Pharmacology in Kidney Disease

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the bioavailability of intravenous (IV) drugs in patients with kidney disease?

100% (correct)

50%

80%

Variable

How does kidney disease affect drug distribution in the body?

It decreases serum albumin levels. (correct)

It prevents drug accumulation.

It increases plasma protein binding.

It enhances drug absorption.

What is the most significant consequence of decreased renal function in terms of drug handling?

Drug accumulation and potential toxicity. (correct)

Decreased bioavailability of IV drugs.

Enhanced drug elimination.

Increased metabolism of drugs.

Which of the following mechanisms explains medication-induced nephrotoxicity?

Glomerular injury. Signup and view all the answers

What happens to the free (active) concentration of drugs in patients with nephrotic syndrome?

It decreases due to lower serum albumin levels. Signup and view all the answers

What is one of the main results of crystal nephropathy?

Obstruction within the renal tubules Signup and view all the answers

Which of these factors contributes to nucleation in crystal nephropathy?

Urine supersaturation with crystal-forming substances Signup and view all the answers

Excess vitamin C can lead to crystal nephropathy by forming which type of crystals?

Calcium oxalate crystals Signup and view all the answers

What condition is associated with uric acid nephropathy?

Hyperuricemia Signup and view all the answers

Which medication should be closely monitored in renal patients due to potential adverse effects?

Thiazide diuretics Signup and view all the answers

Which of the following is a benefit of diuretics in patients with chronic kidney disease (CKD)?

Control of blood pressure Signup and view all the answers

What role do citrates play in kidney health?

Inhibit calcium complexes Signup and view all the answers

Which of the following is a potential cause of tubular injury associated with crystal nephropathy?

Formation of crystalline deposits Signup and view all the answers

Which class of drugs is primarily associated with idiosyncratic acute interstitial nephritis (AIN)?

Antibiotics Signup and view all the answers

What is a characteristic feature of analgesic nephropathy?

Papillary necrosis Signup and view all the answers

Which of the following drugs is NOT commonly associated with acute interstitial nephritis?

Amlodipine Signup and view all the answers

Among the following options, which one reflects a dose and time dependent disorder?

Analgesic nephropathy Signup and view all the answers

Which of the following medications is considered an immune checkpoint inhibitor?

PD-L1 inhibitors Signup and view all the answers

What type of kidney injury is characterized by segmental necrotizing glomerulonephritis?

Small vessel vasculitis Signup and view all the answers

Which of the following analgesics poses the most risk for developing chronic interstitial nephritis?

Combination analgesics in high doses Signup and view all the answers

Which class of drugs can lead to acute renal injury through nephrotoxic effects?

Penicillins Signup and view all the answers

What risk is associated with injudicious diuretic use?

Increased risk of AKI Signup and view all the answers

Which electrolyte disturbance can result from thiazide diuretics?

Hypochloremic metabolic alkalosis Signup and view all the answers

How do RAAS blockers aid in chronic kidney disease (CKD) treatment?

Control hypertension Signup and view all the answers

What is a potential harm of RAAS blockers in certain clinical situations?

Hyperkalemia Signup and view all the answers

Which combination is referred to as the 'triple whammy' in the context of kidney health?

NSAID + RAAS blocker + Diuretic Signup and view all the answers

What is a significant challenge when treating hyperglycemia in patients with T2D and impaired renal function?

Decreased drug excretion leading to adverse effects Signup and view all the answers

What is a risk factor for AKI related to the use of RAAS blockers?

Bilateral renal artery stenosis Signup and view all the answers

What adverse effect can result from higher doses of thiazide diuretics?

Glucose intolerance Signup and view all the answers

What does deprescribing involve?

Discontinuing drugs when harms outweigh benefits Signup and view all the answers

Which of the following is a risk associated with NSAID usage?

Acute kidney injury Signup and view all the answers

What is a caution to consider when using NSAIDs?

Avoid use with diuretics or RAAS inhibitors Signup and view all the answers

What precaution should be taken to avoid contrast-induced nephrotoxicity?

Maintain hydration with isotonic saline Signup and view all the answers

What type of medications require careful monitoring due to their narrow therapeutic index?

Narrow therapeutic index medications Signup and view all the answers

Which of the following represents a risk of licorice consumption?

Fluid retention and hypokalemia Signup and view all the answers

What is an example of an unneeded OTC medication mentioned?

Herbal supplements Signup and view all the answers

What characterizes the ED50 of a medication?

Dose where 50% of patients experience the desired therapeutic effect Signup and view all the answers

Which of the following drugs is associated with arrhythmias as a toxicity effect?

Digoxin Signup and view all the answers

What is the primary measure to evaluate kidney function for staging of CKD?

Glomerular filtration rate (GFR) Signup and view all the answers

Which medication requires caution for its nephrotoxic effects?

Aminoglycosides Signup and view all the answers

What should be included in a comprehensive medication history?

Prescription, OTC, and dietary supplements Signup and view all the answers

When should the dose of a medication be adjusted for a patient with CKD?

Based on patient's eGFR and drug pharmacokinetics Signup and view all the answers

Which of the following is a key component of drug therapy monitoring?

Drug efficacy and toxicity monitoring Signup and view all the answers

What is a potential effect of Warfarin toxicity?

Increased risk of bleeding Signup and view all the answers

Which of these factors should NOT be checked when reviewing a medication list for a patient with CKD?

