Drug use in Renal Failure

Question 1

What effects the amount of solute filtered

Answer 1

GFR and extent of plasma protein binding

Question 2

T/F: Tubular secretion uses ATP

Answer 2

True

Question 3

What is the enzyme that allows efflux

Answer 3

P-gp

Question 4

What are factors that effect reabsorption

Answer 4

Time in filtrate, ionization (unionized become reabsorbed)

Question 5

What is CKD

Answer 5

Reduced number of appropriately functioning nephrons that are compensated by unaffected nephrons cuasing hyperfunction

Question 6

T/F: Patients can be asymptomatic with CKD until disease progresses

Answer 6

True

Question 7

What are the two most common causes for CKD

Answer 7

Diabetes and hypertension

Question 8

What are markers to identify kidney function

Answer 8

Scr, BUN, renal ultrasound

Question 9

What is principal marker of kidney damage

Answer 9

protein or albumin in the urine

Question 10

When taking a 24-hr collection of urine what would be diagnosed as microalbuminuria

Answer 10

30-299 mg/day of albumin

Question 11

When taking a 24-hr collection of urine what would be diagnosed as proteinuria

Answer 11

greater than 300mg/day of albumin

Question 12

When taking a ratio of spot protein:Cr what would be diagnosed as clinical proteinuria

Answer 12

greater than 200 mg/g or 0.2 mg/mg

Question 13

When taking a ratio of spot albumin:Cr what would be diagnosed as microalbuminuria

Answer 13

30-299 mcg/mg

Question 14

When taking a ratio of spot albumin:Cr what would be diagnosed as clinical proteinuria

Answer 14

greater than 300 mcg/mg

Question 15

What is the gold stanard for quantitative index of kidney function

Answer 15

GFR

Question 16

What is the most commonly used way to estimate GFR

Answer 16

Creatinine clearance (CrCl)

Question 17

What is the most common equation to estimate CrCl, what are it variables

Answer 17

Cockcroft-Gault equation/ Scr, Age, and weight

Question 18

What is the Cockcroft-Gault equation

Answer 18

(140-age)ABW/(Scr x 72)

Question 19

What is the adjustment for the Cockcroft-Gault equation for women

Answer 19

(140-age)ABW/(Scr x 72) all multiplied by .85

Question 20

What is the equation for IBW in males

Answer 20

50 kg + 2.3 kg for each inch over 5 feet

Question 21

What is the equation for IBW in females

Answer 21

45 kg + 2.3 kg for each inch over 5 feet

Question 22

What is the equation for adjusted body weight

Answer 22

IBW + 0.4 (actual BW- IBW)

Question 23

When using the Cockcroft-Gault equation what weight should be used if the patient is overweight and/or obese, normal weight, underweight

Answer 23

Adjusted body weight, ideal body weight, actual body weight

Question 24

When does the Cockcroft-Gault equation overestimate kidney fucntion

Answer 24

Liver disease, renal transplant, and HIV patients

Question 25

T/F: When using the Cockcroft-Gault equation Scr should be used for everyone except the elderly, their Scr should be rounded up to 1

Answer 25

False: Rounding Scr up to 1 is not recommended for the elderly

Question 26

What are the variable for the MDRD4 equation

Answer 26

weight, age, Scr, Race

Question 27

T/F: MDRD4 is recommonded for estimating GFR in a patient with CKD

Answer 27

True

Question 28

T/F: Cockcroft-Gault, MDRD6 and MDRD4 all use SCr so they have their limits

Answer 28

True

Question 29

What is an equation that can be used if a patient does not have CKD and is more accurate if they do not have CKD

Answer 29

CKD-EPI

Question 30

What GFR would qualify for CKD

Answer 30

less than 60 ml/min

Question 31

T/F: eGFR by MDRD is good for drug dosing

Answer 31

False: eGFR by MDRD is not recommended to be used for renal dose adjustments, CrCl is

Question 32

What equation is be used to stage CKD

Answer 32

MDRD4

Question 33

What factors can cause a decrease in drug absorption that are also present in CKD patients

Answer 33

Delayed GI transit time, increased gastric pH, vomitting and diarrhea, drugs used in CKD are susceptible to chelate formation, bowel wall edema

Question 34

What factors can cause an increase in drug absorption that are also present in CKD

Answer 34

Magnesium hydroxide and sodium bicarbonate, decreased intestinal metabolism, P-gp reduced drug absorbtion

Question 35

What factors can cause an increase in a drug's distribution due to CKD

Answer 35

less albumin, acidic drugs

Question 36

What factors can cause a decrease in a drug's distribution due to CKD

Answer 36

basic drugs, decreased tissue binding

Question 37

How is metabolism effected in CKD

Answer 37

Reduced phase 1, reduced phase 2 and reduced kidney metabolism

Question 38

How is excretion effected in CKD

Answer 38

less excretion due to less filtration

Question 39

T/F: Loading doses in patients with CKD should not be altered for any medications

Answer 39

False: In most cases, CKD patients should receive normal loading doses except with digoxin (dose lowered)

Question 40

How should the maintenance dose and intervals be adjusted in patients with CKD

Answer 40

reduce the maintenance dose and extended intervals