Renal - Drugs that alter urinary function and promote kidney function Flashcards

1
Q

What are the major routes of drug excretion?

A

Intestine, bile (EHC), and kidneys.

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2
Q

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

A

The kidney.

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3
Q

Name the three fundamental processes of renal excretion.

A

Glomerular filtration, tubular reabsorption, and tubular secretion.

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4
Q

What factors affect renal excretion?

A

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

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5
Q

Why is renal clearance significant for drugs?

A

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

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6
Q

What happens when renal clearance is impaired?

A

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

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7
Q

What should be done to drug dosages in renal impairment?

A

Dosages need to be modified to avoid accumulation and toxicity.

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8
Q

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

A

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

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9
Q

When is dose adjustment required for drugs?

A

When creatinine clearance is below 60 ml/min.

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10
Q

What is a minor dose adjustment in renal impairment?

A

When creatinine clearance is 30-60 ml/min.

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11
Q

What is a major dose adjustment in renal impairment?

A

When creatinine clearance is less than 15 ml/min.

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12
Q

Which antibiotics require dose adjustment in renal impairment?

A

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

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13
Q

Name antifungal drugs that require dose adjustment.

A

Fluconazole, itraconazole.

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14
Q

Which antiviral drugs require dose adjustment in renal impairment?

A

Acyclovir, famciclovir, valacyclovir.

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15
Q

List hypoglycemic agents that need dose adjustment in renal impairment.

A

Metformin, glibenclamide, glimepiride, gliptins, insulin.

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16
Q

Which cardiac drugs require dose adjustment?

A

Digoxin, atenolol, sotalol.

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17
Q

Name psychotropics and anticonvulsants requiring dose adjustment.

A

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

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18
Q

Which NSAIDs and opioids require dose adjustment?

A

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

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19
Q

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

A

Allopurinol, colchicine.

20
Q

Name anticoagulants that require dose adjustment in renal impairment.

A

Low molecular weight heparin (LMWH).

21
Q

Which diuretics need dose adjustment in renal impairment?

A

Potassium-sparing diuretics, thiazide diuretics.

22
Q

Which drugs do not require dose reduction in renal impairment?

A

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

23
Q

Define nephrotoxic drugs.

A

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

24
Q

What are the common mechanisms of drug-induced nephrotoxicity?

A

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

25
Q

Name some nephrotoxic antimicrobials.

A

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

26
Q

List nephrotoxic analgesics.

A

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

27
Q

Which chemotherapeutic agents are nephrotoxic?

A

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

28
Q

Name nephrotoxic immunosuppressives.

A

Calcineurin inhibitors, sirolimus, everolimus.

29
Q

List other nephrotoxic drugs.

A

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

30
Q

What are nephrotoxic diagnostic agents?

A

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

31
Q

Name some nephrotoxic environmental intoxicants.

A

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

32
Q

What percentage of renal calculi are drug-induced?

A

1-2%.

33
Q

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

A

Drug-containing calculi and metabolically induced calculi.

34
Q

What is drug-containing calculi?

A

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

35
Q

What are metabolically induced calculi?

A

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

36
Q

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

A

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

37
Q

Which type of stone is caused by urinary tract infections?

A

Struvite stones.

38
Q

What are some rare types of renal stones?

A

Uric acid stones and cystine stones.

39
Q

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

A

Laxatives.

40
Q

Which antacids can lead to silica stones?

A

Magnesium trisilicate.

41
Q

List antibiotics that can cause drug-induced renal calculi.

A

Quinolones (ciprofloxacin), sulfonamides (sulfadiazine).

42
Q

Name potassium-sparing diuretics that can cause renal stones.

A

Triamterene.

43
Q

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

A

Indinavir, atazanavir.

44
Q

What is the radiographic status of ciprofloxacin-induced stones?

A

Radiolucent.

45
Q

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

A

High doses and/or chronic drug use.