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Pharmacotherapeutics - Final > CKD > Flashcards

CKD Flashcards

1
Q

2 mc causes of CKD

A

DM
HTN

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2
Q

5 labs used to evaluate CKD

A

SCr
albuminuria/ACR
GFR
BUN
K+

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3
Q

what lab is specific and pathognomonic for CKD

A

albuminuria

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4
Q

what lab value is very good at detecting early CKD

A

albuminuria

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5
Q

what lab value is good at monitoring chronicity of CKD

A

SCr

doubling = 50% decrease in renal fxn

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6
Q

what 3 labs are used to stage CKD

A

GFR
CrCl
ACR

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7
Q

GFR is based off of what lab

A

SCr

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8
Q

goal of tx for CKD

A

halt progression of renal dz

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9
Q

goal of tx for T2DM

A

improve glycemic control
decrease CV factors
avoid nephrotoxic drugs

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10
Q

what 2 classes of drugs can halt progression of renal dz

A

ACEI
ARB

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11
Q

5 common nephrotoxic drugs

A

metformin
cetirizine (zyrtec)
hctz
vit c
vit d

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12
Q

bp goal for DM + CKD

A

< 140/90 w.in 2-4 weeks

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13
Q

common drug-related problem with CKD management

A

failing to avoid nephrotoxic drugs

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14
Q

what lab must be calculated in order to select drugs safe for pt’s w. CKD

A

GFR

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15
Q

CKD stages based on GFR

A

90 or higher: nl
60-89: stage 2
45-59: stage 3a
30-44: stage 3b
15-29: stage 4
< 15: stage 5

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16
Q

4 contraindications for naproxen

A

dkd (diabetic kidney dz)
diuretics
ACE/ARB
GFR < 30

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17
Q

metformin is contraindicated in pt w. GFR < __
and safe for use if GFR is >

A

contraindicated: < 30
safe: > 45

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18
Q

when should GFR be evaluated w. pt on metformin

A

prior to initiation
at least annually

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19
Q

8 classes of DM meds

A

biguanides (metformin)
sulfonylureas - (rides, glypizide)
alpha glucosidase inhibitors (agi) - (acarbose, miglitol)
tzd’s - (glitazone)
dpp-4 inhibitors - (liptin)
incretin mimetics/glp1 agonists - (atide, utide)
sglt2 inhibitors - (gliflozin)
insulin

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20
Q

2 moa for metformin

A

inhibits gluconeogenesis and glycogenolysis
enhances insulin sensitivity in muscle and fat

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21
Q

effect of metformin on A1C

A

1-2% decrease

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22
Q

t/f: metformin causes weight gain

A

f!

it is weight neutral

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23
Q

max dose for metformin

A

2,000 mg/day

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24
Q

3 contraindications for metformin

A

GFR < 30
hepatic impairment
cardiac failure

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25
Q

2 s.e of metformin

A

GI
lactic acidosis

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26
Q

mc prescribed DM med

A

metformin

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27
Q

2 moa for sulfonylureas

A

-insulin secretagogues -> promote pancreatic b cell insulin secretion
-potentiate insulin action on extra-hepatic tissue

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28
Q

in order for sulfonylureas to be effective in DM patient , what must be functional

A

endogenous insulin production -> efficacy reduced in later CKD

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29
Q

effect of sulfonylureas on A1C

A

1-2%

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30
Q

2 s.e of sulfonylureas

A

hypoglycemia
wt gain (2 kg/year)

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31
Q

what sulfonylurea is contraindicated in renal failure

A

glyburide

use glimepiride w. caution

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32
Q

__ is the preferred sulfonylurea in DM + CKD

A

glipizide

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33
Q

t/f: glipizide requires renal dosing

A

t!

