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NAPLEX 2023 > Chapter 18: Renal Disease > Flashcards

Chapter 18: Renal Disease Flashcards

1
Q

Most common causes of CKD?

A

HTN and diabetes

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2
Q

Which diuretic works at the loop of henle?

A

loop diuretics

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3
Q

Which diuretic works at the distal convoluted tubule?

A

thiazide diuretics

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4
Q

Loop diuretics block which pump & where?

A

Na-K pump in the ascending limb of the loop of Henle

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5
Q

Thiazide diuretics block which pump?

A

Na-Cl

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6
Q

Loop diuretics cause (increased/decreased) Ca reabsorption back into the blood, while thiazide diuretics cause (increased/decreased) Ca reabsorption

A

Decreased; increased

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7
Q

Long-term use of loop diuretics can (increase/decrease) bone density, whereas long-term use of thiazide diuretics can (increase/decrease) bone density

A

Decrease; increase

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8
Q

When aldosterone antagonists like spironolactone and eplerenone block aldosterone, more ___ and ___ are excreted in the urine and serum ___ increases

A

Na, water

K

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9
Q

What is the normal range for Scr?

A

0.6-1.3 mg/dL

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10
Q

CKD is generally defined as GFR ____ and/or _____

A

<60 ml/min

albuminuria

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11
Q

What drugs are first-line in preventing progression of disease in pts with CKD, diabetes and/or HTN if albuminuria is present?

A

ACE-I and ARB

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12
Q

When starting treatment with an ACEi or ARB, the baseline SCr can increase by up to ___%. This is normal and treatment should not be stopped

A

30%

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13
Q

What should you counsel a patient on when taking an ACE-I or ARB?

A

Avoid potassium supplements and salt substitutes

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14
Q

Patients with advanced kidney disease require monitoring of

A

PTH, phosphorous, Ca and Vitamin D levels

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15
Q

What is the MOA of phosphate binders?

A

Block absorption of dietary PO4 by binding to it in the intestine

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16
Q

When are phosphate binders taken? What is the frequency?

A

TID with meals or right before a meal

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17
Q

Which phosphate binders are first line?

A

Calcium-based (i.e. Ca acetate, Ca carbonate)

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18
Q

What is a side effect of calcium-based phosphate binders?

A

hypercalcemia; especially when used with vitamin D due to increased Ca absorption

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19
Q

Which phosphate binders are non-Ca and non-aluminum

A

Sevelamer carbonate and sevelamer Hcl

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20
Q

What is unique about sevelamer?

A

Can lower total cholesterol and LDL by 15-30%

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21
Q

What are high levels of PTH treated with?

A

vitamin D

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22
Q

How does Vitamin D deficiency occur?

A

when the kidneys cannot hydroxylate vitamin D to the active form, 1,25-dihydroxy vitamin D

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23
Q

What is the difference between vitamin D3 (cholecalciferol) and vitamin D2 (ergocalciferol)

A

D3 is synthesized in the skin after UV exposure and D2 is produced by plant sterols and is the primary source of dietary vitamin D

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24
Q

What is the MOA of vitamin D analogs?

A

increase intestinal absorption of Ca, raising serum calcium concentrations and inhibit PTH secretion

