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Pharmacology > Acute Kidney Injury (Exam 2) > Flashcards

Acute Kidney Injury (Exam 2) Flashcards

1
Q

acute kidney injury (aki)

A

abrupt decline in renal function
inability to properly excrete waste and maintain acid base balance

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2
Q

clinical definitions of AKI (4)

A

decrease of 25% or greater in estimated GFR

an increase in SCr of 0.5mg/dL or greater

an increase of 1mg/dL or more in SCr in pts with CKD

urine output <0.5mL/kg/hour for at least 6 hours

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3
Q

anuria urine output

A

<50 mL/day

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4
Q

non-oliguria urine output

A

greater than 500mL/day
better outcome

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4
Q

oliguria urine output

A

> 50mL but less than 500mL/day

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5
Q

normal urine output

A

1mL/kg/hour

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6
Q

diagnostic criteria for acute kidney injury network

A

an absolute increase in SCr of more than 0.3mg/dL

an increase in baseline SCr by 50% or more

urine output of less than 0.5mL/kg/hour for more than 6 hours

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7
Q

AGENTS used to treat/prevent AKI

A

thiazide diuretics
loop diuretics
potassium-sparing diuretics

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8
Q

thiazide diuretics

A

chlorothiazide - diuril
chlorthalidone
hydrochlorothiazide - microzide
indapamide
metolazone

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9
Q

loop diuretics drugs

A

bumetanide - bumex
ethacrynic acid - edecrin
furosemide - lasix
torsemide - demadex

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10
Q

potassium-sparing diuretics

A

amiloride
eplerenone - inspra
spironolactone - aldactone, carospir
triamterene - dyrenium

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11
Q

loop diuretics increase

A

renal blood flow and urine flow

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12
Q

General principles for prevention of AKI (4)

A

avoid nephrotoxic agents
ensure adequate hydration
patient education
drug therapies to decrease incidence of contrast induced nephropathy

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13
Q

N-acetylcysteine (NAC)

A

contrast induced nephropathy
well tolerated, little adverse effects

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14
Q

goals of therapy for AKI (5)

A

maintain appropriate BP
monitor and manage electrolytes daily
eliminate or minimize insult that precipitated AKI
facilitate renal recovery and minimize injury
expedite recovery of baseline renal function

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15
Q

Mannitol MOA

A

increases the osmotic pressure of glomerular filtrate which inhibts tubular reabsorption of water and electrolytes

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15
Q

what does Mannitol induce?

A

hyperosmolar state

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15
Q

loop diuretics have no benefit for ____ and are _____. Switching loop diuretics is _______.

A

survival outcomes

equally effective

unlikely to be effective

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15
Q

proximal tubule (PCT) components

A

NaHCO3
Na+
Cl-
H2O
Glucose
Amino Acids

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16
Q

thick ascending limb of loop of henle (TAL) components

A

Na+
K+
Cl-
Mg2+
Ca2+

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16
Q

Distal convoluted tubule (DCT) components

A

Na+
Cl-
Ca2+ (PTH)

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17
Q

Thin descending limb of loop of Henle components

A

H2O

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17
Q

what is diuretic resistance?

A

not responding to loop diuretics

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17
Q

Collecting duct components

A

Na+
Cl-
K+ (secretion)
H+ (secretion)

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18
Q

ACEIs

A

angiotensin-converting enzyme inhibitors

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19
Q

NSAIDs

A

nonsteroidal anti inflammatory drugs

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20
Q

A (indications for RRT)

A

acid base abnormalities

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21
Q

E (indications for RRT)

A

electrolyte imbalance

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22
Q

I (indications for RRT)

A

intoxications

23
Q

O (indications for RRT)

A

fluid overload

24
Q

U (indications for RRT)