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34
Q

what DM med does Jaynstein really like

A

sulfonylureas

well tolerated
commonly used

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35
Q

moa for a-glucosidase inhibitors

A

delay GI breakdown and absorption of CHO

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36
Q

effect of a-glucosidase inhibitors on A1C

A

0.5-0.8% decrease

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37
Q

t/f: a-glucosidase inhibitors cause wt gain

A

f!

they are wt neutral

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38
Q

major reason a patient might have poor copmliance w. a-glucosidase inhibitors

A

GI s.e

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39
Q

does Jaynstein like a-glucosidase inhibitors

A

no!

poor acceptance
expensive
modest decrease in A1C

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40
Q

when are a-glucosidase inhibitors contraindicated in CKD pt

A

Cr > 2.0

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41
Q

moa for TZDs

A

insulin sensitization:
decrease hepatic glucose release, promote muscle glucose absorption -> reduce insulin resistance

42
Q

contraindications for TZDs (2)

A

hepatic dysfunction
cardiac dysfunction

43
Q

3 adverse effects of TZDs

A

wt gain
fluid retention
increased fx risk in women

44
Q

effect of TZDs on A1C

A

0.5-1.4%

45
Q

moa of dpp-4 inhibitors

A

inhibit dpp-4 enzyme -> break down proteins that trigger insulin release

increased incretin (GLP-1 and GIP) -> inhibit glucagon
-> decrease BG -> increase insulin and decrease gastric emptying

46
Q

adverse effect of dpp-4 enzyme inhibitors

A

pancreatitis

47
Q

which dpp-4 does not require renal dosing

A

linagliptin

48
Q

moa for incretin mimetics/glp-1 agonists

A

mimic incretin -> regulate fasting and postprandial glucose

stimulate glp-1 receptors -> enhance glucose dependent insulin secretion by beta cells -> suppress inappropriately elevated glucagon secretion and slow gastric emptying

49
Q

route of admin for incretin mimetics/glp-1agonists

A

subq once weekly

50
Q

what 2 dm meds can not be co-prescribed

A

dpp-4 inhibitor AND incretin mimetic/glp-1 agonist

51
Q

moa for sglt2 inhibitors

A

reduce tubular glucose reabsorption -> increased glucose in urine -> reduce bg levels -> reduced insulin

52
Q

added benefits of sglt2 inhibitors (2)

A

wt loss
lower bp

use in dm + obese + htn

53
Q

ho do sglt2 inhibitors affect lipids (2)

A

increase hdl
increase ldl

54
Q

effect of sglt2 inhibitors on a1c

A

0.75%

55
Q

3 s.e of sglt2 inhibitors

A

euglycemic dka
increased uti’s
pancreatitis

56
Q

what dm med has potential for greatest effect on a1c reduction

A

insulin

57
Q

what dm med allows the tightest glucose control

A

insulin

58
Q

2 adverse effects of insulin

A

wt gain
hypoglycemia

59
Q

best dm drug for pt’s w. severe renal dysfxn

A

insulin

60
Q

moa for ACEI

A

inhibit conversion of angiotensin I to angiotensin II -> reduce vasoconstriction and aldosterone

61
Q

what bp meds are used in ckd

A

diuretics
acei/arb
bb
ccb

62
Q

how do acei affect lipid levels

A

it doesn’t!

63
Q

moa for arb’s (2)

A

impair vasoconstriction angiotensin II
block aldosterone secretion

64
Q

some data has shown that ACEI are better for patients w. __
and ARBs are better for patients w. __

A

ACEI: DM1
ARB: DM2

65
Q

HCTZ is recommended in pt’s w. CKD stages __

A

1-3

66
Q

why isn’t HCTZ recommended for CKD 4 and 5

A

worsens hyperglycemia
decreases GFR
increases total cholesterol and TG

67
Q

what diuretic is recommended in ckd 4 and 5

A

loops -> furosemide

68
Q

s.e of furosemide

A

hyperglycemia
alter gtt

69
Q

what drug for class 4 and 5 ckd should not be used as monotherapy

A

furosemide

70
Q

what type of diuretic should be used with extreme caution in ckd

A

potassium sparing

71
Q

what drug reduces mortality in tx of HTN

A

bb

not necessarily best for HTN w. DM dt s.e

72
Q

adverse effects of bb

A

mask s.sx of hypoglycemia
decrease GFR
increase TG
reduce HDL

73
Q

t/f: ccb cause hyperglycemia and elevated TG

A

f!

