Renal Pharm Flashcards
Phosphate-binding drugs?
Selevamer
CaCO3
Vitamin D analogue?
Calcitriol
Calcimemetic?
Cinacelcet
Primary function to maintain constant Ca+ concentration in ECF in response to plasma Ca+ concentration
PTH
Starting with this stage of CKD, you have a decreased renal phosphorus excretion (so elevated serum phosphate) and decreased vitamin D activation: Decreased GI Ca absorption so decreased serum Ca+ concentration
Stage 3 CKD
Released to:
- Increase Ca+ resorption from bone and in PCT
- Decrease phosphorus resorption in PCT
- Increase activation of Vitamin D to increase GI Ca+ absorption and mobilization of Ca+ from bone
PTH
Low serum Ca+ and increased phosphorus cause increased PTH levels and….
sHPT
Calcium based phosphate binder
CaCO3
For use in CKD with hyperphosphatemia; Binds to phosphorus in GI tract and is excreted
CaCO3
For use in HYPERPHOSPHATEMIA; non-absorbed phosphate binder that prevents phosphorus absorption, promoting excretion
Sevelamer
Can also reduce LCL-C up to 30%; Very expensive!
Sevelamer
Activated Vitamin D; used for reduction of PTH levels and hypocalcemia in ESRD
Calcitriol
Up-regulates Vit D receptor on PT gland, decreasing gland hyperplasia and PTH synthesis
Calcitriol
Also up-regulates GI Vit D receptors, increasing Ca+ and phosphorus absorption
Calcitriol
Calcimemetic; used for elevated serum PTH, Ca+ and Ca-P product (in dialysis pts only!!)
Cinacalcet
Reduces PTH secretion by sensitizing PT gland Ca+ receptors (mimicking the action of Ca+ at receptor) lowering Ca+ and phosphorus levels.
Cinacalcet
Caution of use in patients with seizure disorder! Useful for pts who can’t use Vit D
Cinacalcet
Thiazide diuretics used for HTN, edema in nephrotic syndrome; off-label use in lithium induced DI; Loses effectiveness at GFR
HCTZ Chlorthalidone (2x potency)
Na-Cl symporter inhibition in the DCT increasing Na and Cl excretion to max 5% of filtered NaCl
Thiazide Diuretics: HCTZ Chlorthalidone Metolazone (SA) Indapamide (LA)
Chronic use decreases Ca+ excretion & can increase serum uric acid levels
Thiazide diuretics
Secreted into renal tubule via active transport in PCT (organic acid pathway); NSAIS interfere with this secretion
Loop Diuretics
Used for edema secondary to CHF, Renal failure, liver failure; Inhibits Na+-K+-2Cl- symporter in TAL & distal tubule
Loop diuretics
Erythropoesis stimulation agent; Growth Factor-stimulates erythroblasts to proliferate and differentiate into normoblasts, then reticulocytes
Epoetin alfa (Epogen)
Magnesium supplement; indicated in hypomagnesemia (also with low K+ and low Ca+ also)
MgCl
Potassium supplement; indicated in hypokalcemia
KCl
PGE2 causes dilation and AT2 causes constriction
Afferent arteriole
AT2 causes constriction
Efferent arteriole
Inhibits PGE production resulting in unopposed afferent renal arteriole AT2 impact–> vasoconstriction & interferes with PGE modulated inhibition of Na and Cl-reabsorption
NSAIDs
Causes renal vasoconstriction
cyclosporine
Cause an osmotic diuresis; Renal injury may include direct tubular toxicity, renal ischemia, tubular obstruction
Ionic contrast materials
If you must use ionic contrast materials, you must expand EC volume with…
isotonic NaCl solution
One of the first classes of diuretics discovered
Carbonic anhydrous inhibitors
Carbonic anhydrase inhibitor; used in glaucoma and altitude sickness
Acetozolamide
Reversibly blocks carbonic anhydrase in PCT maintaining NaHCO3 in tubule lumen, resulting in diuresis
Acetozolamide
Thiazide diuretics that DON’T lose effectiveness at GFR
Metolazone & Indapamide
K+ Sparing diuretics
Spironolactone
Eplenerone
Amilloride
Triamterine
K+ sparing agent; synthetic steroid that competitively antagonizes aldosterone; Metabolized by the liver
spironolactone
K+ sparing agent; spironolactone analogue with much greater mineralocorticoid receptor selectivity
Eplenerone
K+ sparing agent; direct inhibitor of Na+ influx (and corresponding K+ secretion) in cortical collecting tubule and ducts (DOESN’T BLOCK ALDOSTERONE)
Amiloride Triamterene (shorter T1/2)-more freq dosing
Can decrease myocardial fibrosis
Spironolactone & Eplenerone
CYP34A substrate; more selective for mineralocorticoid receptor and so fewer SE than spironolactone
Eplenerone
Used in combo with Thiazide diuretics
Amiloride & Triamterine
Administerd IV for systemic effect (not absorbed orally and oral use causes osmotic diarrhea)
Mannitol
Not metabolized; filtered via glomerulus; exerts osmotic force in PCT and DL of Loop of Henle decreasing water reabsorption
Mannitol
Osmotic diuretic; used for reduction of intracranial or intraocular pressure and rhabdomyolysis; Works by osmosis producing increased water loss
Mannitol
