W13 Kidneys + Drug Therapy Flashcards

1
Q

what is a nephrotoxic drug

A

drugs that have the potential to harm the kidneys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is important if a drug is classed as being nephrotoxic

A

understand the pharmacokinetics and pharmacodynamics of the prescribed medications

understand the clinical context of the patient and have the ability to interpret the available literature

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what options do we have when reviewing medications for Acute kidney injury or Chronic kidney disease

A

Stop drug

withhold drug

amend dose

continue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what questions should we ask to ourselves if a patient has reduced renal function

A

is the patient in AKI or CKD

is the patient at risk of AKI

which medication should be suspended

which medication should be used with caution

are there any alternative option

what does should a medicine be reduced to

what additional monitoring do we need to do

what are the pharmacokinetics of the drug

what are the pharmacodynamics of the drug

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what issues with absorption (A) can a patient with reduced renal function have

A

patients typically have oedema as their kidneys are less efficient at removing water and salt. this can affect the wall of the bowel leading to reduced absorption of drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what issues with distribution (D) can a patient with reduced renal function have

A

drug distribution is affected by water balance as oedema can affect drugs that are more hydrophillic.

Nephrotic syndrome leads to decreased protein levels in the blood. Many drugs are bound to proteins when in the blood. Lack of proteins will mean higher levels of free drug in blood. leading to toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what issues with metabolism (M) can a patient with reduced renal function have

A

Kidney failure means that these drugs will no longer be metabolised by the kidneys

uraemia can also reduce liver function leading to decreased metabolism of drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what issues with excretion (E) can a patient with reduced renal function have

A

Reduced renal clearance means increased levels of drugs or their metabolites in the blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What does the acronym canada stand for

A
Contrast media
Ace Inhibitors
NSAIDs
Diuretics
ARBs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what does NSAIDs stand for

A

Non-steroidal anti-inflammatory drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are ace inhibitors used to treat

A

hypertension, heart failure, nephropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what do ace inhibitors work on

A

Renin angiotensin aldersterone system as it inhibits the conversion of angiotensin 1 to angiotensin 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what do we do with ace inhibitors when a patient has renal failure

A

hold

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what do we do with NSAIDs when a patient has renal failure

A

hold

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what do selective cox 2 inhibitors do

A

they inhibit prostaglandins which inhbits vasodilation of afferent arteriole leading to reduced kidney perfusion

they also promote sodium retention and therefor fluid retention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what do diuretics cause

A

diuresis

17
Q

what is the purpose of taking a diuretic

A

increase NaCl exretion and hence water exretion

18
Q

what are the 5 different classes of diuretics (PLATO)

A

Potassium sparing diuretics

Loop diuretics

Aldosterone antagonists

Thiazide or thiazide like diuretics

Osmotic Diuretics

19
Q

what is the most powerful diuretic

A

loop

20
Q

what can loop diuretics be indicated for

A

Acute pulmonary oedema

Congestive heart failure

Fluid overload in renal/liver disease

Hypertension

21
Q

when should loop diuretics be given

A

they should not be offered in renal impairment unless managining oedema or when renal function is recovering or patient is awaiting renal replacement therapy

22
Q

what do loop diuretics act on

A

ascending limb of the loop of Henle

23
Q

how do loop diuretics work

A

they inhibit Na+ reabsorption meaning less water uptake and increased urine production

they also inhibit K+ and CL- reabsorption

they also inhibit urate excretion

24
Q

what are the adverse effects of a loop diuretics

A

Cause water excretion leading to dehydration which could lead to hypotension

Inhibit Na reabsorption = hyponatraemia

Inhibit K reabsorption = hypokalaemia

Inhibit Ca2+ reabsorption = hypocalcaemia

Inhibit Mg2+ re-absorption = hypomagnesia

Inhibit urate excretion can lead to hout

25
Q

what do thiazide and thiazide like diuretics act on

A

distal convoluted tubule of the nephron

26
Q

what is a thiazide like diuretic indicated for

A

oedema of cardiac renal or hepatic origin

hypertension: monotherapy or as an adjunct

27
Q

what do thiazide like diuretic do

A

Inhibit Na+ reabsorption = increases water excretion
Inhibit Cl- reabsorption
Inhibit K+ and Mg re-absorption

Increase Ca2+ absorption into the body

28
Q

what are adverse effects of thiazide like diuretics

A
hypokalaemia, 
hyponatraemia, 
hyperuricaemia 
hypercalcaemia,
hyperglycaemia
vasodilation (could be used as a positive)
29
Q

what do aldosterone antagonists do

A

increases water and sodium re absorption in the collecting tubule

inhibitng alodsterone means that less water and Na will be reabsorbed but increases reabsorption of K+ so known as potassium sparing

30
Q

what are other problem drugs

A
analgesics
antibioitcs
antieplieptics
anticholinergics
antispasmodics
antihypertensives
digoxin
hypoglycaemic agnets
Lipid lowering agents
31
Q

what is a sick day rule

A

temporarily discontinue taking certain drugs during acute interuccrent illnesses.