Pharmacology 2 Lecture: Cardiovascular and Renal Diseases PDF

CHAPTER 1: CARDIOVASCULAR AND RENAL DISEASES Pharmacology 2 Lecture ANAPHY OF THE HEART o AKA CARDIOVASCULAR SYSTEM o Part of organ and immune system o Responsible for THERMOREGULATION and DISTRIBUTION of nutrients o Responsible for the flow...

CHAPTER 1: CARDIOVASCULAR AND RENAL DISEASES Pharmacology 2 Lecture ANAPHY OF THE HEART o AKA CARDIOVASCULAR SYSTEM o Part of organ and immune system o Responsible for THERMOREGULATION and DISTRIBUTION of nutrients o Responsible for the flow of blood ANATOMY OF KIDNEY TYPES OF HYPERTENSION o There are two different types of Hypertension: Primary Hypertension, or also known as Essential Hypertension. They mostly occur in adults and this refers to a case of hypertension wherein the specific cause isn’t known or identifiable even after years of analysis. It’s generally thought to be a combination of genetics, diet, lifestyle, and age. PHYSIOLOGY OF THE KIDNEY o Next is Secondary Hypertension which refers to a case of hypertension that has an identifiable and potentially o Filtration: Blood is filtered through the glomerulus, and reversible cause. Though, only 5% to 10% of cases are waste products are removed. known to be secondary. o Reabsorption: Essential substances like water, glucose, CLINICAL MANIFESTATION and amino acids are reabsorbed back into the blood. o Secretion: Waste products and excess ions are secreted o Blurred Vision into the tubules to form urine. o Chest pain o Excretion: Urine is stored in the bladder and excreted o Headaches through the urethra. o Shortness of Breath BLOOD PRESSURE COMPLICATIONS o This is the amount of force your blood uses to get 1. Vision impairment through your arteries. When the heart pumps, it uses 2. Aneurysm force in order to push the blood out in the arteries. 3. Kidney disease o If its readings are too high it can cause a variety of 4. Heart disease & Heart Failure health issues. High blood pressure is usually known as a CAUSITIVE AGENTS silent killer due to it not having any symptoms. It can o Genetic Factors cause damage to the heart, kidneys, and brain before o Psychological stress you know it. o Environmental and Dietary Factors HYPERTENSION o Heritability o Hypertension is recognized as the most common NON-PHARMACOLOGIC TREATMENT cardiovascular disease. Its occurrence often varies with o Diet the patient’s age, race, lifestyle, and many others. o Weight Loss Studies say that risks of damage to the kidney, heart, o Physical activity and brain are blood vessels found in the kidneys, heart, o Smoking Cessation and brain which can lead to manifestations of renal PHARMACOLOGICAL TREATMENT failure, coronary disease, heart failure, and even o HYDROCHLOROTHIAZIDE dementia. Category B o DIAGNOSING HYPERTENSION MOA Block Na/Cl transporter in renal distal 1. Hypertension is usually diagnosed by means of a convoluted tubule blood pressure monitor. It can be used manually Side Effect Weakness, Dizziness, Headache, Erectile or automatically. Its readings measure the dynsfunction, Tingling, Photosensitivity, pressure in the arteries when the heart beats Muscle spasms (systolic blood pressure) and in between heart Drug When combined with NSAIDS may increase beats (diastolic pressure). Interaction the risk of kidney issues. 2. Electrocardiograms can also be used to measure When used with other blood pressure the heart’s electrical activity. It is both quick and medications may lead to an unsafe drop in painless and gives a printed output of the results. blood pressure. o STAGES OF HYPERTENSION o LOOP DIURETICS: FUROSEMIDE Category C MOA Block of Na/Cl transpower in renal distal convoluted tubule in severe hypertension cases Side Effect Diarrhea, Constipation, Loss of appetite, lower legs, Chest pain, Shortness of breath, Numbness, Headache, Dizziness, Blurred Irregular heartbeats, Heart failure vision, Muscle pain Drug Can lead to sinus bradycardia when taken Drug May cause to kidneys or ears when taken Interaction with antiarrhythmic agents and Digitalis Interaction with certain antibiotics like aminoglycosides Its antihypertensive effect can be decreased and