Drug in use in Dialysis Flashcards
How does dialysis replace the function of the kidney
nitrogenous waste removal, fluid and volume removal, electrolyte homeostasis
What stage of CKD would a patient ideally start to prepare for dialysis
Stage G4
In what situations would dialysis be given
End Stage Renal disease, acute kidney injury, emergent removal of toxic substances or dangerously elevated metabolic abnormalities
What is hemodialysis
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
What is required for hemodialysis, what can be needed
AV fistula, AV graft/ temporary catheter
How often and how long is hemodialysis
three times a week for 3 to 5 hours
What are cons of hemodialysis
loss of patient independce, increase in hypotension disequillibirum and muscle cramps, increased risks of infections, more rapid decline of residual renal function
T/F: The most ideal hemodialysis access type is the subclavian vein, interjugural vien, femoral vein
False: AV fistula created distal from the body
Rate the access modes by risk of infection and thrombosis
AV fistula, AV graft, catheter
T/F: AV fistula takes months and patients will have to start with a catheter
True
What medication is used to prevent thrombosis during dialysis
Heparin
What electrolytes are in the dialysate
bicarbonate, potassium
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
True
What are the two principles that control hemodialysis, what do they influence
Diffusion: small sized molecules, convection: excess fluid
What is a dialyzer, how are the blood and dialysate pumped
thin semipermeable membrance, opposite direction
What are the two dialyzers
low-flux and high flux
For low-flux what is diffused, what is the rate of water transfer
urea, water and other small solutes, low/ larger molecules, high
T/F: Increasing dialysate flow rate will increase the diffusion
True
What is the principle way to remove excess fluid in patients
Ultrafiltration
When would a patient be advised to get peritoneal dialysis
may have hypotension, significant residual renal function, larger fluid gains
What is used as the filter for peritoneal dialysis,
peritoneal membrane, blood and lymphatic vessels aid in the process
What are the pros of peritoneal dialysis
more hemodynamic stability, high clearance of larger solutes, better conservation of residual renal function, medication can be given here, less blood and iron loss
What are the cons of peritoneal dialysis
Malnutriton, dialysis, obese individuals have less filtration, high technique failure, hernia, cannot be used if extensive abdominal surgery, no IV access
How is peritoneal dialysis done
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
What part of the catheter is used to reduce peritoneal infections, how long does it take to mature, what is the result of this
Cuff, 2-6 weeks, 60% get infection in the first 6 six weeks
What are the 4 types of peritoneal dialysis, what occurs in each
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
Why is icodextrin and dextrose also used as dialysate in PD, which is more dangerous
allows for ultrafiltration, dextrose
In PD what will increase the osmotic gradient
How long the dialysate stays in the peritoneal cavity (increase in dwell time)
What electrolyte is not removed by PD, why
Phosphorous, the peritoneal cavity is also negative thus causing a repel
Which form of PD has the most clearance of small solutes
continous flow peritoneal dialysate
In a Peritoneal equilibrium test (PET) what is considered high transport, high to average, low to average, low
greater than .81, .81 to.65, .65 to.5, less than .5
T/F: If a patient has a high PET the need more exchanges
False: Patients with a high PET are high transporters and have rapid clearance of small molecules requiring less exchanges
In peritonitis what types of infections are the most common, where are antibiotics given, how is dosing done
Gram positive, intraperitoneal, intermitten vs continous exchanges and type of PD
What are the three types of Continous Renal Replacement methods
Continous veno-venous hemofiltration, continous veno-venous hemodialysis, continous veno-venous hemodiafiltration
Which Continous renal replacement is most convection based therapy, diffusion based therapy, both
CVVH, CVVHD, CVVHDF
What is the urea reduction ratio, what is the equation, how much should it be
Measurement of how much urea is being removed, Predialysis BUN- Postdialysis BUN/(Predialysis BUN), should be greater than 65
What should the Kt/V be if a patient is on HD, Pd
greater than 1.2, greater than 1.7
T/F: Solutes will have peak clearance if small, not protein bound and have a small VD
true
What is the ranking of drug clearance for the methods of continous renal replacement
CVVH,CVVHDF, CVVH
What drug and drug classes are dialyzable
ACEIs, Beta-blockers, Hydrazline, Minoxidil, Midrodrine
What are exceptions in specific drug classes are not dialyzable
Lisinopril, carvedilo and labetolol
What drug is dialyzable and dosed afterwards, not likely but still dosed afterwards
Hydralizine, Clonidine
What antibiotics are dialyzable and should be dosed after dialysis
amoxicillin, cephalexin, levofloxacin. ciprofloxacin, olfloxacin, bactrim
What antibiotics are not dialyzable but should be dosed after dialysis
metronidazole, clarithromycin
T/F: Phenytoin should be dosed after dialysis and pay attention only to free drug
True