neutral effect on both

74
Q

benefit of ccb for pt w. htn and ckd

A

reduce proteinuria

75
Q

when should ccb be used in pt w. ckd and htn (2)

A

second line therapy when ACEI or ARB fail
adjunct therapy if intense tx is needed

76
Q

what drugs are used for hyperlipidemia in ckd

A

statins -> usually effective alone
bile acid sequestrants/binding resins
fibrates

77
Q

what type of statin is generally recommended in ckd pt

A

moderate

but don’t need to change high intensity to moderate if pt is tolerating hith

78
Q

how can ckd affect lipid panel

A

may be inaccurate in ckd pt

79
Q

what are the high intensity statins

A

atorvastatin 40-80
rosuvastatin 20

80
Q

what drugs are used for hyperlipidemia in ckd

A

statins -> usually effective alone
bile acid sequestrants/binding resins
fibrates

81
Q

what are the bile acid sequestrants/binding resins

A

cholestyramine
colestipol
colsevelam

82
Q

why might a pt have poor compliance w. bile acid sequestrants

A

GI s.e
frequent dosing

83
Q

what are the fibrates

A

bezafibrate
gemfibrozil
fenofibrate

84
Q

what hyperlipidemia drug combo is contraindicated in ckd, and why

A

statin + fibrate
high risk for rhabdo

85
Q

name 2 ARBs

A

valsartan
telmisartan

86
Q

when do ACEI/ARB reach maximum effect
what is the bp goal at 4 weeks

A

4 weeks
< 130/80

87
Q

2 labs to monitor on ACEI/ARB

A

K+
SCr

d.c if elevated

88
Q

first line DM drug for pt in case study
alt tx

A

1st line: insulin
alt: sulfonylurea (glipizide) OR DPP-4 inhibitor (linagliptin)

89
Q

what DM drugs are weight neutral

A

metformin
dpp-4 inhibitors
a-glucosidase inhibitors

90
Q

what DM drugs have GI s.e

A

metformin
a-glucosidase inhibitors

91
Q

what dm drugs may cause pancreatitis

A

dpp-4 inhibitors
sglt2 inhibitors

92
Q

what DM drugs are contraindicated in hepatic impairment

A

metformin
tzd’s

93
Q

what DM drugs are contraindicated in end stages of ckd

A

metformin
glyburide (only sulfonylurea that is contraindicated)
a-glucosidase inhibitors
glp-1 agonists
sglt2 inhibitors
incretin mimetic/GLP1 agonists

94
Q

what DM drugs can be used safely in end stages of ckd

A

insulin
sulfonylureas
TZD’s
dpp4 inhibitors

95
Q

what dm drugs cause hypoglycemia

A

sulfonylureas
insulin

96
Q

what dm drugs require renal dosing

A

metformin
sulfonylureas
SGLT2 inhibitors
dpp-4 inhibitors
+/- insulin

97
Q

list the dm drugs in order of effect on a1c, high to low

A

insulin
biguanides: 1-2%
sulfonylureas: 1-2%
tzd’s: 0.5-1.4%
dpp-4 inhibitors: 0.5-1%
a-glucosidase inhibitors: 0.5-0.8%
SGLT2 inhibitors: 0.75%

98
Q

what dm drugs cause weight gain

A

sulfonylureas
tzd’s
insulin

99
Q

what dm drugs are associated w. weight loss

A

incretin mimetics/GLP-1 agonists
SGLT2 inhibitors

100
Q

what are the short acting insulins

A

regular: novolin, humulin
aspart: novolog
lispro: humalog
glulisine: apidra

101
Q

what are the intermediate acting insulins

A

nph: novolin N, humulin N

102
Q

what are the long acting insulins

A

glargine: lantus
detemir: levemir

Pharmacotherapeutics - Final (6 decks)

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