vancomycin. by TCAas, phenothiazine derivatives, Can lead to hypotension when taken with chlorpromazine, oral contraceptives. ACE inhibitors or ARBs. May cause hypertensive crisis when given to patient who was previously treated with o SPIRONOLCATONE MAOIs Category C MOA increase NA and decrease K excretion Side Effects Diarrhea, Belly cramps, Nausea and o PRAZOSIN vomiting, Hyperkalemia, Leg cramps, Category C Headache, Dizziness, Drowsiness MOA Prevent sympathetic vasoconstricition and Drug May increase the risk of hyperkalemia when reduce prostatic smooth muscle tone Interaction taken with ACE inhibitors, ARBs, or NSAIDS. Side Effects Dizziness, Drowsiness, Headache, Low When use with colestyramine may cause blood pressure, Nausea, weakness, lack of hyperkalaemic metabolic acidosis. energy, Heart palpitations and slowed heart It can also increase the PSA levels when rate, Persistent or painful erections, taken by prostate cancer patients being Pancreatits and liver abnormalities treated with abiraterone. Drug Can cause symptomatic hypotension with Interaction PDE-5 inhibitors. o CLONIDINE Can also add to the hypotensive effect Category C when taken with Diuretics and other MOA Reduce central sympathetic outflow and Antihypertensive agents. reduce norepinephrine release from noradrenergic nerve endings o TERAZOSIN Side Effects Drowsiness, Dizziness, Dry mouth, Category C Constipation, Loss of appetite, Insomnia MOA Prevent sympathetic vasoconstricition and Drug May cause hypotension when taken with reduce prostatic smooth muscle tone Interaction narcotic analgesics and other Side Effects Weakness, Low blood pressure, Drowsiness, antihypertensive agents. Stuffy or runny nose, Impotence, Blurred Can reduce the antihypertensive effects vision, Nausea, Swelling, Headache when taken with mirtazapine. Drug Increased incidence of dizziness when taken May cause sudden death with Interaction with ACE inhibitors and Diuretics methylphenidate Can also increase the risk of hypotension when taken with Antihypertensive agents o RESERPINE and PDE-5 inhibitors Category C MOA Reduces all sympathetic effects and reduce o METOPROLOL blood pressure Category C Side Effects Nasal congestion, Nausea, Vomiting, Weight MOA Prevent sympathetic cardiac stimulation gain, Gastric intolerance, Gastric ulceration, and reduce renin secretion Stomach cramps, Diarrhea Side Effects Dizziness, Weakness, Confusion, Irregular Drug May cause hypotension effects when taken heartbeat, Blurred vision, Sweating, Interaction with thiazide diurectics and other Diarrhea, Constipation hypertensive agents. Drug May enhance the cardiodepressant effect Can cause excitation and HTN in patients Interaction when taken with inhalation anesthetic receiving MAOIs (Monoamine oxidase drugs inhibitors) Can result to hypertension when taken with Increased risk of cardiac arrhythmias with other antihypertensive agents Digitalis or Quinidine May also enhance the rebound Can enhance the effects of CNS depressants hypertension that follows the withdrawal of clonidine o GUANETHIDINE Category C o DILTIAZEM MOA Reduces all sympathetic effects and reduce Category C blood pressure MOA Reduce cardiac rate and output and reduce Side Effects Postural and exercise hypotension, Sexual vascular resistance dysfunction, Diarrhea, Swelling of feet or Side Effects Swelling, Infections, Trouble breathing, Side Effects Dizziness, Tiredness, Low blood pressure, Headache, Slower heart rate, Pain, Bruising, Low blood sugar, Diarrhea, Back pain, Swelling, Nausea, Rashes Colds, Asthenia Drug Can increase the depression of cardiac Drug Increased risk of hypotension with TCAs, Interaction conduction, risk of bradycardia, and AV Interaction antipsychotics, baclofen, and amifostine. block when taken with beta-blockers, May increase the plasma concentration of amiodarone, or digoxin. losartan but can decrease the plasma When used alongside clonidine, can result concentration of the active metabolite to sinus bradycardia which can lead to when taken fluconazole. hospitalization and insertion of a pacemake. Increased risk of worsening renal function when used with NSAIDs. o HYDRALAZINE Increased