AST 4 Quizzes Flashcards
What kind of risk factor are nephrotoxins?
Exposure
What mechanism(s) do RAS inhibitors use?
-decrease glomerular hypertension
-decrease proteinuria
What causes hypocalcemia?
Hyperphosphatemia
What acid/base disorder results from altitude, and what drug treats it?
respiratory alkalosis
acetazolamide
What drug acts on site II of the nephron (the loop of Henle)?
Furosemide
What is a complication of late-stage SHPT?
Osteo- disorders
Why is furosemide an efficacious diuretic?
-The region it acts on is responsible for 20-30% of filtration
-it disrupts the counter-current multiplier
What site in the nephron is responsible for diuretic-induced hypokalemia?
Site IV- collecting duct
What is the recommended treatment for shock-induced (?) Anion Gap Metabolic Acidosis?
Norepinephrine
What is the preferred term for acute renal insufficiency?
Acute kidney disease
What diuretic acts at site III, the distal tubule?
HCTZ (thiazides)
What class of medications can cause pre-renal AKI?
diuretics
True or false: Loading doses should be avoided in patients with kidney impairment
False: if anything is changed, it should be the maintenance dosing
Where is the ultrafiltrate in the nephron?
Site I (proximal tubule)
Which part of the nephron does triamterene affect?
Site IV (collecting duct)
What differentiates chronic kidney disease?
Adaptation
__1__ are used to prevent esophageal varices from bleeding by __2__ the __3__ vasculature
- Non-selective beta blockers
- Vasoconstricting
- Splanchnic
Which of the following beta blockers are non-selective:
Acebutolol
Metoprolol
Timolol
Timolol
What type of anemia is associated with low hemoglobin and elevated MCV?
macrocytic, normochromic
What is required to diagnose SBP?
ONLY a PMN count>250
(WBC count x Poly %)
What drugs treat Non-Alcoholic Fatty Liver Disease?
None!
How long should SBP be treated with antibiotics?
5 days
(7 days for prophylaxis)
If a patient on epoetin has an Hgb of 11.2 when checked, what should be done to their dosing?
Decreased by 25%
What should patients be advised when taking po ferrous sulfate?
take with food for tolerability
How to diagnose a patient with CKD?
-More than 3 months!
-eGFR<60?
What treatment should be given to a CKD patient with a phos level 5.6 and calcium level 10.2?
Sevelamer 800 mg po tid with food
G3a/A2 patient on HCTZ not controlling hypertension
keep HCTZ dose and initiate losartan
What lab value is most important to determine liver function?
Albumin
What is the pathophysiology of anemia in CKD?
- shortened RBC lifespan
- uremic inhibition of epoetin
- Up-regulation of hepcidin
What drug should be discontinued in a hospitalized CKD patient to avoid AKI?
furosemide
(diuretics)
A patient has been on ergocalciferol for 2 weeks and their 25(OH) vitamin D level is unchanged. What should be done to their dosing?
Keep dose the same, wait another few weeks
What lab test helps to determine the etiology of ascites?
SAAG (serum ascites albumin gradient)
What are the indications for dialysis?
Acidosis, EIOU
Which form of dialysis can cause hypotension?
IHD
How is the severity of ascites determined?
amount of fluid AND response to diuretics
What drug should be avoided in kidney failure?
morphine/codeine
What analytic determines the severity of alcoholic hepatitis and whether to start steroids?
Maddrey Discriminant Function (MDF)
start steroids if over 32
What is a common chronic condition leading to kidney failure?
Hypertension
Which diuretic’s mechanism of action works with the pathophysiology of ascites?
Spironolactone
What severity is an acute variceal bleed?
Active bleeding is ALWAYS severe life-threatening
When should 25% albumin be given in ascites?
Only to patients who undergo large-volume paracentesis
How will decreasing dialysate flow rate affect the rate of drug removal?
Decrease the rate of drug removal
How is HRS-AKI (hepatorenal syndrome-acute kidney injury) treated?
vasopressors and albumin
What vasoactive substances operate in the liver?
nitric oxide and endothelins
What scale is used to evaluate hepatic encephalopathy?
West Haven Criteria
How often is intermittent hemodialysis delivered?
2-3 times/week
How does the dialysate in IHD run?
countercurrent to blood flow through the filter
What is a common cause for acute kidney failure?
Drug toxicity
What factors make a drug likely to be cleared by the kidneys?
-Low molecular weight
-low protein binding
-low volume of distribution
In what two conditions is a TIPS procedure a possible treatment?
-variceal bleeding
-ascites
What is the Lille score used for?
Alcoholic hepatitis when steroids are not working
What OTC pain medication is appropriate in cirrhotic patients, and at what dose?
Acetaminophen, max 2 g/day
