide, orlistat, statins, mesalamine.

Question 30

What are nephrotoxic diagnostic agents?

Answer 30

High osmolar, low osmolar, iso-osmolar radiocontrast, gadolinium (high dose), oral NaP solution.

Question 31

Name some nephrotoxic environmental intoxicants.

Answer 31

Heavy metals (lead, mercury, cadmium, uranium, copper, bismuth), solvents (hydrocarbons), silicon, germanium.

Question 32

What percentage of renal calculi are drug-induced?

Answer 32

1-2%.

Question 33

What are the two main subtypes of drug-induced calculi?

Answer 33

Drug-containing calculi and metabolically induced calculi.

Question 34

What is drug-containing calculi?

Answer 34

Stones where the medication or its metabolites are the primary constituents.

Question 35

What are metabolically induced calculi?

Answer 35

Stones formed due to medications causing metabolic abnormalities that facilitate stone formation.

Question 36

List drugs that can cause calcium oxalate or calcium phosphate stones.

Answer 36

Loop diuretics, carbonic anhydrase inhibitors, antiepileptics (topiramate, zonisamide).

Question 37

Which type of stone is caused by urinary tract infections?

Answer 37

Struvite stones.

Question 38

What are some rare types of renal stones?

Answer 38

Uric acid stones and cystine stones.

Question 39

Name drugs that can cause ammonium acid urate stones when abused.

Answer 39

Laxatives.

Question 40

Which antacids can lead to silica stones?

Answer 40

Magnesium trisilicate.

Question 41

List antibiotics that can cause drug-induced renal calculi.

Answer 41

Quinolones (ciprofloxacin), sulfonamides (sulfadiazine).

Question 42

Name potassium-sparing diuretics that can cause renal stones.

Answer 42

Triamterene.

Question 43

Which protease inhibitors can lead to drug-induced renal calculi?

Answer 43

Indinavir, atazanavir.

Question 44

What is the radiographic status of ciprofloxacin-induced stones?

Answer 44

Radiolucent.

Question 45

What is a key risk factor for drug-induced nephrolithiasis?

Answer 45

High doses and/or chronic drug use.