risk of hypotension, Category C hyperkalaemia, and changes in renal MOA Vasodilation and reduces vascular function when taken with ACE-inhibitors or resistance aliskiren. Side Effects Headache, Loss of appetite, Nausea, Vomiting, Diarrhea, Fast heart rate, Angina, o ALISKIREN Dizziness, Blurred vision, Muscle or joint Category D pain, Mild itching or skin rash MOA Reduces angiotensin I and II and Drug Hypotension when taken with other aldosterone Interaction antihypertensive agents, TCAs, Levodopa, Side Effects Light-headedness, Kidney issues, High Anaesthetics etc. blood potassium, Fainting, Kidney issues, Can also increase the bioavailability of Dehydration and electrolyte imblanace beta-blockers Drug Risk of hypotension with other Can antagonize the hypotensive effect with Interaction antihypertensives. estrogens, NSAIDs, or corticosteroids. Increased risk of acute renal failure with ACE inhibitors, angiotensin II receptor o NITROPRUSSIDE antagonists or NSAIDS. Category C Increased risk of hyperkalaemia with MOA Powerful vasodilation potassium-sparing diuretics, potassium Side Effects Low blood pressure, Cyanide poisoning, supplements or any substances that may Abdominal pain, Sweating, Dizziness, increase serum potassium levels. Headache, Muscle twitching, Nausea Drug Can enhance the hypotensive effect with ANGINA PECTORIS Interaction other antihypertensives, ganglionic o AKA STABLE ANGINA blockings agetns, negative intropic agents, o Term for chest pain due to coronary heart disease inhaled anaesthetics, and volatile liquid o Occurs when the heart muscle doesn't get enough anaesthetics. blood o Usually causes uncomfortable pressure, fullness, o CAPTOPRIL (ACE INHIBITOR) squeezing pain in the center of the chest Category D o If angina pectoris is left untreated this may cause to MOA Reduce angiotensin II levels and can reduce Myocardial Infarction vasoconstriction and aldosterone secretion MYOCARDIAL INFARCTION and can also increase bradykinin o AKA HEART ATTACK Side Effects Cough, Low blood pressure, Flushing, Low o It is a disease caused by reduced blood flow in the blood cell counts, Decreased sense of taste, coronary artery Mild skin itching or Rashes o It is a damage in the myocardial tissue that is caused by Drug Increased risk of angiodema when taken ischemia and hypoxia Interaction with mTOR inhibitors and vildagliptin. TYPES OF MYOCARDIAL INFARCTION Increased risk of hyperklaemia when taken o TYPE 1 with K-sparing diuretics, K supplements or 1. Caused by atherosclerotic plaque disruption or acute K-containing salt substitutes or other drugs coronary thrombosis associated with increases in serum. 2. Most common form May enhance the hypotensive effects of 3. Manifest STEMI certain TCAs and antipsychotics. o TYPES 2 1. Secondary to an oxygen supply o LOSARTAN 2. Less common form Category D 3. Predominantly in women MOA Same as ACE inhibitors but no increases in o TYPE 3 bradykinin 1. Resulting in death when biomarker values are unavailable  o TYPE 4 MOA Release Nitric oxide in Smooth Muscle that 1. Related to percutaneous coronary intervention activates Guanylyl cyclase and increase o TYPE 5 cGMP 1. Related to coronary artery bypass grafting. Side effects - Headache, Tingling feeling, Difficult CLINICAL MANIFESTATION breathing, Flushing, Fever and Rapid heart o Chest Pain rate o Tightness in the chest Drug Nitroglycerin can interact with Sildenafil, o Shortness of breath Interaction cardenafil, andavanafil. This can cause very o Sweating low blood pressure. o Nausea o Vomiting o LISINOPRIL o Anxiety Category ACE inhibitor ( D ) o Fast heart rate MOA Increase vascular resistance and oxygen COMPLICATION consumption that can lead to myocyte o STEMI -ST elevation myocardial Infarction hypertrophy and vascular smooth muscle o Non STEMI cell proliferation. o Cardiogenic shock Side effects Cloudy urine, Confusion, Blurred vision, o Acute heart failure Sweating and Unusual tiredness o Right ventricular infarction Drug Using Lisinopril with Aliskiren and Sacubitril o Pericardial complications (pericarditis) Interaction is not recommended o Ischemic complication (reinfarction, infarct extension, and