25
Q

DIKD (drug induced kidney disease) primary prevention strategy

A

avoid use of nephrotoxic agents

26
Q

AKI characteristics

A

fluid overload
acid base abnormalities
increased serum Cr and BUN

27
Q

AKI can further classify into stages 1-3 on the basis

A

of degree of SCr rise and urine output

28
Q

RIFLE category

A

risk
injury
failure
loss
ESKD

29
Q

risk urine output criteria

A

less than 0.5 mg/kg/h for 6 hrs

30
Q

injury urine output criteria

A

less than 0.5 mg/kg/h for 12 hrs

31
Q

failure urine output criteria

A

anuria for more than 12 hrs

32
Q

AKIN criteria

A

Stages 1-3

33
Q

AKIN stage 1 urine output criteria

A

less than 0.5 mg/kg/h for 6 hrs

34
Q

AKIN stage 2 urine output criteria

A

less than 0.5 mg/kg/h for 12 hrs

35
Q

AKIN stage 3 urine output criteria

A

less than 0.3 mg/kg/h for 24 hours OR anuria form more than 12 hrs

36
Q

KDIGO criteria

A

stages 1-3

37
Q

KDIGO stage 1 urine output criteria

A

less than 0.5 mg/kg/h for 6 hrs

38
Q

KDIGO stage 2 urine output criteria

A

less than 0.5 mg/kg/h for 6-12 hrs

39
Q

KDIGO stage 3 urine output criteria

A

anuria for more than 12 hrs

40
Q

RIFLE category is based off of ?
AKIN and KDIGO criteria are based off of ?

A

RIFLE - SCr and GFR
AKIN/KDIGO - SCr

41
Q

loop diuretics are useful for

A

management of fluid overload for patients at risk for AKI
DOES NOT prevent

42
Q

nonpharmacologic therapy for AKI

A

avoid nephrotoxic agents
hydration
RRT - dialysis
Target for UOP - greater than 0.5 mg/kg/h

43
Q

pharmacologic therapy for AKI

A

diuretics
mannitol

44
Q

why does someone on Mannitol have to be closely monitored?

A

it can cause AKI

45
Q

dose of Mannitol

A

12.5-25 grams IV over 3-5 minutes
parenterally

46
Q

most common loop diuretic used

A

furosemide

47
Q

torsemide and bumetanide have

A

greater oral bioavailability and are more potent

48
Q

which type of drugs are recommended for prevention in AKI?

A

Isotonic Saline IV
vasopressors

49
Q

which type of drugs are recommended for prevention in contrast induced AKI?

A

isotonic saline IV
NAC (n-acetylcysteine)
Sodium bicarbonate IV

50
Q

monitoring parameters for AKI

A

fluid ins/outs
weight
hemodynamics
blood chemistries
drugs, dose regimens and times of doses
nutritional regimen
blood glucose
urinalysis
plans for RRT

51
Q

Acute Tubular Necrosis

A

damage to tubule cells of the kidneys
proximal and distal tubules

52
Q

the most common cause of AKI

A

acute tubular necrosis

53
Q

ATN can be caused by

A

aminoglycosides
radiocontrast media
amphotericin B

54
Q

Osmosis nephrosis

A

swelling of the renal proximal tubular cells associated with glomerular filtration of sugars and dextrose

55
Q

contrast media induced nephrotoxicity

A

any combination of direct tubular toxicity, renal ischemia and tubular obstruction

56
Q

examples of CM induced nephrotoxicity drugs

A

ethiodol
lipiodol
diatrizoate
iothalamate
gadodiamide
gadobutrol
perflutren

57
Q

CM induced nephrotoxicity incidence

A

7-15% - receiving iodinated contrast
2% - normal renal function
over 50% - CKD

58
Q

Biomarkers of AKI

A

cystatin C
IL -18
KIM-1
NGAL

59
Q

cystatin c source

A

plasma and urine

60
Q

IL-18 source

61
Q

KIM-1 source

62
Q

NGAL source

A

plasma and urine

63
Q

which is the most sensitive biomarker for AKI?

A

NGAL (neutrophil gelatinase associated lipocalin)

64
Q

how much of the three criteria of AKI is required and in what time frame to give a diagnosis (according to the diagnostic criteria)?

A

one of the three criteria within 48 hours

Pharmacology (18 decks)

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