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20 Cards in this Set
- Front
- Back
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low hepatic extraction ration drugs:
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antipyrine
diazepam phenylbutazone theophylline tolbutamide warfarin |
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high hepatic extraction ratio drugs:
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lidocaine, meperidine
propoxyphene propranolol verapamil |
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what happens to free concentration of low CLint drug with varying fraction unbound?
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no change
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what happens to total concentration of low CLint drug with varying fraction unbound?
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the higher fraction unbound will have a lower concentration since more is able to be cleared
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severe level of albumin:
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<2.8
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Moderate albumin level:
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2.8-3.5
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Mild albumin level:
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>3.4
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CYP 2E1<2d6<1a2<2c19
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hard to predict effect of liver disease and look at each individual pthwy and see how effected
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GSH>acetyl >sulfo-transferase
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impaired phase 2's
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ascites
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from decreased albumin, htn, decr renal perfusion, incr aldosterone-->fluid overload, na/water retention.
treat with diuretic spironolactone/furosemide, ascitic taps also. shunt for portal htn. |
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high extraction drugs to decrease the dose of:
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chlormethiazole, propranolol, lidocaine, verapamil, NG
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MW of ? is not filtered at glomerulus
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no protein or anything else over 60,000 daltons
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hallmarks of glomerular disease eg glomerular nephritis
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proteinuria and/or hematuria (RBC)
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drugs that alter renal hemodynamics
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NSAIDS
vasoconstrictors ACE inhibitors hepatorenal syndrome |
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things that can impair proximal tubule action:
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ischemia, prerenal azotemia, crystalluria, nephrotoxicity--AGs, fanconi syndrome
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things that can impair distal tubule action:
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nephrotoxins eg amphotericin
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things that can affect interstitium action
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interstitial nephritis from eg NSAIDS
Fibrosis |
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Collecting duct impairment causes
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SIADH
Nephrogenic diabetes insip |
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drug that is primarily metabolized in liver that has reduced clearance in ESRD:
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ERY
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% normally renally excreted that is of concern in renal insufficiency
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30 or more
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