postinfarction angina) o RAMIPRIL o Electrical complication (ventricular arrhythmias, atrial Category ACE inhibitor ( D ) fibrillation, and atrioventricular block) MOA Blocks a substance in the body that causes o Mechanical complication (LV septal rupture, Lv free wall blood vessels to tighten. That results to rupture and LV aneurysm) lower blood pressure and increase of blood NON-PHARMACOLOGICAL TREATMENT supply of blood and oxygen to the heart. o Diet and proper nutrition Side effects Chest pains, Cough, N/V, Dizziness, o Rest and exercise Diarrhea and Weakness o Change of lifestyle Drug There are no known interaction between PHARMACOLOGICAL TREATMENT Interaction Ramipril and food or drinks. o ASPIRIN Can interact with entresto, Supplements, Category NSAIDS ( N ) diuretic, Nsaids and ACe inhibitors MOA Blocks prostaglandin synthesis. This prevents the pain-causing prostaglandins. o WARFARIN This also stops the conversion of Category Anticoagulant ( D ) arachidonic acid to TXA2 (a potent inducer MOA Inhibits Vitamin K epoxide reductase that of platelet aggregation. prevents the recycling of vitamin K that Side effects Upset stomach, Heartburn, Drowsiness, leads to activation of clotting factors and Mild headache, convulsion and tarry stools results in an anticoagulant effect. Drug Can Interact with NSAIDS, Lithium, Side effects Dermatitis, Nausea, Vomiting, Diarrhea, Interaction Methotrexate, Anticoagulant, Steroid, Bloating and Abdominal pain Diurectics and antiplatelet drug. Drug Can interact with aspirin, Acetaminophen, Interaction Antacids, Ibuprofen, Seizure medicine and o CLOPIDOGREL antibiotics. Also some herbs like Garlic, Category Antiplatelet ( B ) Ginkgo Biloba, Ginseng, Green tea and MOA Activated via a 2 step reaction that results Vitamin E to an active thiol-containing metabolite. The active form is a platelet inhibitor that o PROPRANOLOL irreversibly bind to P2Y12 ADP receptors on Category Beta Blocker ( C ) platelets. The binding prevents ADP binding MOA Nonselective competitive antagonist at B to P2Y12 receptor adrenoceptors Side effects Deep, dark blue bruise, itching, Nausea and Side Effects Uneven heartbeats, Wheezing, Nausea, vomiting and Headache Vomiting, Insomnia and Runny or stuffy Drug Cannot Interact with abciximab, abrocitinib, nose Interaction acetaminophen and aceclofenac Drug Propranolol can interact with the following: Interaction Alcohol, Stimulants, NSAIDS, Antihistamines, o NITROGLYCERIN Migraine Meds, Heart, Rhythm Medication, Category Nitrate ( C ) Warfarin and cigarretes o TICAGRELOR o Also increases the risk of stroke, heart failure and other Category Antiplatelet( B ) heart-related complications. MOA Inhibits the P2Y12 receptor that prevents HEART FAILURE platelet aggregation and reducing the risk of o A chronic condition where the heart muscle weakens occlusive thrombosis, MI, and ischemic and cannot pump blood efficiently to meet the body's stroke needs. Side effects Slow heartbeats, Nosebleeds, Easy bruising , o This leads to a buildup of fluid in the lungs and other Red, pink, brown urine and Bleeding parts of the body. Drug Can interact with the following: HEART FAILURE RELATED DISORDER Interaction Blood Thinners, NSAIDS, Anti-seizure o Hypertensive Heart Failure - Weakening of the heart medication, Opioids, Statins and muscle due to chronic high blood pressure. Anti-Infection Medication o Ischemic Heart Failure - Weakening of the heart muscle due to reduced blood flow caused by coronary artery o PRASUGREL disease. Category Antiplatelet ( C ) o Dilated Cardiomyopathy - Enlargement of the heart MOA Blocks a substance in the body that causes chambers, leading to weakened pumping ability. blood vessels to tighten. That results to o Restrictive Cardiomyopathy - Stiffening of the heart lower blood pressure and increase of blood muscle, making it difficult for the heart to fill with supply of blood and oxygen to the heart. blood. Side effects Allergic reaction, Bleeding, Blood clot, o Arrhythmogenic Right Ventricular Cardiomyopathy Kidney injury, Purple spots in skin or mouth, (ARVC) - Replacement of heart muscle with scar tissue, Stomach pain, Yellowing