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Pharmacology /Pharm Y2S2 - Renal Part 2

Pharm Y2S2 - Renal Part 2

Pharmacology35 CardsCreated about 2 months ago

This deck covers key concepts related to renal pharmacology, including diuretics, kidney function measurement, chronic and acute kidney disease, dialysis, and post-transplant care.

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Give examples of thiazide like diuretics?

Bendroflumethiazide Indapamide Metolazone
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Key Terms

Term
Definition
Give examples of thiazide like diuretics?
Bendroflumethiazide Indapamide Metolazone
Why is indapamide preferred to other thiazide diuretics?
Lowers blood pressure at subdiuretic doses | Does not have as many metabolic effects
What effects do thiazide like diuretics have on small molecule concentrations?
Increase magnesium excretion | Reduce secretion of calcium and uric acid
What is the mechanism of action of potassium sparing diuretics?
Aldosterone antagonists, blocking the reabsorption of sodium and Na/K exchange in the collecting tubule
Give examples of potassium sparing diuretics.
Spironolactone | Eplerenone
What is the mechanism of action of amiloride?
Inhibits reabsorption of sodium in collecting tubules by blocking luminal sodium channels
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Pharm Y2S2 - Renal Part 2
TermDefinition
Give examples of thiazide like diuretics?
Bendroflumethiazide Indapamide Metolazone
Why is indapamide preferred to other thiazide diuretics?
Lowers blood pressure at subdiuretic doses | Does not have as many metabolic effects
What effects do thiazide like diuretics have on small molecule concentrations?
Increase magnesium excretion | Reduce secretion of calcium and uric acid
What is the mechanism of action of potassium sparing diuretics?
Aldosterone antagonists, blocking the reabsorption of sodium and Na/K exchange in the collecting tubule
Give examples of potassium sparing diuretics.
Spironolactone | Eplerenone
What is the mechanism of action of amiloride?
Inhibits reabsorption of sodium in collecting tubules by blocking luminal sodium channels
What is the mechanism of action of osmotic diuretics?
Increase osmolarity of filtrate, increasing sodium and water excretion, mainly in the proximal convoluted tubule, ascending loop of henle and collecting ducts
Give an example of an osmotic diuretic.
Mannitol
What are the two main methods of measuring kidney function?
1- creatinine produced by muscles and freely filtered by kidneys, increase in serum creatinine is suggestive of reduced kidney function 2- inulin administered IV is a fructose polymer that is freely filtered by kidneys, if concentration does not reduce quickly then likely to be kidney issues
What is renal clearance?
The volume of plasma from which a substance is completely removed over unit time
How does glucose reabsorption occur?
Uptake via active transport from tubular fluid to vasa recta via transporters requires sodium
What is dapagliflozin used for? How does it work?
Treatment of diabetes mellitus aiming to reduce plasma levels of glucose. Blocks SGLT 2 glucose transporter to reduce reabsorption from tubules
Name 3 efflux transporters found in the cells of the kidney. Which membrane do they lie on?
Multidrug resistance associated polypeptide Breast cancer resistance protein P-glycoprotein. Found on basolateral membrane
What is chronic kidney disease?
Damage for over 3 months as evidenced by structural or functional abnormalities Abnormal GFR (may not be present) <60mL/min/1.73m
What is the main quantitative marker of kidney disease?
Albumin-creatinine-ratio >3mg/mmol
Why is serum creatinine not always accurate?
Proportional to muscle mass
Under what circumstances is a correction factor applied to GFR values? What is this correction factor?
African and Afro-Caribbean patients | Correction factor of x1.159
What test can be used where an improved assessment of risk is required?
Cystatin C based GFR
Give complications of reduced renal function.
Anaemia CVD Disordered bone mineral metabolism Calcification of blood vessels
Give risk factors of chronic kidney disease.
Diabetes Hypertension Acute kidney injury CVD Family history Structural disease Systemic Lupus Haematuria
What are the standard management aims/treatments for chronic kidney disease?
BP <140/90mmHg or below 130/80mmHg with proteinuria Good glycaemic control Statin therapy Avoid nephrotoxic drugs ACE/ARB not to be used together Three or more antihypertensive agents Anticoagulants for secondary prevention of CVD
What are the risk factors for acute kidney injury?
Over 65 Acute illness/sepsis Hypovalaemia Hypotensive CKD Heart failure Diabetes Liver failure
How is acute kidney injury detected?
Rise in serum creatinine of >26umols/L in 48 hours 50% or more rise in creatinine over 7 days Urine output <0.5mL/kg/hr over 6 hours (8 hours in children) 25% or more reduction in eGFR in young people over 7 days
What is the main benefit of haemodialysis?
Good/efficient removal of electrolytes
What are the disadvantages of haemodialysis?
Anaemia Hypotension Air embolism Infection Pruritis
What are the disadvantages of peritoneal dialysis?
Constipation Pleural effusion Sclerosing peritonitis
What is the standard protocol for immunosuppressant therapy post kidney transplant?
Ciclosporin/tacrolimus | With or without prednisone and mycophenolate/azothioprine
What is the treatment for rejection of transplantation in hospital?
Sirolimus Methylprednisolone Plasma exchange Rituximab
What is the treatment for renal anaemia?
Serum ferritin 200-500mcg/L | Iron and erythropoietin replacement
What is mineral bone disease?
Osteoporosis etc | Deranged calcium, raised phosphate and increased levels of parathyroid hormone
When does acidosis generally occur? How is it treated?
With a GFR <30mL/min/1.73m | Corrected with oral sodium bicarbonate
What are the common side effects of haemodialysis? How can they be managed?
Hypotension due to rapid fluid removal, counteracted with bolus NaCl 0.9% Cramps due to hypotension can be improved with quinine tablets Chest and back pain due to complement activation can occur, a more biocompatible dialysed would be preferred
Give examples of drugs can can increase levels of cyclosporin/tacrolimus.
Amiodarone Erythromycin Ketoconazole Diltiazem Nifedipine Progestogens
Give examples of drugs can can decrease levels of cyclosporin/tacrolimus.
Rifampicin Carbamazepine Phenytoin Phenobarbitone St John's Wort
What are the nephrotoxic drugs?
Contrast agents Aminoglycosides NSAIDs Amphotericin Diuretics ACE inhibitors/ARBs