Renal Failure Drugs Flashcards
What are Drug Therapy used in treatment of renal failure ?
i. Antihypertensive and antidiabetic
ii. Diuretics
iii. Phosphate binder
iv. Erythropoietin
What are´Treatment choices: Antihypertension
1st line: ACEi
ARBs can be added/substituted for ACEi
2nd line: Hydrochlorothiazide
3rd line: Verapamil/Diltiazem
4th line: Beta blocker
Loop diuretic is added if….
CKD class 4 or 5 and fluid
overload
Antidiabetics which are not required for dosage adjustment ?
- Amylin analog
- Thiazolidinediones
- Bile acid sequestrant
Insulin
Dosage reduction needed in stage 4-5 CKD
Thiazide are recommended in those with GFR …
> 30
Loop are recommended in those with GFR …
<30
Potassium-sparing should be used with caution in those with GFR ….
<30
What are Clinical Manifestations of renal Osteodystrophy?
- Bone pain
- Fractures
- Increase CVS mortality
The pathology of Renal Osteodystrophy?
- Adynamic Bone Disease
- Osteomalacia
- Osteitis fibrosa cystica
- Vascular Calcification
What are the example of Phosphate Binders ?
- Aluminium hydroxide
- Magnesium hydroxide
- Calcium carbonate
- Calcium acetate
What is the adverse effect of Aluminium hydroxide ?
Constipation, osteomalacia, neurotoxicity
What is the adverse effect of Magnesium hydroxide ?
Diarrhea, magnesium toxicity
Cause of anaemia associated with renal insufficiency?
decreased erythropoietin and iron availability
What are other causes of Anaemia in CRF?
- Folate deficiency due to losses in dialysis
- Decreased red blood cells survival
- Bone marrow suppression by uraemic condition
- Osteitis fibrosa cystica
- Aluminium toxicity
How to Treating Anaemia in CRF?
- Erythropoietic stimulating agents
- Iron Supplement
- Folic Acid
- B12 Supplement
How CRF can cause anemia ?
Loss of renal parenchymal in CRF reduce production of erythropoietin.
What is the role of Erythropoietin?
It is a glycoprotein that stimulates haematopoiesis . To treat anaemia in CRF
Why EPO is called colony-stimulating factors?
because of their ability to stimulate cells in the bone marrow to multiply and form colonies of identical cells
What are The most common side effects?
- high blood pressure,
- headache,
- joint-pain/athralgia
- clotting at the injection site.
Why Patients with renal insufficiency need iron supplement?
Because they have decreased iron
availability from blood loss, impaired iron absorption and inability to use body iron stores (functional iron deficiency)
Causes of blood loss in patients with renal failure?
- Gastrointestinal blood loss due to uraemia induced platelet
dysfunction - Blood loss due to dialysis
- Iatrogenic blood loss due to investigations
What are the main cause of anaemia that does not respond to erythropoietin?
Impaired iron supply to erythroid precursors due to impaired absorption and a functional iron deficiency
Hepcidin roles in Iron Deficiency?
lowers plasma iron by disrupting iron supply in patients of renal insufficiency .
Hepcidin levels in renal failure are increased due to?
- Inflammation (Infections, exposure of leucocytosis to foreign surfaces
during dialysis and from the underlying cause of renal insufficiency
are the sources of inflammation - decrease elimination as a result of falling GFR.
- Lack of erythropoietin to supress it release.
How hepcidin disrupting iron supply?
- reducing iron absorption in the gut
- hampering the release of macrophage iron causes functional iron
deficiency i.e. diminished iron availability despite adequate iron
stores.
How B12 Deficiency can occur?
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.
What is the role of Vitamin B12?
Vitamin B12 (Cobalamin) is a water-soluble vitamin
´serving as a cofactor for the formation of methionine from homocysteine in blood formation
2 types of dialysis?
- Hemodialysis
- Peritoneal dialysis
Peritoneal dialysis consists of?
Continuous ambulatory peritoneal dialysis
(CAPD) – manual, without a machine.
´Automated peritoneal dialysis (APD) or
continuous cycling peritoneal dialysis
(CCPD) – requires a machine called
cycler.
Dialysate
´Consist of:
water, osmotic agent, buffer, electrolyte
Example of Osmotic agents HMW
Glucose polymers i.e. icodextrin;
polypeptides; Dextran
Example of Osmotic agents LMW
Glucosecontaining solutions i.e. Dextrose; amino acids, xylitol, and glycerol
Example of buffers
Lactate, acetate and bicarbonate
Example of electrolytes
Sodium, potassium, calcium and magnesium