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NAPLEX PREP (RxPrep) > 4. Renal & Liver Disease > Flashcards

4. Renal & Liver Disease Flashcards

1
Q

The _______ arteriole flows INTO the glomerulus, the _______ arteriole flows OUT of the glomerulus (where large, unfilterable substances stay in the blood)

A

Afferent = IN
Efferent = OUT

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2
Q

____ in the urine indicates kidney damage

A

Albumin

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3
Q

What drug works on the PROXIMAL tubule? What blood characteristic is regulated here?

A

SGLT-2is
Blood pH is regulated

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4
Q

What is reabsorbed in the descending limb of the loop of Henle? What is absorbed in the ascending limb?

A

Descending = WATER reabsorbed
Ascending = SODIUM reabsorbed

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5
Q

What is the mechanism of the DISTAL tubule of the nephron? What drug affects the distal tubule?

A

Regulates K, Na, Ca, and pH
Thiazide diuretics inhibit the Na-Cl pump, and increases Ca reabsorption

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6
Q

What drugs affect the COLLECTING DUCT (and distal tubule)?

A

**Potassium-sparing diuretics (including aldosterone antagonists [eg. spironolactone, eplerenone])
Decreased Na+ and water reabsorption, increased K+

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7
Q

What drugs can cause nephrotoxicity?

A

Aminoglycosides
Amphotericin B
Cisplatin
Cyclosporine + Tacrolimus
Loop diuretics
Contrast dyes
NSAIDs
Polymyxins
Vancomycin

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8
Q

What two lab markers can be used to estimate kidney function?

A

BUN
SCr

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9
Q

What is BUN?

A

Amount of nitrogen in blood from urea (waste of protein metabolism)

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10
Q

What is SCr? What is a normal range?

A

A waste product of muscle metabolism
Normal: 0.6 - 1.3 mg/dL

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11
Q

When is the Cockroft-Gault equation NOT PREFERABLE? (3)

A

Very young children
Kidney failure
Unstable, fluctuating renal function

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12
Q

What are two drugs dosed based on GFR?

A

SGLT2is
Metformin

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13
Q

Albumin in the urine is used to measure what?

A

Assess kidney disease
Albuminuria/proteinuria

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14
Q

What are the CKD guidelines?

A

KDIGO

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15
Q

What are the 2 criteria that confirms a CKD diagnosis?

A

eGFR < 60 mL/min/1.73 m2
Albumineria (AER ≥ 30)

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16
Q

What meds are used to delay CKD progression?

A

ACEi/ARBs SCr may increase up to 30%
SGLT2i
Finerinone

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17
Q

What drugs require dose reduction in CKD?

A

Anti-infectives (aminoglycosides, beta-lactams, fluconazole, quinolones, vanco)
Cardiovascular drugs (DOACs, enoxaparin)
GI drugs (H2RAs, metoclopramide)
Bisphosphonates
Lithium

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18
Q

What drug is contraindicated in CrCl < 60 mL/min?

A

Nitrofurantoin

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19
Q

What drugs are contraindicated in CrCl < 50 mL/min?

A

Tenofovir disoproxil
Voriconazole IV only

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20
Q

What drugs are contraindicated in CrCl < 30 mL/min?

A

Tenofovir alafenamide
NSAIDs
Dabigatran

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21
Q

What drug is contraindicated in CrCl < 30 mL/min?

A

Metformin

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22
Q

What some drugs that have CrCl limitations?

A

Meperidine
Rivaroxaban (Xarelto)
SGLT2i

23
Q

What should be monitored in advanced kidney disease/CKD?

A

PTH (elevated)
Phosphorus (elevated)
Calcium (low)
Vitamin D (low)

24
Q

What are some phosphate binders for CKD hyperphosphatemia?

A

Aluminum hydroxide
Calcium acetate/carbonate** (hypercalcemia risk)
Sucroferric oxyhydroxide
Ferric citrate
Lanthanum carbonate
Sevelamer (most common, may lower LDLs)

25
Q

What drugs should be separated from phosphate binders administration?

A

Levothyroxine
Quinolones
Tetracyclines

26
Q

What is vitamin D3 and what is vitamin D2? What is the active form?

A

D3 = cholecalciferol (from UV of the sun)
D2 = ergocalciferol (from diet)
Calcitriol = ACTIVE form

27
Q

What are some treatments for hyperparathyroidism

A

Vitamin D analogs (ie. Calcitriol)
Calcimimetics (cinacalcet, etelcalcetide)

28
Q

What are the treatments of anemia in CKD? What is needed for this medication to be effective? What is the Hgb limit?

A

Erythropoesis-stimulating agents (ESA)
- epoetin alfa, darbapoetin alfa
(Increased risk of HTN and thrombosis)
only for Hgb < 10! [even though Hgb <13 is anemia])
Adequate iron necessary (can give IV iron)

29
Q

What is a normal potassium level?

