Drugs And The Kidney

Front 1

What classes of drugs cause pre-renal renal insufficiency? (2)

Back 1

Antihypertensives
Diuretics

Front 2

What are different types of diuretics and where in the nephron do they act? (3)

Back 2

Thiazides (hydrochlorothiazide): Distal convoluted tubule
Loop (furosemide): ascending loop of henle
K+ sparing: spirnolactone - aldosterone, amiloride - distal tubule/CCD

Front 3

What drugs should be used with caution in patients with pre-renal renal insufficiency and why? (2)

Back 3

NSAIDs: prostaglandins normally maintain renal perfusion
ACEi: reduce glomerular perfusion pressure (by efferent dilation)

Front 4

What drug and non-drug causes of direct tubular injury? (3,3)

Back 4

Drug: aminoglycosides, radiocontrast, chemotherapeutics
Non-drugs: sepsis, hemoglobin/myoglobin, ischemia

Front 5

What are typical findings on urinalysis in a patient with ATN? (3)

Back 5

High sodium
Low osmolarity
Heme granular casts

Front 6

How do you treat ATN? (4)

Back 6

Treat underlying cause
Ensure hydration
Ensure no other renal insults
Dialysis if kidney failure occurs

Front 7

How do you prevent ATN? (4)

Back 7

Adequate hydration
Use alternative drugs that are safe for tubules
Minimize simultaneous use of nephrotoxic meds
Give N-acetylcysteine (Mucomyst) before procedure requiring contrast

Front 8

What are drugs that commonly cause acute interstitial nephritis AIN? (6)

Back 8

Antibiotics (penacillins, cephalosporins, quinolones, sulfonamides)
NSAIDs
Diuretics
Allopurinol
Phenytoin
PPIs

Front 9

What drugs commonly cause chronic interstitial nephritis?

Back 9

Analgesics
Lithium
Cisplatin
Cyclosporin

Front 10

What are signs/symptoms of AIN due to antibiotic use? (4)

Back 10

Rash
Fever
Eosinophilia
Non-oligouria

Front 11

How do you treat AIN?(2)

Back 11

Stop the drug
Steroids

Front 12

What are signs/symptoms of AIN due to NSAIDs?

Back 12

Older patient
Nephrotic range proteinuria with possibly no other symptoms

Front 13

What patients typically get chronic interstitial nephritis?

Back 13

Women
Chronic headache or athritis

Front 14

What drug causes analgesic nephropathy and what typical dose is needed?

Back 14

acetominophen
1g/day for > 2years

Front 15

What are signs/symptoms of analgesic nephropathy? (4)

Back 15

Nocturia/polyuria
Hematuria
Elevation of creatinine
Renal papillary necrosis

Front 16

What types of urinary obstructions can drugs cause/precipitate? (3)

Back 16

Intraluminal
Ureteral (rare)
Outflow

Front 17

What drugs can precipitate lumen of the kidney to cause intraluminal obstruction? (2)

Back 17

Acyclovir
Methotrexate

Front 18

What drugs can cause retroperitoneal fibrosis which can lead to ureteral obstruction? (2)

Back 18

Methysergide
Ergot derivatives

Front 19

What classes drugs can precipitate urinary outflow obstruction? (3)

Back 19

Anticholinergics
Alpha-agonists
Opioids

Front 20

How is drug dosing modified in patients with renal disease? (3)

Back 20

Reduce dose
Lengthen dosing interval
No adjustment

Front 21

How do you decide how much to adjust drug dosing in patients with renal disease? (3)

Back 21

Extent of renal elimination of the drug
Degree of renal insufficiency
Alternate routes of elimination

Front 22

What "considerations" do you take into account when dosing drugs in renal disease? (6)

Back 22

1. Is the patient's renal function impaired?
2. Is the drug effective/will it accumulate to toxic levels in patient with renal disease?
3. Is drug itself nephrotoxic
4. Is an immediate effect desired?
5. Is the drug extensively eliminated by the kidney (>75%)
6. Does the drug have active/toxic metabolites eliminated by the kidney?

Front 23

How do you decide if patient has impaired renal function?

Back 23

Crockcoft-Gault equation. If creatinine clearance is >1ml/sec adjustment is rarely necessary

Front 24

What drugs are ineffective in patients with renal disease? (1)

Back 24

Thiazide diuretics

Front 25

What drugs are unsafe in renal disease?

Back 25

Diabetes meds: chloropropamide, metformin
Gold preparations
Colchicine
Choral hydrate

Front 26

What drugs are neprhotoxic? (5)

Back 26

Aminoglycosides
Amphotericin B
Cyclosporin
NSAIDs
Vancomycin

Front 27

Is it ok to use a loading dose of a drug in patients with kidney disease?

Back 27

Yes, as long as it isn't directly nephotoxic since the loading dose is not influenced by renal dysfunction (while maintainence is)

Front 28

What drugs are extensively eliminated by the kidney (>75%)? (7)

Back 28

Aminoglycosides
B-lactam antibiotics
Digoxin
Lithium
Methotrexate
Vancomycin
Anivirals (acyclovir/ganciclovir/foscarnet)

Front 29

What drugs have toxic/active metabolites which are eliminated by the kidney?

Back 29

Meperidine
Procainamide
Trandolapril

Front 30

What do you reduce dose or increase dosing interval if you want to maintain a steady state level of a drug in a person with renal disease?

Back 30

Lower dose

Front 31

What do you reduce dose or increase dosing interval if you want peaks/troughs in drug levels of a drug in a person with renal disease?

Back 31

Increase interval

Front 32

What drugs often require therapeutic monitoring in patients with kidney disease? (5)

Back 32

Aminoglycosides
Digoxin
Lithium
Theophylline
Vancomycin