renal pharma Flashcards
list of aminoglycosides
amikacin, tobramycin, gentamicin, neomycin, streptomycin
pt started on HAART presents with flank pain and needle crystals in urinary segmentation …. which drug can cause this
crystal induced nephropathy by protease inhibitors (avirs)… the drug precipitates the urine
whn is abacavir contraindicated
whn a pt has HLAb5710 mutation due to increase in hypersensitivity
pt with SIADH due to small cell tumor what is the best initial management step
water resitriction ……. SIADH already causes hyponatremia so if u restrict water intake it may help increase the sodium levels ….
hyponatremia increases ADH secretion
mannitol side effects
pulmpnary edema dehydration
pt with impaired renal and hepatic function how shd the loading dose and maintenance dose be changed
loading remains same as it depends on Vd …. maintenance is lower
hepatic encephalopathy can be exacerbated by many conditions like?
hypokalemia, alkalosis and hypovolemia
how can the use of thiazide diuretics lead to increase in ammonia production
use of thiazide cause hypokalemia… this causes the K+ n the cells to move out into ECF and H+ moves intracellularly making an acidic environment for more ammonia productiopn
why is celcoxib contraindicated in dehydrated pts
dehydration causes increase release of angiotensin II … this causes vasoconstriction at efferent that keeps GFR in checj
also prostaglandins are produced that vasodialate the afferent .. if this is blocked it will cause perfusion problems in the kidney
Na2ClK inhibtors
loooop diuretics … feurosemide … thick asc lmb
lithium can cause what
diabetes insipidus … as it is an aldosterone antagonist
pt has diabetes insipidus and is undertreatment with a drug that causes tooooth discoloration what is this drug
demeclocycline
what antibiotics are contraindicated during pregnancy
tetracyclines, TMP SMX, fluoroquinlones, aminoglycosides
cyclosporin mechanism
blocks transcription of IL2 which is needed for T cell differentiation and activation
inhibition of t cell nucleotide production and DNA synthesis
azathioprine
conn syndrome pt what is the txt
spirinolactone
celecoxib effect on kidney
constrict afferent
uncomplicated UTI first line of txt and also txt incase of sulfa allergy
TMP SMX … nitrofurantoin
causes of AIN
sulfa drugs like thiazaid diuretcs
what is special of blood gas values in aspirin overdose
mixed … resp alkalosis and metabolic acidosis which makes the pH look normal
what does acetazolamide do to the urine
alkalizes urine … treat mountain sickness
when could urine dipstick be psotive for blood but urinalysis reveals 0 RBCs
in tubular necrosis … dipstick tests for heme … for ex in rhabdomyoliss
how does loop diuretic cause metabolic alkalosis
loss of na in urine … ENAC starts reabsp more Na … promotes potassium and proton secretion into urine … acidifies urine
how to treat acute exacerbations of heart failure
if kidney function fine - thiazide
if not + severe HF - looop
liddle syndrome
hypertension… excess sodium reabsp by ENac … low potassium reabsp … hypertension, low renin and aldosterone, hypokalemia and metab alkalosis …. txt with k sparring diuretics
barter syndrome
resembles loop diuretics … problem with Na2clK
which diuretic secondarily increases calcium reabsp
thiazide
effects of PTH
- decrease phosphate reabsp in PCT
- increase calcium reabsp in DCT
- converting 25 hydroxycalciferol to 1,25
which CAH has increased renin
21 hydroxylase … problem in making minerelocorticoid
what happens to oncotic pressure in glomerular capillary and bowmans space
cap= pressure decreased bowmans= increased
mesna
cyclophosphamide to prevent hemorrhagic cystitis
colchicine mechanism
inhibits neutrophil chemotaxis
amifostine
prevent renal damage in cisplatin txt
proximal tubule is the site of what type of reasbso
isosmotic water and solute
which segment reabsp solute but not water
thick asc loop … site of loop diuretics
PTH
- kidney decrease phosphate reabsp
- gut activate alpha 1 hydroxylase and inc calcium absp
- osteoclast activity increased
v2 mechanism
Gs coupled increases aquaporins
v1 mechanism
Gq.. smooth muscle
ctivation of G-protein–coupled receptors in the adrenal cortex elevates cAMP levels and leads to increased production and secretion of corticosteroids.
mechanism of hormones including ACTH, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and thyroid-stimulating hormone (TSH)
what overestimates the GFR
creatinine … secreted by pCT
marathon runner rapidly ingests water … what happens ate the level of medullary colleting duct
decreased reabsp of urea from medullary collecting duct
aldosterone will cause metabolic acidosis or alkalosis
metabolic alkalosis due to hypokalemia and movement of H= intracellularly
iron tablets can be a cause of metabolic acidosis yes or no
YESS
dialysis pt misses his dialysis apt and presnts with acidosis why
uremia
MUDPILES
altered mental status, polyuria, polydipsia, hypotension, hyponatremia, hyperkalemia, and elevated anion gap are consistent with diabetic ketoacidosis (DKA) caused by type 1 diabetes mellitus (T1DM). …mechanism
pathophysiology of T1DM is a viral or autoimmune process causing inflammation in the β islets.
what is the net result of Na+ H+ in PCT
increased HCO reabsp
