kidney and drugs

Renal clearance

Volume of plasma which from drug is completely removed by kidney per unit

Effect of decreased gfr on metformin

Augment it’s adverse effect

Drugs that lose its efficacy due to decrease in gfr and inability to reach target organ

Thiazide diuretics

Nitrofurantoin

Basic Drug need cation transport

Metformin

Acidic drug need anion transporter

Ampicillin

Cefazolin

Furosemide

Nucleoside transporter drug

Zidovudine

P-glycoproteins transporter drug

Digoxin

Steroids

Which transporter are affected more by ckd

Anion

What can inhibit organic anion transporter

Circulating organic acid as blood urea nitrogen

Effect of inhibition of basso lateral drug transporter inhibition and example

Elevate serum concentration leading to systemic toxicity

Methotrexate and metformin

Effect of apical transporter inhibition and example

Intrarenal toxicity

Cisplatin

Example of accumulation of drug metabolites

Oxypurinol of allopurinol

M6g of morphine cause increased risk of prolonged narcosis and respiratory depression

M3g toxic morphine seizures

Replacement of oral furosemide in renal failure patient

IV therapy or torsemide

Measurement needed to consider in a renal patient

Unbound fraction

Criteria needed to measure unbound drug + example

Narrow therapeutic range and variable protein binding

Digoxin phenytoin

Cause of change in aminoglycoside in ckd

Secondary to fluid overload

Kidney is a major site for inactivation in ?

Insulin glucagon

When to use maintenance dose reduction method

Time dependent killing b-lactam

When to use interval extensions method

Concentration dependent aminoglycoside

When to administer loading dose

Rapidly achieve a therapeutic steady state

Drugs cause acute tubular necrosis

Cyclosporine

Aminoglycoside

Drugs cause interstitial nephritis

Penicillin

Proton pump inhibitor

Drugs cause hemodynamic injury

NSAID

Ace inhibitors

ARBs

Safe drug replacement of aminoglycoside

Cephalosporin

Fluroquinolone

Kidney safe replacement of nsaid

Paracetamol