Pharm Module 3

Question 1

the drugs associated with AIN include

Answer 1

• penicillins
• cephalosporins
• ciprofloxacin
• vancomycin
• rifampin
• omeprazole
• lansoprazole

PCC LOVR

Question 2

the drugs associated with ATN include

Answer 2

• aminoglycosides
• amphotericin B
• radiocontrast dyes (iohexol)

Question 3

the drugs associated with RTA Type 4 include

Answer 3

• ACE inhibitors
• ARBs
• cyclosporin
• tacrolimus

CATA

Question 4

the drugs that can induce both AIN and RTA include

Answer 4

• trimethoprim

- NSAIDs

Question 5

acute kidney injury is characterized by

Answer 5

• sudden loss of kidney function

Question 6

prerenal AKI is caused by

Answer 6

• reduced blood flow to the kidneys

Question 7

renal/intrinsic AKI is caused by

Answer 7

• direct damage to the tissues of kidneys themselves

Question 8

post renal Aki caused by

Answer 8

• urinary tract obstruction downstream of the kidneys

Question 9

drug induced AKI is almost always of which type

Answer 9

• intrinsic/renal type

Question 10

damage to the interstitium is called

Answer 10

• acute interstitial nephritis

Question 11

damage to the glomerulus is called

Answer 11

• glomerulonephritis

Question 12

damage to the tubular epithelium is called

Answer 12

• acute tubular necrosis

Question 13

75% of cases of acute interstitial nephritis is caused by

1/3 of it is caused by

the other 2/3 caused by

Answer 13

• adverse reactions to drugs
• antibiotics
• NSAIDs and proton pump inhibitors

Question 14

how drugs cause inflammatory immune response known as AIN

Answer 14

1) drug is recognized as a distinct antigen that the immune system hasn’t recognized before
2) drug structurally similar to authentic antigen to which immune system has already been exposed
3) non-immunogenic drug may bind to endogenous host protein, creating an immunogenic molecular structure (haptenization)

• activate dendritic cells that patrol kidney which initiates inflammatory response

Question 15

other immune reactions of AIN

Answer 15

• rash
• fever
• eosinophilia

Question 16

nephrotoxic ATN causes death of

Answer 16

• epithelial cells in PT and thick ascending limb of LOH

Question 17

how do ahminoglycosides cause nephrotoxic ATN

Answer 17

• positive charges cause them to bind negative charged lipids in tubular cells
• accumulate in tubular epithelial cells
• disrupt cell processes and kill the cell

Question 18

example of an ahminoglycoside that causes nephrotoxicin ATN

Answer 18

• gentamicin

Question 19

the relative renal toxicities of different aminoglycosides correlate with

Answer 19

• their affinity for membrane phospholipids

Question 20

which aminoglycoside has the highest affinity and highest toxicity

Answer 20

• neomycin

Question 21

which aminoglycoside has the lowest affinity and lowest toxicity

Answer 21

• streptomycin

Question 22

how does amphotericin B cause nephrotoxic ATN

Answer 22

• binds to membrane cholesterol instead of ergosterol

- damages renal epithelial cells

Question 23

how do iodinated radio contrast dyes cause ATN

Answer 23

• concentrates in tubular epithelial cells and can lead to their death

Question 24

what causes type 4 renal tubular acidodis

Answer 24

• defect in aldosterone signaling to the kidney

Question 25

type 4 RTA characterized by

Answer 25

- hyperkalemia | - mild acidosis

Question 26

what is type 4 RTA also called

Answer 26

- hypoaldosteronism

Question 27

which drugs reduce aldosterone production

Answer 27

- ACE inhibitors - ARBs - NSAIDs

Question 28

which drugs block the effect of aldosterone on the kidneys

Answer 28

- cyclosporin - tacrolimus - trimethoprim

Question 29

role of ACE inhibitors

Answer 29

- block production of AgII | - block AgII vasoconstriction of efferent arteriole

Question 30

role of ARBs

Answer 30

- block AgII from inducing aldosterone secretion from adrenal cortex

Question 31

role of NSAIDs

Answer 31

- block secretion of renin and AgII-induced release of aldosterone - block prostaglandins and cause afferent arteriole vasoconstriction

Question 32

role of trimethoprim

Answer 32

- directly inhibits ENaC

Question 33

role of cyclosporin/tacrolimus

Answer 33

- reduce levels of aldosterone receptor

Question 34

how do ACE inhibitors exacerbate reduction of glomerular BP caused by bilateral renal artery stenosis

Answer 34

- renal blood flow in bilateral renal artery stenosis is low due to atherosclerotic plaques in afferent arterioles - ACE inhibitors increase efferent dilation which increases blood flow away from glomeruli.