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Phar 503 > Drug in use in Dialysis > Flashcards

Drug in use in Dialysis Flashcards

1
Q

How does dialysis replace the function of the kidney

A

nitrogenous waste removal, fluid and volume removal, electrolyte homeostasis

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2
Q

What stage of CKD would a patient ideally start to prepare for dialysis

A

Stage G4

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3
Q

In what situations would dialysis be given

A

End Stage Renal disease, acute kidney injury, emergent removal of toxic substances or dangerously elevated metabolic abnormalities

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4
Q

What is hemodialysis

A

filtering blood from toxins and removing excess fluid via perfusion of blood and dialysate moving in opposite direction of a semi-permeable membrane outside the body

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5
Q

What is required for hemodialysis, what can be needed

A

AV fistula, AV graft/ temporary catheter

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6
Q

How often and how long is hemodialysis

A

three times a week for 3 to 5 hours

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7
Q

What are cons of hemodialysis

A

loss of patient independce, increase in hypotension disequillibirum and muscle cramps, increased risks of infections, more rapid decline of residual renal function

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8
Q

T/F: The most ideal hemodialysis access type is the subclavian vein, interjugural vien, femoral vein

A

False: AV fistula created distal from the body

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9
Q

Rate the access modes by risk of infection and thrombosis

A

AV fistula, AV graft, catheter

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10
Q

T/F: AV fistula takes months and patients will have to start with a catheter

A

True

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11
Q

What medication is used to prevent thrombosis during dialysis

A

Heparin

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12
Q

What electrolytes are in the dialysate

A

bicarbonate, potassium

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13
Q

T/F: There are two dialysates, this is to make sure that there is not precipitation when. One is only bicarbonate, the other has everything else

A

True

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14
Q

What are the two principles that control hemodialysis, what do they influence

A

Diffusion: small sized molecules, convection: excess fluid

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15
Q

What is a dialyzer, how are the blood and dialysate pumped

A

thin semipermeable membrance, opposite direction

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16
Q

What are the two dialyzers

A

low-flux and high flux

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17
Q

For low-flux what is diffused, what is the rate of water transfer

A

urea, water and other small solutes, low/ larger molecules, high

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18
Q

T/F: Increasing dialysate flow rate will increase the diffusion

A

True

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19
Q

What is the principle way to remove excess fluid in patients

A

Ultrafiltration

20
Q

When would a patient be advised to get peritoneal dialysis

A

may have hypotension, significant residual renal function, larger fluid gains

21
Q

What is used as the filter for peritoneal dialysis,

A

peritoneal membrane, blood and lymphatic vessels aid in the process

22
Q

What are the pros of peritoneal dialysis

A

more hemodynamic stability, high clearance of larger solutes, better conservation of residual renal function, medication can be given here, less blood and iron loss

23
Q

What are the cons of peritoneal dialysis

A

Malnutriton, dialysis, obese individuals have less filtration, high technique failure, hernia, cannot be used if extensive abdominal surgery, no IV access

24
Q

How is peritoneal dialysis done

A

Catheter is placed in and the “old” dialysate is removed into the drainage bag, That part of the Y side is clamped and the “new” dialysate is inserted into the body, this “new” has diffusion occur

25
Q

What part of the catheter is used to reduce peritoneal infections, how long does it take to mature, what is the result of this

A

Cuff, 2-6 weeks, 60% get infection in the first 6 six weeks

26
Q

What are the 4 types of peritoneal dialysis, what occurs in each

A

Continous ambulatory PD: manually do exchanges several times a day, Automated PD: cycler device does several short exchanges overnight leaving 12 to 14 hours of dialysate during the day, nocturnal intermittent PD: similar to APD but no dialysate during the day, continous flow PD

27
Q

Why is icodextrin and dextrose also used as dialysate in PD, which is more dangerous

A

allows for ultrafiltration, dextrose

28
Q

In PD what will increase the osmotic gradient

A

How long the dialysate stays in the peritoneal cavity (increase in dwell time)

29
Q

What electrolyte is not removed by PD, why

A

Phosphorous, the peritoneal cavity is also negative thus causing a repel

30
Q

Which form of PD has the most clearance of small solutes

A

continous flow peritoneal dialysate

31
Q

In a Peritoneal equilibrium test (PET) what is considered high transport, high to average, low to average, low

A

greater than .81, .81 to.65, .65 to.5, less than .5

32
Q

T/F: If a patient has a high PET the need more exchanges

A

False: Patients with a high PET are high transporters and have rapid clearance of small molecules requiring less exchanges

33
Q

In peritonitis what types of infections are the most common, where are antibiotics given, how is dosing done

A

Gram positive, intraperitoneal, intermitten vs continous exchanges and type of PD

34
Q

What are the three types of Continous Renal Replacement methods

A

Continous veno-venous hemofiltration, continous veno-venous hemodialysis, continous veno-venous hemodiafiltration

35
Q

Which Continous renal replacement is most convection based therapy, diffusion based therapy, both

A

CVVH, CVVHD, CVVHDF

36
Q

What is the urea reduction ratio, what is the equation, how much should it be

A

Measurement of how much urea is being removed, Predialysis BUN- Postdialysis BUN/(Predialysis BUN), should be greater than 65

37
Q

What should the Kt/V be if a patient is on HD, Pd

A

greater than 1.2, greater than 1.7

38
Q

T/F: Solutes will have peak clearance if small, not protein bound and have a small VD

A

true

39
Q

What is the ranking of drug clearance for the methods of continous renal replacement

A

CVVH,CVVHDF, CVVH

40
Q

What drug and drug classes are dialyzable

A

ACEIs, Beta-blockers, Hydrazline, Minoxidil, Midrodrine

41
Q

What are exceptions in specific drug classes are not dialyzable

A

Lisinopril, carvedilo and labetolol

42
Q

What drug is dialyzable and dosed afterwards, not likely but still dosed afterwards

A

Hydralizine, Clonidine

43
Q

What antibiotics are dialyzable and should be dosed after dialysis

A

amoxicillin, cephalexin, levofloxacin. ciprofloxacin, olfloxacin, bactrim

44
Q

What antibiotics are not dialyzable but should be dosed after dialysis

A

metronidazole, clarithromycin

45
Q

T/F: Phenytoin should be dosed after dialysis and pay attention only to free drug

A

True

Phar 503 (25 decks)

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