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PHRM844 > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

IBW (males)

A

50kg + (2.3 x in>60)

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2
Q

IBW (women)

A

45kgs + (2.3 x in>60)

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3
Q

Normal body weight (NBW)

A

IBW + 0.25(TBW - IBW)

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4
Q

ADH changes

A

Decrease diuresis
Increase H2O retention

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5
Q

RAAS changes

A

Increase renin secretion
Na / H2O regulation

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6
Q

ANP

A

Decrease ADH release
Counteract RAAS

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7
Q

Isotonic range

A

275-290 mOsm/L

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8
Q

Hypotonic range

A

< 275 mOsm/L
Fluid moves into cell and increases volume

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9
Q

Hypertonic range

A

> 290 mOsm/L
Fluid pulled into blood out of cells

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10
Q

Osmolarity calculation

A

IV solution osm + electrolyte osm added
Convert electrolyte osm mEq -> mOsm

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11
Q

Hypertonic solutions

A

> 600 mOsm/L
Administered in small volumes < 500mL via central line

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12
Q

Clinical estimate MIVF

A

30-40 mg/kg/day
100-150 mL/h = normal rate

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13
Q

Ideal fluid properties

A

Predictable effects
No AEs
Sustained increased IV volume
No tissue accumulation
Cost effective
Stable when stored
Readily available
Easy to administer

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14
Q

Crystalloids

A

Normal saline (NS)
1/2 Normal solution (NS)
Dextrose 5% (D5W)
Lactated ringers (LR)
Balanced salt solutions

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15
Q

Colloids

A

Albumin
Hetastarch
Tetrastarch
Blood
Plasmate

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16
Q

Normal saline (NS)

A

0.9% NaCl
Used for IV replacement
NOT a maintenance fluid

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17
Q

1/2 Normal saline (1/2 NS)

A

0.45% NaCl
Used for maintenance as a combo

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18
Q

Lactated ringers (LR)

A

Used to replace blood loss
Approximated human plasma

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19
Q

Dextrose 5% (D5W)

A

Used for free H2O replacement
No Na or Cl
NOT resuscitative fluid
NOT used for MIVF by itself

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20
Q

Balanced salt solutions

A

Crystalloids with physiological levels of Cl and buffer solutions
Ex. LR, normosol-R, plasma-lyte

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21
Q

NaCl composition

A

154 mEq/L of Na and Cl each

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22
Q

Colloid use in therapy

A

Plasma expanders
Increase MW and half-life
Increase plasma oncotic pressure

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23
Q

Albumin

A

Indications:
Volume expansion, shock, burn, ARDS
AEs:
Hypervolemia, azotemia
Use 5% to increase volume
Use 25% to increase protein

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24
Q

Starches (synthetic colloids)

A

High association with bleeding
Longer half-life -> more side effects and toxicities
Not commonly used

