Sarah- Renal Pharm

Front 1

People with renal insufficiency should avoid which type of drugs?

Back 1

NSAIDs and COX-2 inhibitors

Front 2

What is the MOA and toxicity of Nitrofurantoin?

Back 2

Bactericidal, damages bacterial DNA. It is nephrotoxic, can cause diabetes insipidus

Front 3

What is the MOA of pentamidine? Toxicity?

Back 3

treats pneumonia caused by pneumocystis carini. Nephrotoxic

Front 4

What are the antihyperlipidemics? And what is their MOA

Back 4

Lovestatin and Gemfibrozil. Lovestatin inhibits HMG CoA reductase. Gemfibrozil upregulates lipoprotein lipase (LPL) synthesis and increases oxidation of fatty acids

Front 5

What is the nephrotoxic effect of the antihyperlipidemics?

Back 5

Rhabdomyolysis, muscle injury (myopathy), possible myoglobinuria and renal damage

Front 6

Which drugs of the ACEIs and ARBs are nephrotoxic? And what is their nephrotoxic effect?

Back 6

Losartan and Captopril. Hypotension, renal failure, and hyperkalemia

Front 7

Which of the drugs of the Diuretics are nephrotoxic?

Back 7

Furosemide, Hydrochlorothiazide, Triamterene, and Mannitol

Front 8

What is MESNA? What drugs is it used with?

Back 8

sulfhydryl that inactivates acrolein which is the nephrotoxic metabolite in ifosphamide and cyclophosphamide

Front 9

What two drugs of the chemotherapy drugs are alkylating agents?

Back 9

Cisplatin and Mitomycin

Front 10

What is the MOA of cisplatin?

Back 10

Chemotherapy. Complexes with DNA forming intrastrand and interstrand crosslinks of guanine.

Front 11

What is the mechanism of toxicity of cisplatin?

Back 11

conversion of nephrotoxin in proximal tubules. Results in hypomagnesium, hyokalemia, hypocalcemia, hyponatremia, hypophosphatemia and hyperurecemia

Front 12

What drug causes severe nephropathy and inhibits dihydrofolate reductase (DHFR)

Back 12

Methotrexate, chemotherapy drug

Front 13

What drug can cause microangiopathic hemolytic anemia, and if combined with thrombocytopenia and irreversible renal failure cause Hemolytic Uremic Syndrome?

Back 13

Mitomycin, a chemotherapy drug

Front 14

What are the cyclosporines and what is their MOA?

Back 14

(chemotherapy) Tacrolimus and Immunosuppressine. Block activation of T cells in early stage of differentiation

Front 15

What is the nephrotoxicity of the Cyclosporines (tacrolimus FK-506 and immunosuppressine)

Back 15

Hemodynamic factors- vasoconstriction via the sympathetic system. Results in renal ischemia

Front 16

What is the MOA of ifosphamide and cyclophosphamide?

Back 16

DNA intrastrand and interstrand cross link at N7 of guanine

Front 17

What is the nephrotoxicity of ifosphamide and cyclophosphamide?

Back 17

Hemorrhagic cyctitis and hematuria, Acute tubular necrosis and Fanconi Syndrome- require MESNA

Front 18

How can nephrotocity be avoided when using cisplatin?

Back 18

adequate hydration and dilute drug in saline

Front 19

How can nephrotoxicity be avoided in methotrexate

Back 19

if patient is receiving a high dose, give large volume parenterals (LVP) of Na Bicarbonate in to increase elimination

Front 20

How can nephrotoxicity be avoided when using mitomycin?

Back 20

plasma exchange corrects the hemolytic anemia

Front 21

In what class of people would NSAIDs and COX-2 inhibitors cause renal failure and how?

Back 21

Compromised patients (CHF, cirrhosis, nephrosis). These patients already have overexpressed COX-2 so NSAIDs and COX-2Is block compensatory vasodilation so maintanence of Renal Blood Flow and GFR are lost => acute renal failure

Front 22

Which hormones increase GFR

Back 22

NO and prostoglandins

Front 23

What hormones decrease GFR

Back 23

Norepi, Epi, endothelin

Front 24

What is the nephrotoxity of lithium?

Back 24

Nephrogenic Diabetes Insipidus, from the downregulation of V2, a vasopressin regulated channel on the apical membrane of the collecting duct

Front 25

which drug can be used to avoid Diabetes insipidus in the use of lithium?

Back 25

Desmopressin

Front 26

What is the nephrotoxicity of laxatives, how can you avoid?

Back 26

diffuse tubular injury and abundant deposits of Ca phosphate in Distal and collecting ducts. Causes volume depletion and hypokalemia. Treatment: hydration

Front 27

What is the mechanism of toxicity of contrast nephropathy?

Back 27

causes acute tubular necrosis by direct vasoconstriction by contrast agent and generation of free radicals toxic to glomeruli and tubules

Front 28

How can contrast nephropathy toxicity be avoided?

Back 28

Low dose and isomola, avoid NSAIDs. Drug options: anti-diabetic Metformin, acetylcysteine, large volume parenteral of Na bicarb

Front 29

Nitroglycerin (class and other drugs)

Back 29

Nitrates w/ Amyl nitrate, isosorbide dinitrate, isosorbide mononitrate

Front 30

Sildenafil (class and other drugs)

Back 30

5-phosphodiesterase inhibitors w/ Tadalafil, Vardenafil

Front 31

What is the MOA of the 5-PDEI?

Back 31

increase concentration of cGMP by blocking the degradation of 5-PDE, which line the smooth muscle cells of the blood vessels in the corpus cavernosum

Front 32

What class of drugs should be avoided when using 5-PDEIs?

Back 32

Nitrates

Front 33

What is the MOA of nitroglycerin?

Back 33

NO activates cGMP to cause dephos of myosin light chain to stop smooth muscle contraction => vasodilates, ateriodilates, and relaxes other smooth muscle

Front 34

What anginas can nitrates be used for?

Back 34

Typical and Atypical

Front 35

Which of the nitrates are oral? Inhaled?

Back 35

isosorbide mononitrate and dinatrate (sublingual too), nitroglycerin (subling). Inhaled- amyl nitrate

Front 36

What is the toxicity of nitrates?

Back 36

hypotension, fainting, pulsing headache

Front 37

What are the short-acting nitrates

Back 37

nitroglycerin, isosorbide dinitrate, amyl nitrate

Front 38

What are the long acting nitrates

Back 38

nitroglycerin, isosorbide dinitrate, isosorbide mononitrate

Front 39

What drugs potentiate the natural NO mechanism

Back 39

5-PDE

Front 40

What is the drug toxicity when using a nitrate and a 5-PDEI?

Back 40

Severe hypotension, reflexive tachycardia, V. contractility, cardiac ischemia, anginal pain, MI