Beruflich Dokumente
Kultur Dokumente
Abraham Simatupang
Departemen Farmakologi &
Terapi
FK UKI
Tujuan Pembelajaran
Setelah mengikuti Kuliah ini
diharapkan mahasiswa:
1. Mengetahui obat-obat yang bersifat
nefrotoksik
2. Mengetahui beberapa mekanisme
obat nefrotoksik dan cara
pencegahannya
Ginja
l
Nefron
Drugs Associated
Nephrotoxicity
Drug class/drug(s)
Pathophysiologic mecahnism
of renal injury
Analgesics
Acetaminophen, aspirin
Antidepressant/mood stabilizers
Amitryptilin, doxepin, fluoxetine
(Prozac), Lithium
Antihistamines
Diphenhydramine (Benadryl),
doxylamine
Antimicrobials
Rhabdomiolysis
Chronic interstitial nephritis,
glomerulonephritis,
rhabdomiolysis
Rhabdomiolysis
Drug class/drug(s)
Pathophysiologic mechanism
of renal injury
Amphotericin B
Foscarnet (Foscavir)
Pganciclovir (Cytovene)
Crystal nephropathy
Pentamidine (Pentan)
Quinolones
Rifampin/Rifampisin
Sulfonamides
Vancomycin
Drug class/drug(s)
Antiretrovirals
Adefovir (Hepsera), cidofovir
(Vistide), tenofovir (Viread)
Pathophysiologic mecahnism
of renal injury
Tubular cell toxicity
Indinavir (Crixivan)
Benzodiazepines
Rhabdomyolysis
Calcineurin inhibitors
Cyclosporine (Neoral)
Altered intraglomerular
hemodynamics, chronic
interstitial nephritis, thrombotic
microangiopathy
Tacrolimus (Prograf)
Altered intraglomerular
hemodynamics
Cardiovascular agents
Angiotensin-converting enzyme
inhibitors, angiotensin receptor
blockers
Clopidogrel (Plavix), ticlopidine
(Ticlid)
Altered intraglomerular
hemodynamics
Thrombotic microangiopathy
Drug class/drug(s)
Chemotherapeutics
Carmustine (Gliadel), semustine
(investigational)
Pathophysiologic mecahnism
of renal injury
Chronic interstitial nephritis
Cisplatin (Platinol)
Interferon-alfa (Intron A)
Glomerulonephritis
Methotrexate
Crystal nephropathy
Mitomycin-C (Mutamycin)
Thrombotic microangiopathy
Contrast dye
Diuretics
Loops, thiazides
Triamterene (Dyrenium)
Prevention strategies
Drugs altering intraglomerular
hemodynamics
Medications
Risk-factors
Prevention strategies
Underlying renal
insufficiency;
intravascular volume
depletion; age older
than 60 years;
concomitant use of
ACE inhibitors, ARBs,
NSAIDs, cyclosporine
(Neoral), or
tacrolimus (Prograf
As above, plus:
Monitor serum drug
excessive dose,
concentrations and
concomitant use with renal function
other nephrotoxic
drugs or drugs that
inhibit cyclosporine
or tacrolimus
metabolism
Use lowest effective
dose
Underlying renal
insufficiency,
duration of therapy
> 10 days, trough
concentrations > 2
mcg per mL,
concomitant liver
disease,
hypoalbuminemia
Use extended-interval
dosing Maintain trough
levels 1 mcg per mL
History of chronic
Avoid long-term use,
pain, age older than
particularly of more
60 years, female sex, than one analgesic
cumulative
consumption of
analgesic > 1 gram
per day for more than
two years
Use alternate agents
in patients with
chronic pain
Lithium
Volume depletion,
Discontinue or reduce
Ringkasan
Cukup banyak obat yang bersifat nefrotoksik
Dalam batas-batas tertentu toksisitas bersifat
sementara dan tubuh dapat mengkoreksinya
sendiri
Kerusakan yang timbul tergantung kondisi awal
ginjal dan sistem organ lainnya dan tingkat
nefrotoksisitas obat (mis. Aminoglikosida)
Perlu penyesuaian dosis obat pada keadaan
tertentu (gagal ginjal, gagal jantung, reaksi
alergi, dll.)