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25
Blood / packed RBCs
Used for acute blood loss or if low Hb Hb < 7 def use, Hb < 8 can use 1 unit RBC increases Hb 1g/dL
26
Most common MIVF
D5W + 1/2 NS + 20mEq KCl / L Used to increase plasma oncotic pressure
27
Signs of dehydration
Look dry on physical and cellular levels Tachycardia and hypotension BUN / SCr > 20
28
Na normal range
135-145 mEq/L
29
Hyponatremia
Osmolality 275-290 mOsm/L
30
Osmolality calculations
(2 x Na) + (BUN / 2.8) + (Glucose / 18)
31
Psuedohyponatremia
Na appears low but is actually displaced
32
Hypertonic hyponatremia
> 290 mOsm/L
33
Hypotonic hyponatremia
< 275 mOsm/L
34
Hypovolemic hypotonic hyponatremia
↓TBW ↓↓Na Tx: 3% NaCl if symptoms 0.9% NaCl if asymptomatic
35
Isovolemic hypotonic hyponatremia
↑TBW = Na Tx: Furosemide and judicious 3% NaCl if symptoms Furosemide if asymptomatic
36
Acute hyponatremia
< 48 hrs Brain swells -> cerebral edema -> death Tx: ↑ Serum Na 1-2 mEq/L/hr until sx resolve Max 8-12 mEq/L in first 24 hrs
37
Chronic hyponatremia
≥ 48 hrs Minimal brain swell Mild neurological sx
38
Rule of 8's
Replace 1/2 of Na in first 8 hrs Replace remaining within 8-16 hrs
39
Hypernatremia
> 145 mEq/L Associated with hypertonicity Impaired thirst response
40
Hypovolemic hypernatremia
↓H2O ↓↓TBW ↓Na Associated with renal and GI disease
41
Isovolemic hypernatremia
↓H2O ↓TBW = Na Associated with diabetes
42
Hypervolemic hypernatremia
↑H2O ↑TBW ↑↑Na Associated with Na overload
43
Free H2O deficit calculations
TBW x [(serum Na / 140) - 1]
44
K normal range
3.5-5 mEq/L
45
K levels affected by
Na/K ATPase pump Kidneys Arterial pH
46
Hypokalemia causes
Diuretic loss B-agonist medications (Albuterol) Mg depletion
47
IV K rates
10 mEq/hr without cardiac monitoring 20 mEq/hr with cardiac monitoring
48
Hyperkalemia
Mild: 5.5-6 mEq/L Moderate: 6.1-6.9 mEq/L Severe: ≥ 7 mEq/L
49
Hyperkalemia treatment
C A BIG K DROP Calcium Albuterol Bicarbonate Insulin + Glucose Kayexalate / Lokelma Diuretics Dialysis
50
Chronic hyperkalemia treatment
Patiromer (Valtassa)
51
Mg normal range
1.5-2.5 mg/dL
52
Hypomagnesemia causes
Loop diuretics and thiazides
53
Hypomagnesemia treatment
IV if symptomatic PO if asymptomatic
54
Ca normal range
8.5-10.5 mg/dL
55
Ca metabolism by...
Bones, kidneys, intestines
56
Hypocalcemia causes
Mg deficiency Increased volume of blood products Hypoalbuminemia
57
Corrected Ca calculations
Measured Ca + [(4 - measured albumin) x 0.8]
58
Acute hypocalcemia treatment
100-300mg elemental Ca IV over 5-10 minutes Ca gluconate preferred for PIV administration
59
Chronic hypocalcemia treatment
1-3g elemental Ca / day
60
PO4 normal range
2.5-4.5 mg/dL
61
Hypophosphetemia
Mild to mod: 1-2mg/dL Severe: < 1mg/dL
62
Hypophosphetemia treatment
Mild to mod: oral phosphorus Severe: KPhos (<4) or NaPhos (≥4) NEVER push phosphate
63
in ICU values
K > 4 PO4 > 3 Mg > 2
64
Physiological function of kidney
BP control pH balance Drug metabolism and excretion Endocrine -> hormones
65
AKI causes
Sepsis Ischemia Nephrotoxins
66
CKD progression
Increase glomerular pressure -> Proteinuria -> Glomerulosclerosis
67
Nephritic disease
Inflammation disrupting basement membrane
68
Nephrotic disease
Podocyte damage -> disrupt charge barrier
69
Pyelonephritis
Caused by bacteria traveling into the kidney
70
Antibiotic causes of interstitial nephritis
Penicillin Anticonvulsant Diuretics NSAIDs
71
Don't use NSAIDs with
AKI, CKD, heart failure
72
Classes of diuretics
CA-I's Osmotic diuretics Na/K/Cl symport inhibitors Na/Cl symport inhibitors Renal epithelial Na channel inhibitors Mineralocorticoid receptor antagonists
73
OAT mediated transporters
Furosemide Thiazide Penicillin NSAIDs Active secretion in proximal tubule
74
OCT mediated transporters
Digoxen Metformin Morphine Vancomycin
75
CA-I
Block NaHCO3 reabsorption Weak diuretic Ex. acetazolamide
76
Osmotic diuretics
Inhibit H2O reabsorption 2 sites of action: PCT, descending loop Ex. mannitol, isosorbide, glucose, glycerin, urea
77
PO osmotic diuretics
Isosorbide, glucose, glycerin
78
IV osmotic diuretics
Mannitol, urea
79
Na/K/Cl inhibitors (loop diuretics)
Most active and potent Ex. furosemide, bumetanide, ethacrynic acid, torsemide
80
Na/Cl inhibitors (thiazides)
Increase potency of CA-I 2 sites of action: DCT, PCT Thiazides -> unsaturated Hydrothiazides -> saturated
81
Na channel inhibitors (K sparing)
Act at late distal tubule and collecting duct Relatively weak Ex. Amiloride, triamterene Contraindicated: ACE inhibitors, K supplements
82
Mineralcorticoid receptor antagonists (MRA)
Only diuretic that doesn't act in tubular lumen Always combo therapyi Contraindicated: ACE inhibitors, K supplements
83
Breaking phenomenon
Prolonged use of loop diuretics leads to stabilizing at lower levels showing desensitization
84
CKD causes
Diabetes HTN
85
CKD and GFR
Normal: < 60mL/min G3a: 45-59 G3b: 30-44 G4: 15-29 G5: <15
86
EGFR use
Nephrologists use to stage KD
87
CrCl use
RPh use to dose medications
88
Cockroft and Gault formula
CrCl / kidney function Men: [(140 - age) x IBW] / (SCr x 72) Women: (CrCl) x 0.85
89
MDRD formula
More accurate Less used clinically
90
Uremia effects
Urine breath Metallic taste Uremic frost
91
Edema treatment
If CrCl < 30 mL/min use loop diuretics If CrCl ≥ 30 mL/min use thiazides
92
Ethacrynic acid
No risk of sulfa allergy reaction
93
Hyperphosphetemia treatment
Ca phosphate binders Non-Ca phosphate binders
94
Ca phosphate binders
Ca carbonate (Tums) Ca acetate (PhosLo)
95
Non-Ca phosphate binders
Sevelamer carbonate (Renvela) Lanthanum carbonate (Fosrenol) Sucroferric oxyhydrox (Velphoro) Auryxia (Ferric citrate) Aluminum hydroxide (Amphojel) Mg carbonate (Mag-Carb) Nicotinic acid and nicotinamide
96
Activated Vit. D forms
Calcitriol Pericalcitriol Doxercalciterol
97
Unactivated Vit. D forms
Ergocalciferol (Calciferol) Cholecalciferol (Vit. D3)
98
Calcimimetics
Cinacalcet (Sensipar) -> PO Etelcalcetide (Parsabiv) -> IV Contraindicated: hypocalcemia
99
Anemia MCV
↑MCV = Vit. B12 deficiency ↓MCV = Fe deficiency Normal MCV = 80-96 mcm^3
100
Anemia treatment
Iron therapy (oral, heme, IV) ESAs -> don't push Hb > 11.5
101
ESAs
Recombinant human erythropoietin Darbepoetin alfa (Aranesp) Methoxy polyethylene glycol (Micera)
102
HIF-PHIs
New tx for anemia with CKD Daprodustat (Jesduvroq) Easier dosage form -> ↑ adherence

PHRM844 (16 decks)

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