Pharm2 Neph SUMMARIZED

+ lydia's quizlet

prerenal AKI definition

Hypoperfusion to kidneys with no structural damage

prerenal AKI tx

fluid replacement (normal saline or lactated ringers)

drugs causing prerenal AKI*

=

ACEI/ARBs

NSAIDs

Calcineuron inhibitors

Diuretics

=

causes of prerenal AKI (all)

Diuretics

NSAIDS

ACEI/ARBs

IV contrast materials

→ Reduced renal blood flow and GFR

Intrinsic AKI definition

inflammatory immune response within kidneys

Intrinsic AKI tx

remove offending agent

IV fluids

Drugs causing intrinsic AKI*

Beta lactams

Sulfa drugs

FLQ

Rifampin

PPI

H2 receptor antagonists

Diuretics

Anticonvulsants

(think ATN/AIN/glomerulonephritis)

Aminoglycoside names examples

-mycin

Amikacin

Gentamicin

Neomycin (PO)

Tobramycin

does NOT cross BBB

Aminoglycoside Toxicity lab findings

INC in SCr

DEC in CrCl

DEC in GFR

Aminoglycoside Toxicity management

watch CrCl

hydration

d/c nephrotoxic drug

Aminoglycoside Toxicity - what to measure

trough concentration 30 mins before next dose

peak concentrations after IV infusion and IM injection

Amphotericin B Toxicity findings

INC tubular permeability

arterial vasoconstriction

ischemia

Amphotericin B Toxicity RF

CKD

High doses

Volume depletion

Co-admin of diuretics and nephrotoxins

Rapid infusion

tx proteinuria in nephrotic syndrome*

ACEI/ARB

tx edema in nephrotic syndrome*

thiazide/loop diuretics

sodium restriction

tx hyperlipidemia in nephrotic syndrome*

statins

diet modification

Acute Tubular Necrosis Causes*

Radiographic contrast

Aminoglycoside

Cisplatin

Emphotericin B

Vancomycin

Autosomal Dominant Polycystic Kidney Disease (ADPKD) tx

ARBs**

statins*

ACEI

drug to avoid with Autosomal Dominant Polycystic Kidney Disease (ADPKD)

NSAID

Postrenal Acute Kidney Injury tx

remove blockage

Crystal Nephropathy Causes*

acyclovir

methotrexate

Rhabdomylosis cause

statins [esp when given w/ CYP inhibitors (cimvistatin)]

methadone

heroin

cocaine

safest statin w/ CYP inhibitors

pravastatin

Rhabdomylosis tx

Aggressive IV fluids

Tumor Lysis Syndrome cause

chemo agents

Tumor Lysis Syndrome prevention

IV hydration

allopurinal

urinary alkalization (pH > 7)

Drugs causing Kidney injury

Aminoglycosides

Amphotericin

ACEI/ARB (efferent and vasodilates)

diuretics/mannitol

ASA/NSAIDS (afferent, constricts)

Chemo (Cisplatin, Cyclophosphamide)

Cyclosporine

Bisphosphonates

Lithium

ATN cause

ischemia (prolonged prerenal, hypotension, hypovolemia)

nephrotoxic (drugs or crystals)

acute glomerulonephritis tx

high dose corticosteroids

AIN cause

allergic response to drugs

(PCN, sulfa, NSAIDS, cephs)

go-to drugs for HTN

ACEI/ARB

second go-tos for HTN

spironolactone (K sparing diuretic)

amlodipine (CCB)

Carvedilol (BB)

Chlorthiadone / amiloride (thiazide/loop diuretics)

alpha blockers (-zosins)

first-line for DM

metformin

second-line for DM

SGLT2 inhibitors

GLP-1s

SGLT2 inhibitor names

-gliflozin

SGLT2 inhibitor reduces…

albuminuria

glucose reabsorption

BP

GFR loss

GLP-1 names

-tide or -glutide

GLP-1 MOA

INC insulin secretion

DEC glucagon secretion

DEC gastric emptying

GIP/GLP-1 drug name

Tirzepatide (Zepbound/Mounjaro)

