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Phar 503 > Drug use in Renal Failure > Flashcards

Drug use in Renal Failure Flashcards

1
Q

What effects the amount of solute filtered

A

GFR and extent of plasma protein binding

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2
Q

T/F: Tubular secretion uses ATP

A

True

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3
Q

What is the enzyme that allows efflux

A

P-gp

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4
Q

What are factors that effect reabsorption

A

Time in filtrate, ionization (unionized become reabsorbed)

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5
Q

What is CKD

A

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

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6
Q

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

A

True

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7
Q

What are the two most common causes for CKD

A

Diabetes and hypertension

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8
Q

What are markers to identify kidney function

A

Scr, BUN, renal ultrasound

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9
Q

What is principal marker of kidney damage

A

protein or albumin in the urine

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10
Q

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

A

30-299 mg/day of albumin

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11
Q

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

A

greater than 300mg/day of albumin

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12
Q

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

A

greater than 200 mg/g or 0.2 mg/mg

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13
Q

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

A

30-299 mcg/mg

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14
Q

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

A

greater than 300 mcg/mg

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15
Q

What is the gold stanard for quantitative index of kidney function

A

GFR

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16
Q

What is the most commonly used way to estimate GFR

A

Creatinine clearance (CrCl)

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17
Q

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

A

Cockcroft-Gault equation/ Scr, Age, and weight

18
Q

What is the Cockcroft-Gault equation

A

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

19
Q

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

A

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

20
Q

What is the equation for IBW in males

A

50 kg + 2.3 kg for each inch over 5 feet

21
Q

What is the equation for IBW in females

A

45 kg + 2.3 kg for each inch over 5 feet

22
Q

What is the equation for adjusted body weight

A

IBW + 0.4 (actual BW- IBW)

23
Q

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

A

Adjusted body weight, ideal body weight, actual body weight

24
Q

When does the Cockcroft-Gault equation overestimate kidney fucntion

A

Liver disease, renal transplant, and HIV patients

25
Q

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

A

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

26
Q

What are the variable for the MDRD4 equation

A

weight, age, Scr, Race

27
Q

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

28
Q

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

29
Q

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

30
Q

What GFR would qualify for CKD

A

less than 60 ml/min

31
Q

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

A

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

32
Q

What equation is be used to stage CKD

33
Q

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

A

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

34
Q

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

A

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

35
Q

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

A

less albumin, acidic drugs

36
Q

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

A

basic drugs, decreased tissue binding

37
Q

How is metabolism effected in CKD

A

Reduced phase 1, reduced phase 2 and reduced kidney metabolism

38
Q

How is excretion effected in CKD

A

less excretion due to less filtration

39
Q

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

A

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

40
Q

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

A

reduce the maintenance dose and extended intervals

Phar 503 (25 decks)

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