Acute Kidney Injury part 3

Question 1

creatinine interference - decreased secretion

Answer 1

Trimethoprim
Dronedarone
Dolutegravir, cobicistat

Question 2

creatinine interference - lab interference

Answer 2

Cefoxitin
Flucytosine
Immune globulin

Question 3

prerenal

afferent vasoconstriction

Answer 3

NSAIDs

Cyclosporine, tacrolimus

Question 4

prerenal

efferent vasodilation

Answer 4

ACE inhibitors

ARBs

Question 5

medications that cause acute tubular necrosis

Answer 5

Aminoglycosides

Vancomycin

Amphotericin B

Contrast media

Cisplatin

Question 6

Aminoglycosides

Answer 6

Use once-daily dosing

Limit dose and duration (neomycin ***)

Monitor pharmacokinetics

Avoid concurrent nephrotoxic antimicrobials

Question 7

vancomycin

Answer 7

Limit dose and duration

Monitor pharmacokinetics

Avoid concurrent nephrotoxic antimicrobials

Question 8

Amphotericin B

Answer 8

Prefer liposomal formulations

Provide daily hydration

Limit cumulative dose

Avoid concurrent nephrotoxic antimicrobials

Question 9

contrast media

Answer 9

Prefer low-osmolality agents

Limit dose

Hold other nephrotoxic medications before use, particularly metformin

Question 10

other ways to prevent contrast media

Answer 10

Provide isotonic sodium chloride or bicarbonate
3 mL/kg/hr for 1 hr before contrast,
then 1 mL/kg/hr for 6 hr after

Consider N-acetylcysteine
600 mg PO q12h x 4 doses
(with first dose before contrast)

Question 11

cisplatin

Answer 11

Provide pre- and post-dose hydration (with k and mg supplementation)

Consider hypertonic saline

Consider mannitol or furosemide

Consider amifostine
-910 mg/m2 IV at 30 min before cisplatin

Question 12

virutally, any medication can cause

Answer 12

acute interstitial nephritis. this type of kidney injury is rare, only 2% of people have it.