Renal Pharmacology: NSAIDs and Acute Renal Failure Flashcards
Why is dosage adjustment necessary with renal impairment?
Many drugs are eliminated through the kidney and may become toxic if clearance is impaired.
What three factors contribute to drug clearance?
(1) Glomerular filtration
(2) tubular secretion (requires transporters thus the possibility of DRUG DRUG INTERACTIONS.
(3) Tubular reabsorption
What is the best measure of renal function and how is it measured?
GFR is the measure of renal function and creatinine clearance is the best way to measure GFR.
What is the cutoff for normal renal function?
GFR greater than 80.
What is the cutoff for severe renal impairment
GFR below 30.
Why are NSAIDs so important when considering renal function?
NSAIDs are among the most commonly consumed drugs in the world. 20-30% of people over the age of 65 consume NSAIDs.
What happens to GFR as people age?
GFR declines as people age.
What proportion of preventable adverse events are due to NSAIDs?
15.4%.
Are prostaglandins primary regulators of renal function?
No, they play only a minimal role in healthy individuals with normal volume status.
What effects do PGI2 and PGE2 have on the kidney?
They induce vasodilation in interlobular, afferent, and efferent arterioles
What conditions lead to the production of prostaglandins in the kidney?
(1) true intravascular volume depletion
(2) CHF
(3) cirrohsis
(4) nephrotic syndrome
What can happen to people taking NSAIDs with risk factors for adverses events?
The NSAIDs can induce a reduction in GFR.
Why does CKD lead to increased PG synthesis?
Because the kidney is trying to increase perfusion to the remaining nephrons.
What drugs can significantly increase the risk of ARF when used with NSAIDs?
ACE inhibitors and ARBs both increase the risk of ARF when used with NSAIDs.
What is the effect of PGs on ADH?
PGs inhibit cAMP production thus inhibiting ADH.
