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renal pharmacology 2 Flashcards

1
Q

4 relevant types of drugs

A

altering urine pH drugs

altering excretion of organic molecule drugs

drugs for treating urinary tract disorders

drugs for treating renal failure

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2
Q

healthy urine pH

A

6

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3
Q

the urine’s pH is slightly acidic due to the metabolites - 3

A

urea
ureic acid
createnine

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4
Q

pH altering drugs can change the pH of urine to

A

5-8.5

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5
Q

what causes acidification of urine - 4

A

meat heavy diet

sodium heavy diet

metabolic acidosis - excessive bicarbonate loss

thiazide diuretics

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6
Q

what causes alkination of urine - 3

A

citrus fruit -heavy diet

respiratory alkalosis

urinary tract infection as bacteria converts urea to ammonia

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7
Q

patients with ___ urine may be more susceptible to UTIs

A

alkali

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8
Q

clinical benefits of alkaline urine - 5

A

antibacterial

improves dysuria (difficult urination)

inhibits urinary stone formation

solubilisation of weak acid drugs

enables excretion of toxic substances

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9
Q

example where drug excretion is effected by urine pH

A

methamphetamine - acidic urine = more excretion in less time

less in alkaline urine

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10
Q

carbonic anhydrase inhibitors

A

convert carbon dioxide and water intocarbonic acid, protons, bicarbonate ions - so may be used as diuretic

stop bicarbonate reabsorption in nephron

inc bicarbonate excretion so inc urine pH

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11
Q

sodium bicarbonate can be used to treat __ overdose

A

salicylate

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12
Q

carbonic anhydrase inhibitor example

A

acetazolamide

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13
Q

carbonic anhydrase inhibitor - when does tolerance develop

A

after 3 days

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14
Q

citrate admin

A

oral as Na and K salts

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15
Q

calcium citrate treats

A

calcium deficiency

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16
Q

potassium citrate treats

A

renal tubular acidosis (kidney stone formation)

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17
Q

citrate metabolism is via

A

citric acid/ Krebs cycle

excretes bicarbonate resulting in alkaline urine

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18
Q

at what point in the krebs cycle does citrate feed in

A

when citrate converted to isocitrate via aconitase

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19
Q

drugs that alter the excretion of organic molecules are particularly relevant in treatment of

A

gout

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20
Q

what is gout

A

form of acute arthritis
causes uric acid crystal formal in joints due to accumulation

