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Medicine > Renal Pharmacology > Flashcards

Renal Pharmacology Flashcards

1
Q

What is renin secretion stimulated by?

A

Macula densa

Sympathetic tone

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2
Q

What does aldosterone stimulate?

A

sodium uptake

potassium excretion

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3
Q

What does an ACEi do?

A

Inhibits vasoconstrictive effect of angiotensin II

  • Acts on efferent arteriole
  • Removes sodium and water
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4
Q

What are ACE inhibitors used for?

A

Hypertension
Cardiac failure
CKD (Reduces the intra-renal pressure)

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5
Q

What are side effects of ACE inhibitors?

A

Hypotension
- Consider holding if AKI or risk of AKI

Hyperkalaemia
- Inhibits the action of aldosterone

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6
Q

What are examples of Angiotensin Receptor Blockers (ARBs)?

A

Valsartan

Irbesartan

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7
Q

What do loop diuretics do?

A

Inhibits uptake of sodium, potassium, chloride and water

Remove sodium, potassium and water

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8
Q

In what conditions are loop diuretics used?

A

CKD
Nephrotic syndrome
Hypertension
Cardiac failure

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9
Q

What are side effects of loop diuretics?

A

Hypovolaemia

Hypokalaemia
- Can be used with potassium sparing diuretic (amoloride)

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10
Q

What are 2 types of loop diuretic?

A

Furosemide

Bumetanide

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11
Q

What do thiazides do?

A

Inhibits sodium uptake

Remove sodium and water

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12
Q

In what conditions are thiazides used?

A

CKD
Nephrotic syndrome
Hypertension
Cardiac failure

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13
Q

What is a side effect of thiazides?

A

Hypovolaemia

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14
Q

What does spironolactone do?

A

Inhibits aldosterone
- prevents sodium reabsorption in exchange for potassium

Removes sodium and water

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15
Q

What conditions is spironolactone used to treat?

A

Cardiac failure

Liver cirrhosis - ascites

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16
Q

What is a side effect of spironolactone?

A

Hyperkalaemia

17
Q

What does Amiloride do?

A

Inhibits sodium reabsorption in exchange for potassium

Removes sodium and water

18
Q

What is amiloride used for?

A

to prevent hypokalaemia

19
Q

What is a side effect of amiloride?

A

Hyperkalaemia

20
Q

What four classes of drugs are used in CKD?

A

Anti-hypertensives

Diuretics

Sodium bicarbonate

Statins

21
Q

What do the kidneys do in relation to vitamin D?

A

They activate it (turn it into calcitriol)

22
Q

How does kidney disease affect calcium phosphate metabolism?

A

Decreased activation of vitamin D

Decreased calcium level

Stimulates secretion of parathyroid hormone ( four glands in the neck)

  • Secondary hyperparathyroidism
  • Releases calcium from the bone
  • Develop bone disease
    • Renal osteodystrophy
23
Q

What does a vitamin D analogue do?

A

Hydroxylated by liver to active form
Increases uptake of
Calcium from gut
Phosphate from gut

24
Q

What are side effects of Vitamin D analogues?

A

Hypercalcaemia

Hyperphosphataemia

25
Q

What is an example of a vitamin D analogue?

A

Alpha calcidol

26
Q

What does erythropoetin do?

A

Stimulates erythropoiesis

RBC production

27
Q

Where is erythropoetin produced and what is its secretion stimulated by?

A

Produced by cells in the interstitium

Secretion stimulated by hypoxia

28
Q

When should erythropoetin be given by a clinician?

A

when eGFR

29
Q

What are the side effects of erythropoetin injection?

A

Hypertension
Pure red cell aplasia
- antibodies

30
Q

What do prostaglandins do to the kidney?

A

vasodilate the afferent arteriole

31
Q

What do ACEi and ARBs do to the kidney?

A

inhibit efferent arteriolar vasoconstriction
Decreases transglomerular pressure
Decreased GFR

32
Q

What are the risks of penicillins to the kidneys?

A

Rarely cause: acute interstitial nephritis

Accumulation leads to CNS side effects including seizures

33
Q

What are the risks of opiates in relation to the kidneys?

A

Accumulation of active metabolites, especially morphine, pethidine and codeine

Increased incidence of CNS side effects & respiratory depression

34
Q

Digoxin can be nephrotoxic. What are its effects?

A 
Accumulation leading to 
 - bradycardia
 - visual disturbances
 - mental confusion
Aggravates hyperkalaemia
35
Q

What are the risks of metformin? (oral type II diabetes medicine that helps control blood sugar levels)

A

Lactic acidosis
Accumulation leading to hypoglycaemia

Avoid if GFR

36
Q

Which herbal preparations should you be aware may be nephrotoxic?

A

Chinese herbal medicines with ‘aristocholic acid’ are implicated in interstitial nephritis.
‘Cat’s Claw’ has anti-inflammatory properties but is implicated in causing AKI and hypotension with antihypertensives

(Patients may not consider herbal preparations / teas as medicines)

Medicine (25 decks)

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