of the eyes primarily affecting the right ventricle CAUSITIVE AGENT Drug May interact with medication that prevent o Atherosclerosis (buildup of plaque in the arteries). Interaction blood clots (warfarin), opioid, NSAIDS o Persistent high blood pressure o Caused by infections (viral or parasitic), alcohol abuse, o METOPROLOL or certain medications Category Beta Blocker ( C ) o Amyloidosis - a rare disease that occurs when a protein MOA Inhibits beta-1-adrenergic receptors in called amyloid builds up in your organs. cardiac cells that reduce heart rate and o Sarcoidosis - an inflammatory condition where tiny contractility, which decrease cardiac output clumps of cells, called granulomas, form in various Side effects Slow heartbeats, Shortness of breath, organs of the body. Depression, Confusion and Dizziness o Radiation therapy Drug Can interact with any other heart or blood o Family history of heart rhythm problems or sudden Interaction pressure medication, Epinephrine, and cardiac death. antidepressant. PREVENTION OF HEART FAILURE o Maintain a healthy weight: Being overweight or obese LABORATORY TEST increases the risk of heart disease. o ECG - First test done to diagnose a heart attack records o Regular exercise: Aim for at least 150 minutes of electrical signal as they travel through the heart moderate-intensity exercise per week. o BLOOD TEST - Done to check proteins (cardiac markers) o Balanced diet: Focus on fruits, vegetables, whole grains, o Chest X-RAY - Shows the Condition and size of the heart lean proteins, and low-fat dairy. Limit sodium, saturated and lungs fat, and added sugars. o ECHOCARDIOGRAM - Ultrasound that creates images of o Avoid smoking and too much alcohol consumption: the moving heart. This shows how blood moves Excessive smoking and alcohol consumption damages through the heart and heart valves. blood vessels and increases the risk of heart disease. o CARDIAC CATHETERIZATION (ANGIOGRAM) - A catheter RISK FACTORS is inserted into an artery, usually in the leg, and guided o Smoking to the heart o Family history of heart rhythm disorders o CARDIAC COMPUTED TOMOGRAPHY (CT) / MAGNETIC o Congenital heart defects RESONANCE IMAGING (MRI) - creates images of the o Certain autoimmune diseases heart and chest. CT uses X-rays and MRI uses magnetic o Family history field and radio waves to create images of the heart. o Excessive alcohol consumption Both test can be used to diagnose heart problems that o Certain medications can help show the severity of heart damage. o Obesity ARRHYTHMIA o Lack of physical activity o Irregularities in the heartbeat o High sodium intake o Atrial fibrillation (AFib) is an irregular and often very o High blood pressure rapid heart rhythm. o High cholesterol o Can lead to blood clots in the heart o Diabetes o Cardiomyopathies o Thyroid disorders hypotension, COMMON INDICATION FOR AN INDIVIDUAL shortness of breath o Shortness of breath: This can worsen with activity or cold extremities. when lying down. Drug Calcium channel blockers o Fatigue and weakness: The heart's inability to pump Interaction Insulin enough blood can lead to decreased energy levels. Non-selective beta-blockers o Swelling in the legs and ankles: This is often caused by fluid buildup. o DIGOXIN o Rapid or irregular heartbeat: The heart may work Category Cardiac Glycoside (C) harder to compensate for the damage. MOA Increases cardiac contractility and slows o Persistent cough: A cough that produces white or pink heart rate, improving cardiac output. mucus can be a sign of fluid buildup in the lungs. Side Effects Nausea o Chest pain or discomfort: While not always associated Vomiting with heart failure, chest pain can be a symptom. Anorexia o Weight gain: Sudden weight gain can be due to fluid Arrhythmia retention. Drug Diuretics o Difficulty concentrating: Reduced blood flow to the Interaction brain can affect cognitive function. PHARMACOLOGIC TREATMENT o FUROSEMIDE o AMIODARONE Category Loop Diuretic (D) Category Antiarrhythmic (D) MOA Inhibits sodium and chloride reabsorption MOA Prolongs action potential duration and and promoting diuresis and reducing fluid refractory period, suppressing