A

Normal K = 3.5 - 5 mEq/L

30
Q

What drug causes an increase in intracellular shift of potassium?

A

Insulin
(Pts w diabetes are at higher risk of hyperkalemia d/t lower insulin)

31
Q

What is the most common cause of hyperkalemia?

A

Renal failure

32
Q

What adverse events may occur in hyperkalemia?

A

Muscle weakness
Bradycardia
Fatal arrhythmias

33
Q

What drugs raise K levels?

A

ACEi/ARBs
Aliskerin
Canagliflozin
Drospirenone COCs
K-sparing diuretics
Bactrim
Cyclosporine/tacrolimus

34
Q

What drug may be given to prevent arrhythmias in the setting of hyperkalemia?

A

Calcium gluconate (preferred) or chloride

35
Q

What medications can shift K intracellularly in the setting of hyperkalemia?

A

Insulin (regular) + dextrose
Sodium bicarbonate
Albuterol (nebulized)

36
Q

What medications can be given to eliminate K from the body in hyperkalemia?

A

Loop diuretics

[Potassium binders]
Sodium polystyrene sulfonate
Sodium zirconium cyclosilicate
Patiromer

Hemodialysis

37
Q

What factors affect if/how much drug is removed during dialysis?

A

Molecular weight/size
Vd (larger Vd = less removed by dialysis)
Protein-binding
Dialysis membrane
Blood flow rate

38
Q

Define hepatitis

A

Inflammation of the liver

39
Q

Describe hepatitis A

A

Acute & self-limiting

Transmission: fecal-oral
- improper handwashing, contaminated food/water

Sx: mild and non-specific

40
Q

Describe hepatitis B and C (HBV, HCV). What is a preventative measure?

A

Acute + chronic illness
Sx: chronic infection, cirrhosis, liver cancer, liver failure, death
Transmission: blood (B+C), body fluids (B)
All adults should get the HBV vaccination

41
Q

Treatments for hep A? B? C?

A

Hepatitis A = supportive only
Hepatitis B = Peg-interferon, NRTI (tenofovir, entecavir)
Hepatitis C = Direct-acting antivirals combo

42
Q

Treatment for naive hepatitis C patients w/o cirrhosis (2)

A

Glecaprevir/pibrentasa (Mavyret) x 8 weeks [with food! Avoid w statins]
Sofosbuvir/velpatasvir (Epclusa) x 12 weeks [avoid amiodarone, PPIs]

All DAAs = avoid strong CYP3A4 inducers

43
Q

What is the MOA of NRTIs?

A

Inhibit HBV replication by inhibiting polymerase

44
Q

What NRTIs are primarily used for hepatitis B treatment?

A

Tenofovir disoproxil fumarate (TDF) [renal tox, Falcons syndrome, weak bones]
Tenofovir alafenamide (TAF) [renal tox, Falcons syndrome, weak bones]
Entecavir (Baraclude) [take wo food]
Lamivudine do not use for HIV, since hep B dose is lower and may cause resistance

45
Q

Interferon alfa is used in hepatitis B treatment. What is the advantage of using pegylated interferon alfa (Pegasus)?

A

Pegylated = prolongs half life

46
Q

Pegylated interferon alfa is used in hepatitis B treatment. What are its boxed warnings? Major AEs?

A

Boxed warnings:
Neuropsychiatric disorders
Autoimmune diseases
Ischemic diseases
Infectious diseases

AEs:
CNS effects, GI, increased LFTs, flu-like sx (pretreat w APAP and antihistamine)

47
Q

Define cirrhosis

A

Advanced fibrosis/scarring of the liver, most commonly caused by hep C and alcohol abuse

48
Q

What is the defining clinical presentation of cirrhosis

A

JAUNDICE

49
Q

What are the lab values to look at for cirrhosis?

A

Increased AST/ALT (unless extremely advanced, then normal)
Increased Alk phos
Increased total bilirubin, lactate dehydrogenase
Increased PT INR
Decreased albumin

50
Q

What assessment tool is used to assess severity of liver disease?

A

Child-Pugh

51
Q

In alcoholic liver disease, is AST or ALT generally higher?

A

AST is generally 2x higher than ALT

52
Q

What natural product is used for liver disease? Which natural product is a known hepatotoxins?

A

Treatment: Milk thistle
Hepatotoxins: Kava,

53
Q

What lab value limit indicates that a hepatotoxic medication should be D/Ced?

A

> 3x ULN LFTs

54
Q

What are some common hepatotoxic drugs? (10)

A

APAP
Amiodarone
Isoniazid
Ketoconazole
Methotrexate
Nefazodone
Nevirapine
PTU
Valproic acid
Zidovudine

NAPLEX PREP (RxPrep) (7 decks)

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