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25
What is the MOA of calcimimetics?
increases sensitivity of Ca-sensing receptor on PT gland, causing decreased PTH, decreased Ca, and decreased phosphate
26
What is an ADE of cinacalcet?
hypocalcemia
27
A sudden loss of kidney function due to a non-renal condition (e.g., drugs)
Acute Kidney Injury (AKI)
28
Common cause of AKI
dehydration
29
How can AKI present
BUN:SCr ratio > 20:1 plus decreased urine output, dry mucous membranes, and tachycardia
30
What drug class works at the proximal tubule
SGLT2 inhibitors
31
Where does aldosterone work in the kidney
DCT and collecting duct
32
What does aldosterone do
Increases Na and water reabsorption and decrease K reabsorption
33
Which key drugs can cause kidney disease
``` Aminoglycosides Amphotericin B Cisplatin Cyclosporine Loop diuretics NSAIDs Polymyxins Radiographic contrast dye Tacrolimus Vancomycin ```
34
Besides renal impairment, what else can cause increased BUN
dehydration
35
Low muscle mass = ____ SCr
low
36
When is the Cockcroft-Gault formula not preferred
Very young children, in ESRD or in unstable renal function
37
Which two drugs use GFR instead of CrCl for dose adjustments
SGLT2 inhibitors and metformin
38
Which key drugs require dose decrease or increase interval in CKD
- Aminoglycosides (increase dosing interval) - BL antibiotics (except antistaphylococcal PCNs and ceftriaxone) - Fluconazole - Quinolones (except moxifloxacin) - Vancomycin - LMWHs (enoxaparin) - Rivaroxaban (for AFib) - Apixaban (for AFib) - Dabigatran (for AFib) - H2RAs (famotidine and ranitidine) - Metoclopramide - bisphosphonates - Lithium
39
Key Drug(s) that are CI in CrCl < 60 mL/min
Nitrofurantoin
40
Key Drug(s) that are CI in CrCl < 50 mL/min
- Tenofovir disoproxil fumarate containing products (e.g., Stribild, Complera, Atripla, Symfi, Symfi Lo) - Voriconazole IV
41
Key Drug(s) that are CI in CrCl < 30 mL/min
- Tenofovir alafenamide containing products (e.g., Genvoya, Biktarvy, Descovy, Odefsey, Symtuza) - NSAIDs - Dabigatran (DVT/PE) - Rivaroxaban (DVT/PE)
42
Key Drug(s) that are CI in GFR < 30 mL/min/1.73m2
- SGLT2 inhibitors (canagliflozin, dapagliflozin, empagliflozin) - Metformin
43
Treatment of hyperphosphatemia is initially focused on
Restricting dietary phosphate (e.g., avoid dairy products, cola, chocolate and nuts)
44
If a dose of a phosphate binder is missed and a patient has already eaten, what should be done
The dose should be skipped
45
What are the 3 types of phosphate binders
1. aluminum based 2. calcium based 3. aluminum free, calcium free drugs
46
What is a side effect of aluminum hydroxide
"dialysis dementia"
47
Benefits of aluminum-free, calcium-free phosphate binders
No aluminum accumulation, less hypercalcemia
48
Counseling point for lanthanum carbonate
Must chew tablet thoroughly to reduce risk of severe GI adverse effects
49
Side effect of ferric citrate
Iron absorption - dose reduction of IV iron may be necessary
50
Side effects of Lanthanum carbonate
Nausea/vomiting, diarrhea, constipation
51
Side effects of sevelamer
N/V/D
52
Phosphate binders must be separated from ____ and ___
levothyroxine and antibiotics that chelate (e.g., quinolones and tetracyclines)
53
Calcium-based phosphate binders interact with many drugs, including
Quinolones, tetracyclines, oral bisphosphonates, and thyroid products
54
What drug must be taken 1 hour before both Sucroferric oxyhydroxide and ferric citrate
Doxycycline
55
What drug should be separated by 2 hours from ferric citrate
ciprofloxacin
56
Which drug should not be used with sucroferric oxyhydroxide
levothyroxine
57
Which drug class should be given 1 hour before or 2 hours after lanthanum
quinolone antibiotics
58
Which drug should be separated by at least 2 hours from lanthanum
Levothyroxine
59
Which drug class should be given 2 hours before or 6 hours after sevelamer
quinolone antibiotics
60
____ serum concentrations can be decreased and doses of these medications should be given several hours before sevelamer
Levothyroxine
61
What is the active form of vitamin D3
Calcitriol
62
Which drug is a calcimimetic
Cinacalcet (Sensipar)
63
Side effect of Vitamin D analogs
Hypercalcemia
64
Cinacalcet brand name
Sensipar
65
Side effects of etelcalcetide
Muscle spasms and paresthesia
66
Which drug class can prevent the need for blood transfusions
Erythropoiesis-stimulating agents (ESAs)
67
Which ESA is long-acting
darbepoetin alfa
68
Brand names of epoetin alfa
Procrit, Epogen
69
Brand name of darbepoetin alfa
Aranesp
70
Risks of ESAs
elevated BP and thrombosis
71
ESAs should only be used when Hgb is < ___ g/dL The dose of ESAs should be held or d/c if the Hgb exceeds ___ g/dL
10 11 (risk of thromboembolic disease is increased with higher Hgb levels)
72
ESAs are only effective if adequate ____ is available to make Hgb
iron
73
What is the most abundant intracellular cation
Potassium
74
Renal K excretion is increased by ___ & ___
``` aldosterone diuretics (loops > thiazides) ```
75
What causes K to shift into the cells
insulin
76
Which patients are at a higher risk for hyperkalemia
Pts with diabetes - insulin deficiency reduces the ability to shift K into the cells, and many pts with diabetes take ACEi or ARBs
77
Symptoms of hyperkalemia
Muscle weakness, bradycardia and fatal arrhythmias
78
Key drugs that can increase K levels
``` ACEi Aldosterone receptor antagonists Aliskiren ARBs Canagliflozin Drosperinon-containing COCs Potassium-containing IV fluids (including PN) K supplements Trim-Sulfa Transplant drugs (cyclosporine, everlomius, tacrolimus) ```
79
What should be done to the pts meds if they have hyperkalemia
D/c all K sources
80
What is done first if hyperkalemia is severe
There is an urgent need to stabilize the myocardial cells to prevent arrhythmias and to rapidly shift K intracellularly or induce elimination from the body
81
Which med is used in hyperkalemia to stabilize the heart/prevent arrhythmias
``` Calcium gluconate (IV) Onset: 1-2 min ```
82
Which meds are used in hyperkalemia to shift K intracellularly Include route and onset
Regular insulin (IV) Dextrose (IV) Sodium bicarb (IV) Albuterol (nebulized) Onset: all 30 min
83
Which meds are used in hyperkalemia to eliminate K from the body
Furosemide (IV) Onset: 5 min Sodium polystyrene sulfonate (oral) Onset: 1 hr Patiromer (oral) Onset: 7 hrs Sodium zirconium cyclosilicate (oral) Onset: 1 hr Hemodialysis Onset: immediately
84
sodium polystyrene sulfonate brand name
Kayexalate
85
sodium polystyrene sulfonate warning
Can bind to other oral meds
86
patiromer warnings/SE
WARNINGS Hypomagnesemia Binds to many oral drugs, separate by at least 3 hours before or 3 hours after SE Constipation
87
sodium zirconium cyclosilicate warning
can bind other drugs, separate by at least 2 hours before or 2 hours after
88
What is required if CKD progresses to failure (Stage 5 disease)
Dialysis
89
Drug removal during dialysis depends primarily on which factors
Molecular weight/size Vd Protein-binding High-flux and high-efficiency HD filters & higher dialysis blood flow rates

NAPLEX 2023 (88 decks)

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