arrhythmias. overload. Side Effects Thyroid dysfunction Side Effects Hypokalemia Pulmonary Fibrosis Hyponatremia Liver damage Hypotension Drug Warfarin Dizziness Interaction Digoxin Ototoxicity Beta-blockers Drug NSAIDs Interaction Aminoglycosides o AMLODIPINE Lithium Category Calcium Channel Blocker (C) MOA Blocks calcium entry into smooth muscle o HYDRALAZINE AND ISOSORBIDE DINITRATE cells, leading to vasodilation and Category Vasodilators Hydralazine (C) Isosorbide decreased blood pressure. Dinitrate (B) Side Effects Peripheral edema MOA Hydralazine relaxes arterial smooth muscle, Headache while isosorbide dinitrate reduces preload Flushing and afterload. Dizziness Side Effects Headache Drug Grapefruit juice Dizziness Interaction Diltiazem Flushing Verapamil Tachycardia Reflex tachycardia o APIXABAN Drug Antihypertensive agents Category Anticoagulant (B) Interaction Nitrates MOA - Prevents blood clots -inhibits conversion of prothrombin to o LISINOPRIL thrombin Category (ACE) Inhibitor (D) Side Effects Bleeding risk MOA Prevents the conversion of angiotensin I to Increased risk of hemorrhage angiotensin II, a potent vasoconstrictor. Drug Aspirin Side Effects Cough Interaction NSAIDs Dizziness Other anticoagulants Hypotension Hyperkalemia o CARVEDILOL Angioedema Category Beta-blocker (C) Drug Diuretics MOA Blocks both beta-1 and beta-2 receptors Interaction Potassium supplements and reducing heart rate. NSAIDs Side Effects Fatigue bradycardia, o METOPROLOL Category Beta Blocker (C) Certain cancers along with their MOA Blocks the effects of adrenaline on the heart. medications Inhibits B1 adrenergic receptors Heart failure Side effects Fatigue Clinical Tiredness Bradycardia manifestation Weakness and fatigue Hypotension Loss of appetite Shortness of breath Pressure in the chest area Cold extremities Fluid buildup Drug Calcium channel blockers Nausea Interaction Insulin Itchiness Non-selective beta-blockers Confusion Less urine output LABORATORY TEST Irregular heartbeat Seizures or coma o Imaging Tests (Echocardiogram) - This test uses sound waves to create images of the heart. It can help assess heart function, identify heart muscle damage, and o CHRONIC detect any structural abnormalities. - A condition that progresses slowly which can lead to a o A heart scan also known as a myocardial perfusion scan permanent kidney failure. - is a specific type of nuclear medicine test that uses Causes Prolonged obstruction in the urinary tract SPECT to visualize blood flow to the heart muscle and is Hypertension used to determine if there is an occurring heart failure. Systemic lupus erythematosus o Blood Tests (Complete Blood Count or CBC) - This can Polycystic kidney disease help identify anemia, which can contribute to heart Cystinosis failure. Nephrotic syndrome o Cardiac Magnetic Resonance Imaging (CMRI): This test Interstitial nephritis can provide detailed images of the heart and blood Diabetic nephropathy vessels, helping to assess heart function and identify Alport syndrome areas of damage. Complication Old age o Brain Natriuretic Peptide (BNP): This hormone is Diabetes released by the heart in response to stress. Elevated High blood pressure BNP levels can be a sign of heart failure, including Heart disease dilated cardiomyopathy. Smoking o Troponin I and T: These proteins are released into the Genetics bloodstream when heart muscle is damaged. Elevated Obesity levels can indicate a recent heart attack or ongoing Use of medication heart muscle damage, which might be associated with Clinical Tiredness restrictive cardiomyopathy. Manifestation Weakness and fatigue o ECG (Ventricular arrhythmias) - ARVC is characterized Loss of appetite by an increased risk of ventricular arrhythmias, such as Pressure in the chest area ventricular tachycardia and ventricular fibrillation. Fluid buildup RENAL FAILURE Nausea o A general term that refers to damage in the kidneys, Itchiness which impairs their ability to function properly. High blood pressure o Renal failure refers to the inability of one or both Urinating more or less kidneys to function properly. It is considered as the Muscle cramps most severe stage