泌尿系統(tǒng)課件：腎臟與藥物

1、Kidney and Drugs腎臟與藥物,Kidney, Drugs, and Medication Miscellaneous talks about drugs and the kidneys,Understand how a drug is connected with the kidney and the whole body,Kidney and Medication,Know the action site of diuretics Understand the role of the kidney in the action and metabolism of commonly

2、 used drugs Understand the antibiotic distribution, elimination and drug choices Know the common drug-related renal damage Know the role of the kidney in blood pressure control, pharmacology of antihypertensive drugs which act through or related with the kidney and clinical use,Diuretics, osmotic di

3、ureticsThiazides, Loop diuretics, K+-sparing diureticsmannitol 利尿藥與滲透性利尿藥: 噻嗪類 袢利尿劑 保鉀利尿劑 甘露醇,Collecting tubule,Thiazides Inhibit active exchange of Cl-Na in the cortical diluting segment of the ascending loop of Henle,K+-sparing Inhibit reabsorption of Na in the distal convoluted and collecting tub

4、ule,Loop diuretics Inhibit exchange of Cl-Na-K in the thick segment of the ascending loop of Henle,Hematuria?,Renal elimination of endogenous metabolites and foreign substances,Endogenous metabolic products less than half of this may be unaltered antibiotic. Adjustment of dosage is not necessary in

5、patients with impaired renal function. Rifampin is distributed throughout the body and is present in effective concentrations in many organs and body fluids, including the CSF. This is perhaps best exemplified by the fact that the drug may impart an orange-red color to the urine, feces, saliva, sput

6、um, tears, and sweat; patients should be so warned. 告知患者,Patient urine sample,應(yīng)預(yù)先 告知患者,Understand how a drug is connected with the kidneys and other systems as well as other drugs,Know the urinary system Functional anatomy Connection with other systems Role in drug metabolism Know the drug pharmacol

7、ogy Metabolism Action Application Unwanted effect Know the way of connecting pharmacology with the kidney is important to the care and attending of a patient,Pyelonephritis and Medication A common and treatable infectious disease 腎盂腎炎是一種常見(jiàn)的感染性疾病,Ascending urinary tract infection逆行尿路感染 Effective anti

8、bactericidal medication is important as well as elimination of infection source. 消除導(dǎo)致感染的原因,大多數(shù)腎臟疾病是 可治療和可治愈的,Antibiotics抗生素: distribution, elimination and drug choices,Antimicrobials that appear in high concentrations in urine or eliminated mainly through the kidneys: Aminoglycosides 氨基糖苷類 effective

9、 for urinary infection but with unwanted effects, tend to result in renal dysfunction in old patients and patients with renal damage Penicillins, some -lactam antibiotics 青霉素類與內(nèi)酰胺類 eliminated in the urine and are the drugs of choice with sensitive bacteria infection Quinolones 喹諾酮類 less side effects

10、, effective for infection of the most organs and tissues especially the urinary and the lung Rifampin 利福平,How the kidney is connected with the other systems,The kidney is intimately connected with the circulation system by many ways Anatomy connection Functional connection Disease connection Medicat

11、ion connection Taking rifampin as an example,Rifampin is a hepatic microsomal enzyme inducer 利福平為肝藥酶誘導(dǎo)劑,Following absorption from the gastrointestinal tract, rifampin is eliminated rapidly in the bile, and an enterohepatic circulation ensues. During this time, the drug is progressively deacetylated,

12、 such that after 6 hours, nearly all of the antibiotic in the bile is in the deacetylated form, which retains essentially full antibacterial activity. The half-life of rifampin varies from 1.5 to 5 hours and is increased by hepatic dysfunction. The half-life of rifampin is progressively shortened by

13、 about 40% during the first 14 days of treatment, owing to induction of hepatic microsomal enzymes that accelerate rifampin deacetylation.,If the patient with chronic kidney disease whose BP is under control on antihypertensive medication (amloidipine, bisoprolol) reports poor blood pressure when he

14、 begin to take rifampin for lung tuberculosis, what would you consider ? Rifampin enhances the liver metabolism of antihypertensive agents, which leads to shorten the t1/2 of antihypertensives and weaken their BP lowering effects. The resulting elevated pressure may further accelerate renal dysfunct

15、ion. Does rifampin impair renal function? -Yes，interstitial nephritis,Combined Medication CaseKnow how a drug is connected with the kidney and other drugs,The drug-related renal damageAntimicrobials hyperkalaemia may be severe owing to reduced aldosterone secretion. Such renal failure is reversible

16、provided that it is recognised promptly and treatment with ACEI discontinued. ACEIs and ARBs are not recommended to use simultaneously in patients with renal dysfunction.腎功能障礙者建議避免使用ACEIs及ARBs,The drug-related renal damageAspirin,Aspirin阿司匹林 Salt and water retention Edema, worsening of renal functio

17、n in renal/cardiac patients Decreased effectiveness of antihypertensives Decreased effectiveness of diuretics Decreased urate excretion Hyperkalemia Use of long-term aspirin (as an antiplete medication) should be cautious in patients with renal disease,Prostaglandins (PGE2 and PGI2) as local vasodil

18、ators前列腺素是腎臟內(nèi)源性保護(hù)因素,Prostaglandins (PGE2 and PGI2)：act as local vasodilators, are produced in response to sympathetic stimulation and Ang II 腎臟局部擴(kuò)血管的前列腺素系統(tǒng)對(duì)交感興奮及血管緊張素II具有一定的拮抗作用 NSAIDs inhibit prostaglandin biosynthesis. Since prostaglandins are one of the factors that counteract the constriction of

19、 renal arterioles, especially afferent arterioles, NSAIDs may be detrimental to the kidney blood flow, leading to acute ischemic renal failure.非甾體類抗炎藥抑制腎臟前列腺素的生成可能減少腎血流導(dǎo)致腎臟缺血 It is especially so in patients with heart failure and liver disease, glomerular filtration depend critically on prostaglandi

20、n biosynthesis.,Vascular disorders of the kidney and antihypertensives 腎血管疾病與抗高血壓藥,ACEIs and ARBs- A case 一個(gè)臨床案例 Cardiac catheterization心導(dǎo)管檢查 revealed normal coronary arteries in an elderly patient with heart failure, but after initiation of therapy with an ACEI and spironolactone, progressive kidne

21、y disease with hyperkalemia and poor blood pressure control ensued.開(kāi)始用ACEI及螺內(nèi)酯后出現(xiàn)進(jìn)展性腎功能障礙、高血鉀，高血壓難以控制 Renal Doppler ultrasonography suggested bilateral renal artery stenosis, as confirmed by angiography. 多普勒血流顯示雙側(cè)腎動(dòng)脈狹窄，血管造影證實(shí) The patient underwent successful percutaneous 經(jīng)皮 revascularization in stag

22、es leading to a return to normal left ventricular function and improved blood pressure control.血管成形術(shù)后心衰及血壓得到改善,Vascular disorders of the kidney and antihypertensives 腎血管疾病與抗高血壓藥,ACEIs and ARBs- A case Cardiac catheterization revealed normal coronary arteries in an elderly patient with heart failure,

23、 but after initiation of therapy with an ACEI and spironolactone, progressive kidney disease with hyperkalemia and poor blood pressure control ensued. Renal Doppler ultrasonography suggested bilateral renal artery stenosis, as confirmed by angiography. The patient underwent successful percutaneous revascularization in stages leading to a r