Is the drug effective for all patients? Signup and view all the answers

Study Notes

Safe Prescription in Renal Disease

Renal function is crucial for drug metabolism and elimination, impacting drug accumulation and toxicity.
Kidney disease alters drug distribution, absorption, metabolism, and elimination.
IV drugs have 100% bioavailability, unaffected by kidney disease.
Oral drug bioavailability can be affected by decreased drug absorption.
Kidney disease impacts plasma protein binding.
Uremic toxins displace drugs from binding sites, increasing free drug concentration leading to enhanced effects or toxicity.
Serum albumin levels are altered in nephrotic syndrome, impacting drug distribution.

Therapeutic Effects and Safe Prescription

Hepatic and renal drug metabolism is impacted in patients with chronic kidney disease (CKD).
Drugs altering afferent arteriolar blood flow, affect GFR (Calcineurin inhibitors, NSAIDs).
Drugs affecting efferent arteriolar vasoconstriction (RAAS blockers) can influence GFR, important in bilateral renal artery stenosis.
Mechanisms of medication-induced nephrotoxicity: functional/hemodynamic effects, glomerular injury, and tubulointerstitial injury (AIN, analgesic nephropathy, crystal nephropathy).

Medication-Induced Glomerular Disease

Direct cellular injury (epithelial, endothelial, mesangial) can be caused by various drugs.
Immune-mediated injury includes immune complex diseases and small vessel vasculitis linked to specific drugs (e.g., antibiotics, analgesics).
Note the important distinction of idiosyncratic (dose- and time-independent) injuries from direct cellular injuries.

Analgesic Nephropathy

Caused by chronic use of combination analgesics (NSAIDs + paracetamol).
This leads to papillary ischemia and necrosis due to prostacyclin synthesis, and vasoconstriction of medullary blood vessels.

Crystal Nephropathy

Chemical agents and medications form crystalline deposits, causing tubular injury, interstitial inflammation, or obstruction.
Excess vitamin D and calcium cause calcium phosphate crystals.
Excess vitamin C produces calcium oxalate crystals.
Hyperuricemia (excess uric acid) results in uric acid nephropathy.

Contributing Factors in Crystal Formation

Urine supersaturation with crystal-forming substances.
Urine volume depletion.
Lack of urinary inhibitors (e.g., citrates, magnesium) limiting stone formation.
Other factors influence crystal formation.

Medication Usage in Renal Patients

Medications commonly used in renal patients.
Medications which should be deprescribed in renal patients.
Close monitoring is required for medications with narrow therapeutic indices in renal patients.

Diuretics

Loop and thiazide diuretics can increase the risk of acute kidney injury (AKI).
They cause electrolyte imbalances (e.g., potassium, magnesium, chloride).
Potentially higher doses of thiazide diuretics lead to heightened glucose intolerance and hyperlipidemia.
K+-sparing diuretics can cause hyperkalemia.

RAAS Blockers

ACE inhibitors and ARBs are contraindicated in bilateral renal artery stenosis.
These drugs can cause hypotension and hypovolemia, and increase the risk of hyperkalemia.
Potential for acute renal failure if used in circumstances such as bilateral renal artery stenosis, or volume depletion.

RAAS Blockers (Double-Edged Sword)

Essential for chronic kidney disease (CKD) treatment.
Contributes to controlling hypertension, delaying CKD progression, and benefitting heart health.
Risk factors include two RAAS blockers combined, and concomitant use with other drugs (e.g., potassium-sparing diuretics, NSAIDs, TMP-SMX, heparin).
Causes AKI and hyperkalemia under certain clinical circumstances.

Anti-Hyperglycemic Agents

Treatment of hyperglycemia in patients with type 2 diabetes and impaired renal function is challenging due to decreased drug metabolism and excretion, increasing drug levels leading to adverse effects including hypoglycemia.
Medications, identified for potential harm that outweighs potential benefits, in renal patients should be deprescribed. Examples include NSAIDs and iodinated contrast media.

Iodinated Contrast Media

Use the lowest dose possible.
Hydration with isotonic saline.
Consider N-acetylcysteine or sodium bicarbonate.
Avoid high osmolarity agents, concomitant nephrotoxins, and gadolinium-containing media

Other Medications

Unneeded OTC medications and dietary supplements (herbal supplements, non-herbal supplements, vitamins).
Risk of sodium and water retention, hypokalemia with licorice.
Possible kidney and non-kidney related harm with prolonged usage of PPI's

Medications with Narrow Therapeutic Index

Aminoglycosides, Digoxin, Lithium, Warfarin.
These drugs have close monitoring requirements in renal function cases.
Narrow therapeutic indices mean toxicity and side-effects are common.

Approach to Safe Medication Prescription in Renal Patients

Assess kidney function (GFR).
List all medications (prescription, OTC, dietary supplements).
Check if the drug is nephrotoxic, or contraindicated; for a specific GFR level.
Monitor for adverse effects; whether drug has a narrow therapeutic index.
Adjust dosage based on patient eGFR.
Monitoring drug efficacy, toxicity, and drug levels (if available).

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz explores the pharmacological considerations in patients with kidney disease, focusing on drug bioavailability, distribution, and the impact of renal function on medication handling. You'll also learn about nephrotoxicity, crystal nephropathy, and the monitoring of specific medications. Test your knowledge on how kidney health affects drug therapy.