Renal Pharmacology Flashcards
What is renin secretion stimulated by?
Macula densa
Sympathetic tone
What does aldosterone stimulate?
sodium uptake
potassium excretion
What does an ACEi do?
Inhibits vasoconstrictive effect of angiotensin II
- Acts on efferent arteriole
- Removes sodium and water
What are ACE inhibitors used for?
Hypertension
Cardiac failure
CKD (Reduces the intra-renal pressure)
What are side effects of ACE inhibitors?
Hypotension
- Consider holding if AKI or risk of AKI
Hyperkalaemia
- Inhibits the action of aldosterone
What are examples of Angiotensin Receptor Blockers (ARBs)?
Valsartan
Irbesartan
What do loop diuretics do?
Inhibits uptake of sodium, potassium, chloride and water
Remove sodium, potassium and water
In what conditions are loop diuretics used?
CKD
Nephrotic syndrome
Hypertension
Cardiac failure
What are side effects of loop diuretics?
Hypovolaemia
Hypokalaemia
- Can be used with potassium sparing diuretic (amoloride)
What are 2 types of loop diuretic?
Furosemide
Bumetanide
What do thiazides do?
Inhibits sodium uptake
Remove sodium and water
In what conditions are thiazides used?
CKD
Nephrotic syndrome
Hypertension
Cardiac failure
What is a side effect of thiazides?
Hypovolaemia
What does spironolactone do?
Inhibits aldosterone
- prevents sodium reabsorption in exchange for potassium
Removes sodium and water
What conditions is spironolactone used to treat?
Cardiac failure
Liver cirrhosis - ascites
What is a side effect of spironolactone?
Hyperkalaemia
What does Amiloride do?
Inhibits sodium reabsorption in exchange for potassium
Removes sodium and water
What is amiloride used for?
to prevent hypokalaemia
What is a side effect of amiloride?
Hyperkalaemia
What four classes of drugs are used in CKD?
Anti-hypertensives
Diuretics
Sodium bicarbonate
Statins
What do the kidneys do in relation to vitamin D?
They activate it (turn it into calcitriol)
How does kidney disease affect calcium phosphate metabolism?
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
What does a vitamin D analogue do?
Hydroxylated by liver to active form
Increases uptake of
Calcium from gut
Phosphate from gut
What are side effects of Vitamin D analogues?
Hypercalcaemia
Hyperphosphataemia
What is an example of a vitamin D analogue?
Alpha calcidol
What does erythropoetin do?
Stimulates erythropoiesis
RBC production
Where is erythropoetin produced and what is its secretion stimulated by?
Produced by cells in the interstitium
Secretion stimulated by hypoxia
When should erythropoetin be given by a clinician?
when eGFR
What are the side effects of erythropoetin injection?
Hypertension
Pure red cell aplasia
- antibodies
What do prostaglandins do to the kidney?
vasodilate the afferent arteriole
What do ACEi and ARBs do to the kidney?
inhibit efferent arteriolar vasoconstriction
Decreases transglomerular pressure
Decreased GFR
What are the risks of penicillins to the kidneys?
Rarely cause: acute interstitial nephritis
Accumulation leads to CNS side effects including seizures
What are the risks of opiates in relation to the kidneys?
Accumulation of active metabolites, especially morphine, pethidine and codeine
Increased incidence of CNS side effects & respiratory depression
Digoxin can be nephrotoxic. What are its effects?
Accumulation leading to - bradycardia - visual disturbances - mental confusion Aggravates hyperkalaemia
What are the risks of metformin? (oral type II diabetes medicine that helps control blood sugar levels)
Lactic acidosis
Accumulation leading to hypoglycaemia
Avoid if GFR
Which herbal preparations should you be aware may be nephrotoxic?
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)
