W13 Kidneys + Drug Therapy Flashcards
what is a nephrotoxic drug
drugs that have the potential to harm the kidneys
what is important if a drug is classed as being nephrotoxic
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
what options do we have when reviewing medications for Acute kidney injury or Chronic kidney disease
Stop drug
withhold drug
amend dose
continue
what questions should we ask to ourselves if a patient has reduced renal function
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
what issues with absorption (A) can a patient with reduced renal function have
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
what issues with distribution (D) can a patient with reduced renal function have
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
what issues with metabolism (M) can a patient with reduced renal function have
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
what issues with excretion (E) can a patient with reduced renal function have
Reduced renal clearance means increased levels of drugs or their metabolites in the blood
What does the acronym canada stand for
Contrast media Ace Inhibitors NSAIDs Diuretics ARBs
what does NSAIDs stand for
Non-steroidal anti-inflammatory drugs
what are ace inhibitors used to treat
hypertension, heart failure, nephropathy
what do ace inhibitors work on
Renin angiotensin aldersterone system as it inhibits the conversion of angiotensin 1 to angiotensin 2
what do we do with ace inhibitors when a patient has renal failure
hold
what do we do with NSAIDs when a patient has renal failure
hold
what do selective cox 2 inhibitors do
they inhibit prostaglandins which inhbits vasodilation of afferent arteriole leading to reduced kidney perfusion
they also promote sodium retention and therefor fluid retention