of kidney disease. Trouble sleeping Vomiting TYPES OF RENAL FAILURE o ACUTE DIAGNOSTIC LABORATORY TEST - A type of renal failure that has a quick onset, and potentially irreversible. Aluminum/chromium Causes Decreased blood flow to the kidney Anion gap Obstruction in the urinary tract Arterial blood gases Consumption of toxic medications BUN/creatinine Myocardial Infarction CO2 content Rhabdomyolysis Complete blood count Hemolytic uremic syndrome Creatinine clearance Glomerulonephritis Electrolytes, blood Electrolytes, urine complication Old age Homocysteine Diabetes Immunoglobulin quantification High blood pressure Magnesium Liver diseases Microglobulin Side Effects Dizziness, fatigue, stuffy nose Myoglobin Osmolality, blood/urine o PRAVASTATIN Phosphate Category X Protein quantification MOA Inhibits HMG CoA reductase, lowers Pyelography cholesterol Renal biopsy Side Effects Muscle pain, fatigue, loss of appetite, dark Renal scan urine Uric acid Urinalysis o ERYTHROPOIETIN PHARMACOLOGICAL TREATMENT Category C ACUTE MOA Binds to EPO-R and activates intracellular o FUROSEMIDE signaling transduction pathways Category C Side Effects Nausea, decreased weight, swelling, MOA Increase urinary excretion hypertension Side Effects Potentially damage blood vessels of the heart, brain, and kidney CHRONIC o ENALAPRIL o BUMETINIDE Category C for first trimester, D for second and third Category C trimester MOA Increase urine output MOA Blocks the production of angiotensin II Side Effects Dizziness, heart arrhythmia, muscle Side Effects cramps, headache o RAMIPRIL o MANNITOL Category C for first trimester, D for second and third Category C trimester MOA Maintains urine flow and promotes urine MOA Blocks the production of angiotensin II excretion Side Effects Fatigue, heart arrhythmia, low blood Side Effects Allergic reactions, loss of appetite, pressure, allergy vomiting, diarrhea o DAPAGLIFLOZIN o CALCIUIM Category - Category C MOA Inhibits sodium-glucose cotransporter 2 MOA Ensures sufficient amount of calcium is Side Effects Rapid breathing, irritation, cough, nausea maintained in the bones Side Effects Constipation, stomach pain, allergic o ATORVASTATIN reaction Category X MOA Inhibits HMG CoA reductase, lowers o SOLIRIS cholesterol Category - Side Effects Increased urination, difficulty swallowing, MOA C5 inhibitor that binds to the complement rash, constipation protein C5 Side Effects Back pain, cough, headache, diarrhea o SIMVASTATIN Category X o ECULIZUMAB MOA Inhibits HMG CoA reductase, lowers Category - cholesterol MOA C5 inhibitor that binds to the complement Side Effects Muscle pain, bloating, cloudy urine, hair protein C5 loss Side Effects Back pain, cough, headache, diarrhea o SODIUM ZIRCONIUM CYLOSILICATE o LISINORPIL Category Z Category C- First trimester and D- second and MOA Selectively binds to potassium ions third trimester Side Effects Edema, low potassium levels MOA Blocks the production of angiotensin II Side Effects Headache, cough, rashes, nausea o FUROSEMIDE Category C o LOSARTAN MOA Increase urinary excretion Category D Side Effects Potentially damage blood vessels of the MOA Blocks AT1 receptors, reduces production heart, brain, and kidney of angiotensin II o ERYTHROPOIETIN Category C MOA Binds to EPO-R and activates intracellular signaling transduction pathways Side Effects Nausea, decreased weight, swelling, hypertension o CALCIUM Category C MOA Ensures sufficient amount of calcium is maintained in the bones Side Effects Constipation, stomach pain, allergic reaction o CYCLOPHOSPHAMIDE Category D MOA Immunosuppressant that adds alkyl group to guanine base of DNA Side Effects Nausea, vomiting, diarrhea, loss of appetite, mouth sores LABORATORY TESTING o Furosemide (amylase, creatine kinase) o Bumetanide (amylase, calcium) o Mannitol (phosphate, uric acid) o Calcium (calcitonin, gastrin) o Lisinopril (creatinine, renin assay) o Pravastatin (apolipoproteins) o Erythropoietin (red blood cell count, triglycerides) o Enalapril (creatinine, brain scan) o Ramipril (creatinine, brain scan) o Simvastatin (apolipoproteins) o Cyclophosphamide (antidiuretic hormone, antidiuretic hormone suppression)