Renal pharm

Question 1

What gout drug does not work for gout if pt has CKD? why?

Answer 1

Probenecid.

b/c it acts on OAT transporters in tubules, which are not functioning in CKD.

probenecid competitively binds to OAT (organic anion transporter), which means uric acid stays in the urine

Question 2

Kidney transplantation:

• 3 signal approaches to immunosuppression
• drugs for each

Answer 2

All about APC-T cell interaction:

1. Calcineurin inhibitors–stop IL2 generation
   - Cyclosporine (cyclophilin)
   - Tacrolimus (FKBP)
2. mTOR inhibitors–stop IL2 response in target cell
   - Sirolimus
3. DNA transcription inhibitors
   - Azathioprine (6-MP)

Question 3

Cyclosporine and Tacrolimus for kidney transplant:

-biggest side effect

Answer 3

nephrotoxicity for both

but Sirolimus is not nephrotoxic

Question 4

name some nephrotoxic drug groups

Answer 4

• Calcineurin inhibitors
• NSAIDs
• aminoglycosides
• Vancomycin
• Acyclovir, gancyclovir

Question 5

sirolimus:

side effect specific to kidney transplant

Answer 5

lymphocele

-can cause ureteric compression

Question 6

Hirsutism: which drug’s side effect?

(transplantation drug)

Answer 6

Cyclosporine

Question 7

Sirolimus

• biggest side effect
• next major side effect

Answer 7

1. Hyperlipidemia
2. bone marrow suppression (anemia, leukopenia, thrombocytopenia)

(cyclosporine and tacrolimus also can cause HL)

Question 8

MMF

-major side effects

Answer 8

1. bone marrow suppression (leukopenia, anemia, thrombocytopenia)
2. opportunistic infections (esp CMV, and also bacterial UTI)

Question 9

kidney transplant pt on MMF:

watch out esp for what infection?

Answer 9

CMV infection

Question 10

hyperlipidemia and bone marrow suppression in transplant pt

what drug?

Answer 10

Sirolimus

Question 11

what drug increases toxicity of azathioprine?

Answer 11

Allopurinol

-both act on purine synthesis pathway. XO inhibitors decrease metabolism of metabolites (and AZA) into uric acid.

Question 12

Azathioprine

-major side effects

Answer 12

• bone marrow suppression
• also toxicity can increase if allopurinol is taken

Question 13

Prednisolone

• mech
• time to effect

Answer 13

• inhibit transcription of NK-kB, a pro inflammatory TF
• reduces T and B cell proliferation
• works by binding to a steroid response element that is a TF itself, so takes 8 hours. (transcription, protein synthesis)