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BST2 > Renal Failure Drugs > Flashcards

Renal Failure Drugs Flashcards

1
Q

What are Drug Therapy used in treatment of renal failure ?

A

i. Antihypertensive and antidiabetic
ii. Diuretics
iii. Phosphate binder
iv. Erythropoietin

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2
Q

What are´Treatment choices: Antihypertension

A

1st line: ACEi
ARBs can be added/substituted for ACEi
2nd line: Hydrochlorothiazide
3rd line: Verapamil/Diltiazem
4th line: Beta blocker

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3
Q

Loop diuretic is added if….

A

CKD class 4 or 5 and fluid
overload

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4
Q

Antidiabetics which are not required for dosage adjustment ?

A
  1. Amylin analog
  2. Thiazolidinediones
  3. Bile acid sequestrant
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5
Q

Insulin

A

Dosage reduction needed in stage 4-5 CKD

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6
Q

Thiazide are recommended in those with GFR …

A

> 30

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7
Q

Loop are recommended in those with GFR …

A

<30

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8
Q

Potassium-sparing should be used with caution in those with GFR ….

A

<30

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9
Q

What are Clinical Manifestations of renal Osteodystrophy?

A
  1. Bone pain
  2. Fractures
  3. Increase CVS mortality
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10
Q

The pathology of Renal Osteodystrophy?

A
  1. Adynamic Bone Disease
  2. Osteomalacia
  3. Osteitis fibrosa cystica
  4. Vascular Calcification
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11
Q

What are the example of Phosphate Binders ?

A
  1. Aluminium hydroxide
  2. Magnesium hydroxide
  3. Calcium carbonate
  4. Calcium acetate
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12
Q

What is the adverse effect of Aluminium hydroxide ?

A

Constipation, osteomalacia, neurotoxicity

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13
Q

What is the adverse effect of Magnesium hydroxide ?

A

Diarrhea, magnesium toxicity

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14
Q

Cause of anaemia associated with renal insufficiency?

A

decreased erythropoietin and iron availability

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15
Q

What are other causes of Anaemia in CRF?

A
  1. Folate deficiency due to losses in dialysis
  2. Decreased red blood cells survival
  3. Bone marrow suppression by uraemic condition
  4. Osteitis fibrosa cystica
  5. Aluminium toxicity
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16
Q

How to Treating Anaemia in CRF?

A
  1. Erythropoietic stimulating agents
  2. Iron Supplement
  3. Folic Acid
  4. B12 Supplement
17
Q

How CRF can cause anemia ?

A

Loss of renal parenchymal in CRF reduce production of erythropoietin.

18
Q

What is the role of Erythropoietin?

A

It is a glycoprotein that stimulates haematopoiesis . To treat anaemia in CRF

19
Q

Why EPO is called colony-stimulating factors?

A

because of their ability to stimulate cells in the bone marrow to multiply and form colonies of identical cells

20
Q

What are The most common side effects?

A
  1. high blood pressure,
  2. headache,
  3. joint-pain/athralgia
  4. clotting at the injection site.
21
Q

Why Patients with renal insufficiency need iron supplement?

A

Because they have decreased iron
availability from blood loss, impaired iron absorption and inability to use body iron stores (functional iron deficiency)

22
Q

Causes of blood loss in patients with renal failure?

A
  1. Gastrointestinal blood loss due to uraemia induced platelet
    dysfunction
  2. Blood loss due to dialysis
  3. Iatrogenic blood loss due to investigations
23
Q

What are the main cause of anaemia that does not respond to erythropoietin?

A

Impaired iron supply to erythroid precursors due to impaired absorption and a functional iron deficiency

24
Q

Hepcidin roles in Iron Deficiency?

A

lowers plasma iron by disrupting iron supply in patients of renal insufficiency .

25
Q

Hepcidin levels in renal failure are increased due to?

A
  1. Inflammation (Infections, exposure of leucocytosis to foreign surfaces
    during dialysis and from the underlying cause of renal insufficiency
    are the sources of inflammation
  2. decrease elimination as a result of falling GFR.
  3. Lack of erythropoietin to supress it release.
26
Q

How hepcidin disrupting iron supply?

A
  1. reducing iron absorption in the gut
  2. hampering the release of macrophage iron causes functional iron
    deficiency i.e. diminished iron availability despite adequate iron
    stores.
27
Q

How B12 Deficiency can occur?

A

The B12-IF complex is absorbed in the ileum via the cubilin receptor.Defects in cubilin, a proximal tubular membrane protein, have been associated with both megaloblastic anemia and tubular proteinuria.

28
Q

What is the role of Vitamin B12?

A

Vitamin B12 (Cobalamin) is a water-soluble vitamin
´serving as a cofactor for the formation of methionine from homocysteine in blood formation

29
Q

2 types of dialysis?

A
  1. Hemodialysis
  2. Peritoneal dialysis
30
Q

Peritoneal dialysis consists of?

A

Continuous ambulatory peritoneal dialysis
(CAPD) – manual, without a machine.
´Automated peritoneal dialysis (APD) or
continuous cycling peritoneal dialysis
(CCPD) – requires a machine called
cycler.

31
Q

Dialysate
´Consist of:

A

water, osmotic agent, buffer, electrolyte

32
Q

Example of Osmotic agents HMW

A

Glucose polymers i.e. icodextrin;
polypeptides; Dextran

33
Q

Example of Osmotic agents LMW

A

Glucosecontaining solutions i.e. Dextrose; amino acids, xylitol, and glycerol

34
Q

Example of buffers

A

Lactate, acetate and bicarbonate

35
Q

Example of electrolytes

A

Sodium, potassium, calcium and magnesium

BST2 (10 decks)

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