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Pharmacology

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Cancer Chemotherapy

Question
64 out of 100
 

Hypomagnesemia is caused by (LQ)


A furosemide
B digoxin

C aminoglycoside
D cisplatin

Ans. A Furosemide (Harrison, 17the edition, Table 346 –4, P 2372)

a. Furosemide is a sulphanilamide derivative and is most commonly used diuretic. It impairs the electronegative potential of the tubule cells at distal convoluted tubules and hence can reduce absorption of both calcium and magnesium.

b. Digoxin is an inotropic drug and increases cardiac output by inhibiting the membrane bound cardiac enzyme called Na+K+ ATPAse. The drug has diuretic activity but it does not per se cause reduced calcium or magnesium excretion. However, this action helps in clearing salt and water of CHF patients.

c. Aminoglycosides are narrow therapeutic index drugs with ability to block protein synthesis in bacteria. The drugs are nephrotoxic and potassium levels can increase.

d. Cisplatin is a complex plantin compound and has significant nephrotoxicity that can involve renal tubular acidosis and proteinuria. The drug can also cause hyperkalemia.

Extra edge points about causes of hypomagnesemia

Table 346-4 Causes of Hypomagnesemia

I. Impaired intestinal absorption

A. Primary infantile hypomagnesemia

B. Malabsorption syndromes

C. Vitamin D deficiency

II. Increased intestinal losses

A. Protracted vomiting/diarrhea

B. Intestinal drainage, fistulae

III. Impaired renal tubular reabsorption

A. Genetic magnesium-wasting syndromes

1. Gitelman syndrome

2. Bartter syndrome

3. Paracellin-1 mutations

4. Na+,K+-ATPase g-subunit mutations (FXYD2)

5. Autosomal dominant, with low bone mass

B. Acquired renal disease

1. Tubulointerstitial disease

2. Postobstruction, ATN (diuretic phase)

3. Renal transplantation

C. Drugs and toxins

1. Ethanol

2. Diuretics (loop, thiazide, osmotic)

3. Cisplatin

4. Pentamidine, foscarnet

5. Cyclosporine

6. Aminoglycosides, amphotericin B

D. Other

IV. Extracellular fluid volume expansion

A. Hyperaldosteronism

B. SIADH

C. Diabetes mellitus

D. Hypercalcemia

E. Phosphate depletion

F. Metabolic acidosis

G. Hyperthyroidism

V. Rapid shifts from extracellular fluid

A. Intracellular redistribution

1. Recovery from diabetic ketoacidosis

2. Refeeding syndrome

3. Correction of respiratory acidosis

4. Catecholamines

B. Accelerated bone formation

1. Post parathyroidectomy

2. Treatment of vitamin D deficiency

3. Osteoblastic metastases

C. Other

1. Pancreatitis, burns, excessive sweating

2. Pregnancy (3rd trimester) and lactation

Cancer Chemotherapy Flashcard List

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