CKD raises what electrolytes

Na

K

Cl

H

Mg

ammonium

phosphate

PTH

CKD lowers what

calcium

epo

vit D

CKD → electrolyte cycle

INC phosphate → DEC Ca

DEC vit D → DEC Ca

DEC Ca → INC PTH

INC PTH → DEC phosphate + INC Ca

CKD tx when GFR 25-40

restriction of dietary phosphate intake

phosphate binders (even if looks normal)

biphosphonate if osteoporosis

calcium containing phosphate binders

calcium carbonate

calcium acetate

calcium containing binder SE

hypercalcemia

vascular calficiation

before starting calcium-containing phosphate binders, what to do

check calcium levels

calcium acetate MOA

it is the unabsorbed drug that binds and removes phosphate

noncalcium containing phosphate binders

sevelamer carbonate

lanthanum carbonate

Sevelamer Carbonate SE

metabolic acidosis

dyspepsia

Sevelamer Carbonate MOA

binds to phosphate within intestinal lumen

limits absorption and dec serum phosphate

Sevelamer Carbonate binds to

bile acids

fat-soluble vitamins

noncalcium containing phosphate binders MOA

binds to dietary phosphate to prevent absorption

Lanthanum Carbonate dosing consideration

chew/crush completely

do NOT swallow intact

all phosphate binders have what SE

GI

Cinacalcet (Sensipar) is used for _

CKD-MBD

Cinacalcet (Sensipar) MOA

inc sensitivity of calcium sensor on parathyroid gland

Cinacalcet (Sensipar) dosing for secondary hypoparathyroidism

30-180 mg QD (dialysis)

start 30 mg QD titrate q2-4 weeks

Take with food or shortly after meal

Cinacalcet (Sensipar) SE

low calcium

myalgia

GI

hypoparathyroidism

drugs for CKD

cinacalcet

vit D

calcitriol

calcitonin

biphosphonate

calcitriol usage

HYPOcalcemia (in CKD)

calcitriol MOA

vit D analog/activator → INC calcium absorption

calcitonin MOA

inhibits osteoclast activity

DEC plasma Ca

Calcitonin dosing

intranasal

alternate nostrils daily

Calcitonin FDA risk

risk of cancer

women should NOT use this

biphosphonate MOA

DEC osteoclastic bone resorption

long time to see benefits

biphosphonate SE*

atypical femoral fracture

biphosphonates dosing

renally dosed

give calcium and vit D supp at same time

anemia level in male

Hb < 13.0 g/dl

anemia level in female

Hb < 12.0 g/dl

first line tx of anemia

iron supplementation

(oral iron, IV iron dextran, ESAs, epoetin alfa, darbepoetin alfa)

osteoporosis first-line tx

bisphosphonates

bisphosphonates MOA

(suppresses osteoclast, which is what does bone turnover)

osteoporosis 2nd line

calcitonin

calcitonin MOA

(inhibits osteoclast activity, nasal spray, less effective than bisphos)

biphosphonates name

-dronates

(ie risedronate)

only IV biphosphonate

risedronate

rest of PO

se of biphos

esophagitis

femoral fractures

DM on metformin, what else to add

SGLT2

GLP1

Hyperphosphatemia in CKD tx

phosphate binders or cinacalcet

lanthanum carbonate taking consideration

MUST CHEW

do NOT swallow

drugs that cause AIN

rifampin, vanco, sulfas, PCN (b-lactams), FLQ (cipro/moxi), H2, PPIs, diuretic, anti-convulsants, contrast

drugs that cause ATN

aminoglycosines, vanco, NSAIDs, chemo agent (cisplatin + amphotericin B), IV contrast media

when to check peak trough for aminoglycosides

30 mins before dose

aminoglycoside IV infusion when to measure trough

30-45 mins after

IM injection aminoglycosides when to measure trough conc

60 mins after

NSAID GFR by

dec

constrict afferent arteriole

ACEI ___ GFR by _

dec

dilate efferent arteriole

ACEI CI

pregnancy

bilateral artery stenosis

proteinuria in nephrotic syndrome

ACEI/ARB

edema in nephrotic syndrome

thiazide/loop

hyperlipidemia in nephrotic sydnrome tx

statin

should you give drugs to nephrotic syndrome hypercoag?

no

PKD drug tx

ACEI/ARB

statins

definitive = renal transplant

education for PKD

genetic testing and screening family hx

avoid NSAIDs

crystal neph drug cause

MTX

acyclovir

rhabdo causes

statins

cocaine

heroin

methadone

cause of tumor lysis syndrome

chemo agents

prevention of tumor lysis syndrome

vigorous IV hydration BEFORE chemo

take allopurinol

Drug induced nephrotoxicity caued by

aminoglycide, NSAIDS, chemo agents, diuretics, cyclosporin, bisphosphonates, lithium, ACEI/ARB

tx for vid D in CKD

Vit D, calcitriol, calcitonin