Renal Pharm Flashcards
pharmacokinetics+ therapuetic effect colchincine
oral
6-12 hour admin
pain relief at 18hr, max at 48
Reduces inflammation
____ favors ionization while ____ disfavors ionization
___ percipitates tetany and laryngospasm in Ca deficiency
acidosis favors ionization while alkalosis disfavors ionization
hyperventilation percipitates tetany and laryngospasm in Ca deficiency
factors underlying increased PTH in secondary hyperparathyroidism
decreased calcitriol production (vit D3)
decreased serum Ca
increased serum phos
pharmocokinetics Epoetin
IV or subq (better response)
half life 4-6 hours
2-3times/week
emerging antiapoptotic drugs
caspase inhibitors
minocycline (antibiotic)
signs of 1,25 hydroxy Vita D def in CKD
fractures (esp elderly)
hyperparathyroidism
first generation bisphosphate (simpler side change)
second gen (amino or ntirogenous side chain)
third gen
eidronate+tiludronate
2: Pamidronate, aldedronate, ibadronate
3 - Risedronate, Zoledronate
(ET PAI RZ)
mechanism bisphosphates
pyrophosphate analogs
bind hydroxyapatite crystals in bone matrix > inhbit resorption
important consideration of calcitriol analogs in kidney disease
ergocaliferol, alfacalcidol or calcitriol must be activated in kidney via 1-a activation
must used active form
side effects Bisphosphates
GI, abdmonial pain
osteonecrosis of jaw (IV)
drug interactions xanthine oxidase inhibitors allopurinol febuxostat
inhibit metabolism of azathioprine
emerging vasodilators
fenoldompam (dopamine)
ANP
(prior to event (thoracic surgery))
benefits of renin-angiotensn inhbitors in CKD
reduced progression of albuminuria
reduced progression of GFR decline
reduced risk of ESRD
indications, bisphosphates
hypercalcemia
side effects of calcitriol+vitamin D analogs
excessive dosing > hypercalcemia
bisphosphate that can supress bone absorption for up to a year (all other have weekly admin)
Zoldondrate
xanthine oxidase inhibitors for gout
Allopurinol (purine)
Febuxostat (non-purine
emerging anti inflammatory drugs
adensoine - a2a agonist
phosphatidyserine binding protein
mechanism ruasburicase, indication
recombinate version of urate oxidase
primarily used as prophylaxis in chemo, also for CKD
emerging growth factor drugs
recombinant EPO
therapeutic effect of EET analogs
protect kidney from HTN
drug classes to minimize proteinuria in diabetic nephropathy
ACEi and ARB
therapeutic mechanism Calcitriol and Vitamin D analogs
increase synth of Ca channels+calbindin carrier protein
bind cytoplasmic VitD receptor > promotes endocytoic capture of calcium and transport across duodenal mucosa
also
enhances renal tubular reab of Ca
enhances recruitment+dif of osteoclast preccursors for remodeling
side effects phosphate binders
GI
hypercalcemia
due to high PTH levels in CKD, transplant patients may experience
hypercalcemia
reduced Ca and increased phosphate in kidney disease lead to
secondary parathyroidism
(metabolic bone disease, soft tissue calcifications)
symptoms of enemia
fatigue
decreased cognition
half life of intra-musc or SubQ injection of calcitonin
20 minutes
(but since hormone, lasting effects)
side effects colchincine
GI toxicity
rash
kidney failure leads to decreased renal excretion of phosphate and diminished production of
calitriol
impact on Ca levels of hypoalbuminemia
no decrease in Ca concentration
normal plasma Ca
9-11mg/dl
side effects Rasburicase
Fever
Hypersensitivity
hemolysis (due to hydrogen peroide as by proudct of allantoin)
emerging anti sepsis drugs
insulin
calcitonin produced by
parafollicular cells of thyroid
calcitriol and vitamin D analogs
ergocaliferol
alafacalcidol
paricalcitol
side effects Calcitonin
facial flushing
headache/dizziness
GI
Taste disturbance
side effects EPO
headache
flu like symptoms early in treatment
HTN
thrombosis and ateriovenous shunts
pure red cell abx rxn in subQ use
phosphate binders
calcium carbonate
calcium acetate
lanthanum carbonate
sevelamer (aluminum free)
hormones regulating plasma calcium
parathormone
calcitonin
calcitriol (active vit D)
% of filtered uric acid load that is excreted
8-12%
side effect xanthine oxidase inhibitors allorpurinol
febuxostat
GI
acute gout
hypersensitivity (esp in renal disease pt)
halmark of secondary hyperparathyroidism
increased PTH
