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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
Q

Blood / packed RBCs

A

Used for acute blood loss or if low Hb
Hb < 7 def use, Hb < 8 can use
1 unit RBC increases Hb 1g/dL

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26
Q

Most common MIVF

A

D5W + 1/2 NS + 20mEq KCl / L
Used to increase plasma oncotic pressure

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27
Q

Signs of dehydration

A

Look dry on physical and cellular levels
Tachycardia and hypotension
BUN / SCr > 20

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28
Q

Na normal range

A

135-145 mEq/L

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29
Q

Hyponatremia

A

Osmolality 275-290 mOsm/L

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30
Q

Osmolality calculations

A

(2 x Na) + (BUN / 2.8) + (Glucose / 18)

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31
Q

Psuedohyponatremia

A

Na appears low but is actually displaced

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32
Q

Hypertonic hyponatremia

A

> 290 mOsm/L

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33
Q

Hypotonic hyponatremia

A

< 275 mOsm/L

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34
Q

Hypovolemic hypotonic hyponatremia

A

↓TBW
↓↓Na
Tx:
3% NaCl if symptoms
0.9% NaCl if asymptomatic

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35
Q

Isovolemic hypotonic hyponatremia

A

↑TBW
= Na
Tx:
Furosemide and judicious 3% NaCl if symptoms
Furosemide if asymptomatic

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36
Q

Acute hyponatremia

A

< 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

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37
Q

Chronic hyponatremia

A

≥ 48 hrs
Minimal brain swell
Mild neurological sx

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38
Q

Rule of 8’s

A

Replace 1/2 of Na in first 8 hrs
Replace remaining within 8-16 hrs

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39
Q

Hypernatremia

A

> 145 mEq/L
Associated with hypertonicity
Impaired thirst response

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40
Q

Hypovolemic hypernatremia

A

↓H2O
↓↓TBW
↓Na
Associated with renal and GI disease

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41
Q

Isovolemic hypernatremia

A

↓H2O
↓TBW
= Na
Associated with diabetes

42
Q

Hypervolemic hypernatremia

A

↑H2O
↑TBW
↑↑Na
Associated with Na overload

43
Q

Free H2O deficit calculations

A

TBW x [(serum Na / 140) - 1]

44
Q

K normal range

A

3.5-5 mEq/L

45
Q

K levels affected by

A

Na/K ATPase pump
Kidneys
Arterial pH

46
Q

Hypokalemia causes

A

Diuretic loss
B-agonist medications (Albuterol)
Mg depletion

47
Q

IV K rates

A

10 mEq/hr without cardiac monitoring
20 mEq/hr with cardiac monitoring

48
Q

Hyperkalemia

A

Mild: 5.5-6 mEq/L
Moderate: 6.1-6.9 mEq/L
Severe: ≥ 7 mEq/L

49
Q

Hyperkalemia treatment

A

C A BIG K DROP
Calcium
Albuterol
Bicarbonate
Insulin + Glucose
Kayexalate / Lokelma
Diuretics
Dialysis

50
Q

Chronic hyperkalemia treatment

A

Patiromer (Valtassa)

51
Q

Mg normal range

A

1.5-2.5 mg/dL

52
Q

Hypomagnesemia causes

A

Loop diuretics and thiazides

53
Q

Hypomagnesemia treatment

A

IV if symptomatic
PO if asymptomatic

54
Q

Ca normal range

A

8.5-10.5 mg/dL

55
Q

Ca metabolism by…

A

Bones, kidneys, intestines

56
Q

Hypocalcemia causes

A

Mg deficiency
Increased volume of blood products
Hypoalbuminemia

57
Q

Corrected Ca calculations

A

Measured Ca + [(4 - measured albumin) x 0.8]

58
Q

Acute hypocalcemia treatment

A

100-300mg elemental Ca IV over 5-10 minutes
Ca gluconate preferred for PIV administration

59
Q

Chronic hypocalcemia treatment

A

1-3g elemental Ca / day

60
Q

PO4 normal range

A

2.5-4.5 mg/dL

61
Q

Hypophosphetemia

A

Mild to mod: 1-2mg/dL
Severe: < 1mg/dL

62
Q

Hypophosphetemia treatment

A

Mild to mod: oral phosphorus
Severe: KPhos (<4) or NaPhos (≥4)
NEVER push phosphate