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21
Q

what is gout caused by

A

hyperuricaemia - serum uric acid level of larger than 404micromol per L

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22
Q

what is gout exacerbated by - 3

A

alcohol consumption

meat consumption

diuretic ise

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23
Q

what is hyperuricaemia

A

serum uric acid level of larger than 404micromol per L

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24
Q

gout is more common in which sex

A

men

as inc consumption of meat, alcohol vs women

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25
kidneys are an important __ of uric acid secretion
regulator
26
approx __% of uric acid is secreted by kidneys
65%
27
approx __% of uric acid is secreted by intestine
35%
28
how is uric acid formed
through the catabolism of purines
29
uric acid excretion via kidneys pathway
uric acid passes into glomerular filtrate then most reabsorbed in proximal tubule small amount excreted into tubule via an anionic secreting mechanism
30
small amount excreted into tubule via an anionic secreting mechanism. how much?
8-12% filtered urate is excreted
31
treatment focus to treat gout
inc elimination of urate
32
types of drugs used to treat gout by inc elimination of urate - 2
uricosuric agents inhibition of urate synthesis
33
examples of uricosuric agents used to treat gout by inc elimination of urate - 2
probenecid sulfinpyrazone
34
examples of drugs used to treat gout by inc elimination of urate that inhibit urate synthesis
allopurinol
35
probenecid inhibits
penicillin excretion
36
when using uricosuric agents, uric acid excretion
decreases before it begins to increase - nike tick shape on graph hehe
37
probenecid mechanism of action
inhibits URAT1 and OAT4 transporters in human proximal tubule cannot facilitate uric acid reabsorption so excreted
38
where are URAT1 and OAT4 transporters located
in human proximal tubule
39
xanthine oxidase
enzyme oxidises xanthine to convert it to uric acid
40
s-allyl cystine and allopurinol
inhibits xanthine oxidase
41
what is renal failure
waste product accumulation decline in kidney functions potentially fatal
42
renal failure causes - 2
congenital disease acquired disease
43
renal congenital disease example
polycystic kidney disease - formation of cysts on kidney inherited autosomal dominant 1 PKD1 or PKD2 mutated copy per cell
44
renal acquired diease example
hypertension (cause and symptom of renal failure)
45
types of renal failure - 2
acute aka acute kidney injury chronic aka end stage renal disease ESRD
46
acute kidney injury causes - 5
not enough blood reaching kidneys kidney damage blocked ureter drug abuse heart attack
47
chronic kidney disease causes - 5
diabetes autoimmune disease e.g. lupus genetic disease e.g. PKD nephrotic syndrome urinary tract problems
48
three main approaches to treating renal failure
artificial dialysis/ filtration renal transplantation pharmaceuticals
49
three types of drugs that treat consequences of renal failure (renal failure itself is not always reversible)
antihypertensive drugs ACE (angiotensin converting enzyme) inhibitors Angiotensin II antagonists
50
angiotensin
blood pressure increasing-hormone
51
healthy kidneys produce a hormone called
erythropoetin or EPO
52
erythropoetin or EPO
stimulates RBC formation unhealthy kidneys produce less EPO causing anemia
53
vitamin D preparations examples - 2
calcitriol alphacalcidol
54
use of vitamin D preparations
treat osteodystrophy / defective bone development
55
canaglifozin
new reduce risk of chronic kidney disease/ cardiovascular events in diabetic patients
56
canaglifozin mechanism of action
binds and inhibits sodium glucose cotransporter 2 SGLT2 is found in proximal tubule of nephron and reabsorbs glucose inhibition leads to inc glucose excretion
57
renal failure leads to plasma imbalances. what are two examples of these
hyperphosphataemia hyperkalaemia these can be treated with pharmaceuticals
58
what is hyperphosphataemia
phosphate levels in plasma above 1.45 mmol/L
59
hyperphosphataemia clinical consequences - 3
vascular smooth muscle cells differentiate into osteoblast like cells - can lead to cardiac disease calcium phosphate deposits in joints, dec mobility conjuctivitis in eye
60
drugs used to treat hyperphosphataemia - 3
aluminum hydroxide or antacid calcium carbonate sevelamer hydrochloride
61
aluminum hydroxide or antacid mechanism of action
binds phosphate in GI tract to prevent absorption
62
calcium carbonate side effect
predispose to tissue calcification due to calcification of arteries
63
aluminum hydroxide or antacid side effect
long term use can cause loss of bone density
64
sevalmer hydrochloride mechanism of action
lowers plasma phosphate conc lower risk of arterial calcification than caclium carbonate lowers LDL cholesterol
65
sevalmer hydrochloride side effects - 2
GI disturbance contraindicated in bowel obstruction
66
what is hyperkalaemia
elevated potassium ion conc in plasna abive 6.5mmol/L
67
hyperkalaemia causes - 5
renal failure metabolic acidosis (as inc protons inc K+ expelled) potassium sparing diuretics drugs that interfere with renin secretion angiotensin II formation/ action (ACE inhibitors)
68
hyperkalaemia treatments IV - 4
calcium gluconate glucose + insulin salbutamol sodium bicarbonate counteracts cardiac toxicity admin IV
69
hyperkalaemia treatments IV mechanism of reaction
shift K+ into intracellular compartment, out of circulation
70
cation exchange resins - hyperkalaemia treatment
new e.g. Na polystyrene sulfonate orally or as enema removes K+ from system dialysis often needed
71
patiromer - hyperkalaemia
new drug potassium binder promoted faecal potassium ion excretion
72
renal vulnerability to drug toxicity may be
patient specific kidney specific drug related - e.g. crystal formation, interactions with pH can vary based on age, sex, pharmacogenomics, metabolic enzyme expression
73
urinary tract disorders include - 3
enuresis - bed wetting urinary incontinence urinary tract infections/ UTIs
74
noctural enuresis causes - 3
uti constipation anxiety
75
noctural enuresis treatments - 2
desmopressin amitriptyline also use alarm and restrict fluid intake
76
desmopressin
antidiuretic hormone analog - red in water vol excreted by kidneys
77
amitriptyline
tricycline antidepressant
78
amitriptyline admin length
up to 3 months
79
amitriptyline side effect
behaviour disturbance as is psychoactive
80
urinary incontinence causes - 2
structural problems (e.g. prostatic hypertrophy, unterine prolapse) neurogenic detrusor muscle instability - becomes more active
81
urinary incontinence structural problems treatment
surgery
82
urinary incontinence neurogenic detrusor muscle instability treatments - 2
pelvic floor exercises AND muscarinic receptor antagonists
83
muscarinic receptor antagonist example
oxybutinin
84
uti infections are more common in women than men because
they have a shorter urethra, so bacteria can enter bladder more easily
85
example of uti
cystitis
86
cystitis cause
e. coli
87
uti treatment
antibiotics like ciprofloxacin (broad spec quinolone)
88
congenital disease leading to kidney failure
mutations/ abnormal development of kidneys during fetal life e.g. polycystic kidney disease PKD
89
acquired disease leading to kidney failure
after birth develop due to external factors, more common in adults e.g. acute kidney injury
90
NSAID induced acute kidney injury example case study
elderly osteoarthritis patient used high dose ibuprofen for pain management, developed acute kidney injury indicated by elevated serum creatinine levels treated via discontinuation of ibuprofen and inc supportive care importance of preventative measures - dose adjustment and personalisation od NSAIDs to reduce nephrotoxicity risk, hydration preventing crystal formation, alt to nephrotoxic meds

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