Day 1: Dr Dey Flashcards
What is the avg GFR for an adult?
120-130ml/min
180L/day
Avg urine = 1-1.5 L/day = 99% gets reabsorbed
What is the equation to find Clt?
This s the total body clearance
Clt = k*Vd
What is the importance of the extraction ratio of a drug?
Extraction is the done by the liver and its when it takes a large chunk of of a drug even tho it gets absorbed quickly.
EX: a drug has an oral bioavailability of 46% and it is rapidly and completely absorbed, how can you explain this poor bioavailability? It’s due to the liver metabolizing the drug and make it into a non active form and giving a poor bioavailability
ER = 1 - F
What happens when drugs have a low ER?
They have very little first pass and it gives them a High F value
What happens to drugs that have a high ER value?
It means they have extensive first pass and will have a low F value
What is a restrictive clearance
It means the drug is likely to be protein bound and that makes it DEPENDENT on protein binding
What does non-restrictive clearance mean?
It means that they drug is not likely to be bound to protein so it is INDEPENDENT of protein binding
What is stage 1 of CKD?
Description : Kidney dmg, with normal of inc GFR
GFR: >90
Action: Diagnosis and treatment, Treatment of comorbid conditions, Slowing progression, CVD risk reduction
What is stage 2 of CKD?
Description: Kidney dmg, with mild dec in GFR
GFR: 60-89
Action: estimating progression
What is stage 3 of CKD?
Description: Moderate dec in GFR
GFR: 30-59
Action: Evaluating and treating complications
What is stage 4 of CKD?
Description: Severe dec in GFR
GFR: 15-29
Action: Preparation for kidney replacement therapy
What is stage 5 of CKD?
Description: Kidney Failure
GFR: <15 (or dialysis)
Action: Kidney replacement
What’s the equation for a male for the Cockroft-Gault Method?
Clcr = [140-age]xIBW / 72(Scr)
If ABW < IBW use the ABW
If ABW > IBW use but less than OBW use the IBW
If ABW > IBW and ABW is greater than OBW use adjusted body weight
What is the equation of IBW for a male?
IBW = 50+2.3(Height in inches - 60)
What is the equation for IBW for women?
IBW = 45+2.3(height in inches -60)
How do you find OBW?
IBW * 1.3 will tell you a persons OBW
What is the equation for female Clcr using the Cockcroft-Gauls Method?
Clcr = ([140-age]xIBW / 72Sr) * 0.85
How is Cirrhosis defined?
Replacement of liver tissue by scare tissue leading to loss of liver function
- ## Alcoholic cirrhosis is th worst
What is the Child-Pugh (CTP) score?
Use to assess the prognosis of chronic liver disease, primarily cirrhosis and the necessity of liver transplantation
What is Class A of the Child-Pugh (CTP) score?
5-6 points
Life expectancy is 15-20 years, Abdominal surgery peri-operative mortality: 10%
Two year survival: 85%
What is class B of Child-Pugh (CTP) score?
7-9 points
Ready for liver transplantation
Abdominal surgery peri-operative mortality: 30%
Two year survival: 57%
What is class C Child-Pugh (CTP) score?
10-15 points
Life expectancy 1-3 years
Abdominal surgery peri-operative mortality: 82%
Two year survival: 35%
What is the MELD?
Model for end-stage liver disease
Scoring system to assess severity of liver disease
Useful to prioritizing patients for liver transplantation
The higher the score means a higher 3 month mortality
**higher the score means more likely to die
