Renal Pharm Flashcards
What ist he treatment for anemia in chronic kidney disease?
Epoetin – IV or subcut
What are the side effects of epoetin?
nausea headache influenza HTN Thrombosis of arteriovenous shunts
How do you treat secondary hyperparathyroidism in chronic kidney disease?
calcitriol and vitamin D analogs
What is the mechanism of action of calcium and vitamin D analogs?
enhancement of absorption of calcium and PO4 from intestine
What are the unwanted effects of calcitriol?
excessive dosing leads to hypercalcemia
What are phophate binders?
calcium carbonate
calcium acetate
lanthanum carbonate
seelamer
What is the biphosphonates used for?
prophosphate analogues that bind to hydroxyapatitie crstals in bone matrix to treat hypercalcemia
What are the unwanted side effects of bisphosphonates?
GI disturbance, abdominal pain, nausea
osteonecrosis of jaw
What is calcitonin?
produced by parafollicular or C cells of thyroid gland
secreted when calcium levels rise
main action is lowering of plasma calcium by limiting bone resorption and increases phosphate secretions
What are the side effecs fo calcitonin?
facial flushing
headache
GI
Taste disturbance
What is rasburicase used to treat?
recombinant version of enzyme urate oxidase
used as prophylaxis during chemo
What are the unwanted side effects of rasburicase?
fever
nausea
HSN
hemolysis-due to hydrogen peroxide
What are calcineurin inhibitors used to treat?
decrease T cella ctivationa nd proliferation, to lower immune reaction or prevent organ rejection
What is the mechanism of action of tacrolimus?
macrolide that bind to and inhibit calcinuerin; inhibits transcripton of cytokines and IL2
What are the side effects of cyclosporine?
nephrotoxicity HTN and fluid rentetion hepatic dysfunction tremor, headache, fatigue GI hypertrichosis Gum hhypertrophy hyperlipidemia hypomagnesia hypokalemia
What are the side effecs of Tacrolimus?
doesnt stim TGFBeta
pleural and pericardial effusion
cardiomyopathy
What ist he mechanism of action fo siroloimus?
bidns to FKB12 and acts to modulate the mechanism of mTOR; inhibiitin cytokin/IL2 induced cell cycle progression
What are the side effects of sirolimus?
edema, ascites, HTN GI hyperlipidemia hypokalemia hypophosphatemia lymphocele rash drug interactions
What are the benefits of siroloimus?
protent phrophylaxis against cellular rejection
less vasocontriction
not associated with acute or chronic renal insufficiency
What is the mechanism of action of mycophenolate mofetil?
competitive, reversible inhibition of IMPDH a critical rate-limiing enzyme in de novo purine synthesis
lymphocytes dependent on de novo pathway
inhibits proliferation of B + T lymphocytes
What are the unwanted side effect of mycophenolate mofetil?
HTN, edema, tachy dyspnea, cough dizziness, insomnia, termor, seizures leucopenia, thrombocytopenia, anemia opportunistic infections lymphoproliferative disease
What is the mechanism of action of azathioprine?
purine analogue
metabolized in liver to 6-mercaptopurine and tehn to TIMP
blocks CD28 costim of T cells
What is the mechanism of action of basiliximab?
anti-CD25 antibody; blocks IL2 receptor antibody
What is the mechanism of action of belatacept?
fusion protein binds CD80 and CD86; blocks co stim action
What is teh role for belatacept?
used for renal transplantation in patients seropsoivitve for EBV
What is the unwanted side effects for belatacept?
HSN reaction rarely occur
lymphoproliferative disorder in those with no prior exposure to EBV
What is the side effects of prednisolone?
acne cushingoid hirsutism mood disorder HTN glucose intolerance cataracts osteoporosis growth retardation in children
What are the induction agents role in combating kindye transplant rejection?
monoclonal or polyclonal antibody
admin IV imediately following surgery
What are the maintenance agents for combatting kidney tranplant rejection?
prednisolone
calcineurin inhibitor
anti-proliferative agents
triple agents
