CKD part 2

Question 1

Pharmacological Interventions

Control

__________

__________

Hyperlipidemia

Avoid nephrotoxic agents

Answer 1

Hypertension

Diabetes

Question 2

What can be nephroxtoic for pts? NSAIDS, aminoglycosides, certain antibiotics, chemo drugs, _____________,tacrolimus which is an immunosuppressant, calcineurin inhibitors

Answer 2

metformin

Question 3

Treatment of hypertension

Approximately 50 to 75% of individuals with eGFR <60ml/min have ______________
_
Antihypertensive therapy slows down progression of CKD and reduces risk of CVD

Answer 3

hypertension

Question 4

What is a standardized approach vs

Standardized process if you have someone come in and check your blood pressure and do a manual blood pressure on you and you have the Medical assistant come and then you have the pharmacist come alot of times people will have different results as opposed if you have a standardized process so they recommended moving away from manual blood pressures and doing more of like the automatic blood pressure monitoring and thats just because it keeps it standard across the board so that everybody’s getting monitored and values being obtained in the same way

Question 5

Treatment of hypertension-monitoring

Recommend _____________office BP measurement in preference
to routine office BP measurement for the management of high
BP in adults (1B)

Suggest that out-of-office BP measurements with ambulatory BP
monitoring (ABPM) or _____________ (HBPM) be used to
complement standardized office BP readings for the
management of high BP (2B)

Answer 5

standardized

home BP monitoring

Question 6

Make sure pt is sitting for awhile, ask about caffeine use or smoking, whens the last time they took their medications to make sure the blood pressure is a true blood pressure your taking

Question 7

Majority of pts with CKD should have a blood pressure of what?

Answer 7

less than 130/80

Question 8

If you push blood pressure too low what can happen to the pt? pt can feel lightheaded or dizzy

Question 9

Clinicians can reasonably offer less intensive BP-lowering therapy in patients with very limited life expectancy or
symptomatic postural hypotension

Question 10

For treatment of hypertension for pts with CKD you must start an ACE or ARB do we start both?

Answer 10

No we don’t use them together because both of these medicatiosn contribute to lowering blood pressure so more concern with hypotension but professor stated the more concern is with HYPERKALEMIA WITH USING BOTH ACE AND ARBS TOGETHER DON’T DO THAT

Question 11

Don’t recommend ACE and ARBS together ever for hypertension!!

Question 12

Transplant pt won’t be given on exam professor stated

Question 13

Drug Therapy-Hypertension in CKD

ACEIs and ARBs are preferred antihypertensive agents

Monitor K+ and _________ as well as pt’s GFR

Answer 13

Scr (serum creatinine)

Question 14

ACE inhibitors and ARBs increase serum potassium

Question 15

ACE inhibitors block conversion of angiotensin I to angiotensin II

Question 16

Adverse effects with ACE inhibitors

Dry cough
Angioedemia
Low blood pressure
Hyperkalemia

Fetal harm has been demonstrated with use in pregnant women

Question 17

If pt has an allergic reaction to ACE inhibitors, what can we do? switch to a ________

Answer 17

ARB

Question 18

ACE inhibitors ends in -pril

Question 19

ARBs block binding of angiotensin II from AT1 receptors

Question 20

ARBs ending in sartans

Question 21

ARBs don’t have the side effect of dry cough or angioedema

Higher incidence of hypotensive symptoms and _____________

Answer 21

hyperkalemia