63
Q

in ICU values

A

K > 4
PO4 > 3
Mg > 2

64
Q

Physiological function of kidney

A

BP control
pH balance
Drug metabolism and excretion
Endocrine -> hormones

65
Q

AKI causes

A

Sepsis
Ischemia
Nephrotoxins

66
Q

CKD progression

A

Increase glomerular pressure ->
Proteinuria ->
Glomerulosclerosis

67
Q

Nephritic disease

A

Inflammation disrupting basement membrane

68
Q

Nephrotic disease

A

Podocyte damage -> disrupt charge barrier

69
Q

Pyelonephritis

A

Caused by bacteria traveling into the kidney

70
Q

Antibiotic causes of interstitial nephritis

A

Penicillin
Anticonvulsant
Diuretics
NSAIDs

71
Q

Don’t use NSAIDs with

A

AKI, CKD, heart failure

72
Q

Classes of diuretics

A

CA-I’s
Osmotic diuretics
Na/K/Cl symport inhibitors
Na/Cl symport inhibitors
Renal epithelial Na channel inhibitors
Mineralocorticoid receptor antagonists

73
Q

OAT mediated transporters

A

Furosemide
Thiazide
Penicillin
NSAIDs
Active secretion in proximal tubule

74
Q

OCT mediated transporters

A

Digoxen
Metformin
Morphine
Vancomycin

75
Q

CA-I

A

Block NaHCO3 reabsorption
Weak diuretic
Ex. acetazolamide

76
Q

Osmotic diuretics

A

Inhibit H2O reabsorption
2 sites of action: PCT, descending loop
Ex. mannitol, isosorbide, glucose, glycerin, urea

77
Q

PO osmotic diuretics

A

Isosorbide, glucose, glycerin

78
Q

IV osmotic diuretics

A

Mannitol, urea

79
Q

Na/K/Cl inhibitors (loop diuretics)

A

Most active and potent
Ex. furosemide, bumetanide, ethacrynic acid, torsemide

80
Q

Na/Cl inhibitors (thiazides)

A

Increase potency of CA-I
2 sites of action: DCT, PCT
Thiazides -> unsaturated
Hydrothiazides -> saturated

81
Q

Na channel inhibitors (K sparing)

A

Act at late distal tubule and collecting duct
Relatively weak
Ex. Amiloride, triamterene
Contraindicated: ACE inhibitors, K supplements

82
Q

Mineralcorticoid receptor antagonists (MRA)

A

Only diuretic that doesn’t act in tubular lumen
Always combo therapyi
Contraindicated: ACE inhibitors, K supplements

83
Q

Breaking phenomenon

A

Prolonged use of loop diuretics leads to stabilizing at lower levels showing desensitization

84
Q

CKD causes

A

Diabetes
HTN

85
Q

CKD and GFR

A

Normal: < 60mL/min
G3a: 45-59
G3b: 30-44
G4: 15-29
G5: <15

86
Q

EGFR use

A

Nephrologists use to stage KD

87
Q

CrCl use

A

RPh use to dose medications

88
Q

Cockroft and Gault formula

A

CrCl / kidney function
Men: [(140 - age) x IBW] / (SCr x 72)
Women: (CrCl) x 0.85

89
Q

MDRD formula

A

More accurate
Less used clinically

90
Q

Uremia effects

A

Urine breath
Metallic taste
Uremic frost

91
Q

Edema treatment

A

If CrCl < 30 mL/min use loop diuretics
If CrCl ≥ 30 mL/min use thiazides

92
Q

Ethacrynic acid

A

No risk of sulfa allergy reaction

93
Q

Hyperphosphetemia treatment

A

Ca phosphate binders
Non-Ca phosphate binders

94
Q

Ca phosphate binders

A

Ca carbonate (Tums)
Ca acetate (PhosLo)

95
Q

Non-Ca phosphate binders

A

Sevelamer carbonate (Renvela)
Lanthanum carbonate (Fosrenol)
Sucroferric oxyhydrox (Velphoro)
Auryxia (Ferric citrate)
Aluminum hydroxide (Amphojel)
Mg carbonate (Mag-Carb)
Nicotinic acid and nicotinamide

96
Q

Activated Vit. D forms

A

Calcitriol
Pericalcitriol
Doxercalciterol

97
Q

Unactivated Vit. D forms

A

Ergocalciferol (Calciferol)
Cholecalciferol (Vit. D3)

98
Q

Calcimimetics

A

Cinacalcet (Sensipar) -> PO
Etelcalcetide (Parsabiv) -> IV
Contraindicated: hypocalcemia

99
Q

Anemia MCV

A

↑MCV = Vit. B12 deficiency
↓MCV = Fe deficiency
Normal MCV = 80-96 mcm^3

100
Q

Anemia treatment

A

Iron therapy (oral, heme, IV)
ESAs -> don’t push Hb > 11.5

101
Q

ESAs

A

Recombinant human erythropoietin
Darbepoetin alfa (Aranesp)
Methoxy polyethylene glycol (Micera)

102
Q

HIF-PHIs

A

New tx for anemia with CKD
Daprodustat (Jesduvroq)
Easier dosage form -> ↑ adherence

PHRM844 (16 decks)

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