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Therapeutics Spring 2015 > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

What is the role of the glomerulus?

A

The initial filtration of blood

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2
Q

How many nephrons are there per kidney?

A

1-2 million

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3
Q

What is the role of mesangial cells?

A

They contain growth factors, control matrix proteins, and contractile ability

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4
Q

What is the role of the basement membrane?

A

Gives the membrane structure

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5
Q

What causes protein and blood to be filtered into the blood?

A

disease or damage to the kidney

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6
Q

What is Azotemia?

A

elevation of BUN and creatinine where there is a decrease in GFR

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7
Q

What is uremia?

A

Excess of urea and other nitrogenous waste in the blood

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8
Q

Is uremia a toxic condition?

A

Yes

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9
Q

What causes Uremia?

A

Failure of renal excretory function, metabolic and endocrine alterations and renal damage

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10
Q

What is proteinurea?

A

protein in the urine

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11
Q

What is hematuria?

A

blood in the urine

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12
Q

what is natureisis?

A

excretion of sodium

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13
Q

Water follows ____?

A

Sodium

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14
Q

What characterizes acute kidney disease/injury/failure?

A

Abrupt decrease in GFR or increase in SCr

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15
Q

How is AKD classified?

A

RIFLE

  • Risk
  • Injury
  • Failure
  • loss of function
  • End stage kidney disease
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16
Q

What are the 3 types of AKD?

A

Prerenal
Intrinsic
Postrenal

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17
Q

What is prerenal AKD?

A

decreased renal blood flow

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18
Q

What is intrinsic AKD?

A

A structure within the kidney is damaged

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19
Q

What is postrenal AKD?

A

An obstruction is present within the urine collection system

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20
Q

What is CKD?

A

Progressive loss of function over several months to years

and is characterized by the gradual replacement of normal kidney tissue with parenchymal fibrosis

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21
Q

What are 3 chronic disease states that influence CKD?

A

DM, HTN,HLD

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22
Q

What is hemodialysis?

A

Perfusion of blood and dialysate on opposite sides of a semipermeable membrane.

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23
Q

What force removes substances from the blood in hemodialysis?

A

diffusion and convection

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24
Q

How is excess plasma water removed in hemodialysis?

A

Through ultrafiltration

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25
Q

What is peritoneal dialysis?

A

Instillation of dialysate into the peritoneal cavity via a permanent peritoneal catherer

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26
Q

What are some causes of drug induces kidney disease?

A

Antibiotics
Diuretics
NSAIDS
Can all cause analgesic nephropathy and kidney necrosis

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27
Q

What is nephritis?

A

Chronic glomerulonephritis is the most common chronic renal failure in humans

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28
Q

What are the 2 types of chronic glomerulonephritis?

A

primary

secondary- associated with systemic diseases (SLE, HTN, DM)

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29
Q

What are 3 immune reactions that are involved in glomerular disease?

A
  1. Antibody associated disease
  2. Cell - mediated
  3. Other mechanisms
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30
Q

What are 2 types of antibody mediated glomerular injury?

A

Circulating antigen-antibody complexes

Anti Glomerular Basement Membrane Antibodies

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31
Q

How do ciculating antibodu complexes work?

A

The complexes deposit in the basement membrane–>body attacks membrane–> membrane breaks down–> proteinurea

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32
Q

What are 3 major glomerular syndromes?

A
  1. Nephrotic syndrome
  2. Nephritic syndrome
  3. Chronic glomerulonephritis
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33
Q

What causes Nephrotic Syndrome?

A

The blood vessels in the glomeruli become leaky which allows proteins to leave the body

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34
Q

What causes Nephritic syndrome?

A

associates with disorders affecting the kidneys, glomerular disorders

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35
Q

Nephrotic syndrome symptoms

A 
proteinuria
hypoalbuminemia
edema
hyperlipidemia
lipiduria
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36
Q

Nephritic syndrome symptoms

A

hematuria
oliguria
azotemia
hypertension

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37
Q

What is acute pyelonephritis?

A

a bacterial spread, usuually ascending from a bladder infelction, vesicoureteral reflux and interenal reflux

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38
Q

What is a simple cyst?

A

A bag-like sac filled with fluid or air

Benign- not a tumor

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39
Q

What does APKD stand for?

A

Autosomal Dominant Polycystic Kidney Disease

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40
Q

What is APKD?

A

multiple expanding cysts of both kidneys that destroy tissue

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41
Q

What gene causes APKD?

A

PKD1 or PKD2

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42
Q

what is the Tx for APKD?

A

Kidney transplant

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43
Q

What gene causes autosomal recessive polycystic kidney diease?

A

autosomal recessive inheritance

mutation in PKHD1

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44
Q

What are the effects of ARPKD?

A

Infants often die of pulmonary or renal failure
fibrocystin (polyductin)
congenital hepatic fibrosis

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45
Q

What is diuresis?

A

increase in urine volume

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46
Q

What is naturesis?

A

increase in renal sodium excretion

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47
Q

What are the clinical uses of diuretics?

A

HTN, edema, CHF, CKD, hepatic cirrhosis, hypercalcemia, Diabetes insupidus

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48
Q

Where do acetazolamides act?

A

The proximal convoluted tubule

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49
Q

Where do osmotic agents (mannitol) act?

A

The PCT

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50
Q

Where do loop diuretics act?

A

the thick ascending limb of the loop of henle

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51
Q

Where do thiazide diuretics act?

A

The proximal straight tubule and DCT

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52
Q

Where do aldosterone antagonists act?

A

in the collecting tubule

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53
Q

Where do ADH antagonists act?

A

In the collecting duct

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54
Q

Where does adenosine act?

A

The glomerulus, the PCT and the thick ascending limb

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55
Q

What are three examples of look diuretics?

A

Furosemide
Bumetanide
Ethacrynic Acid

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56
Q

What are 2 examples of thiazides?

A

HTCZ

Chlorthalidone

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57
Q

What are some K+ sparing diuretics?

A

Spironolactone
Triamterene
Amiloride

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58
Q

How doe K+ diuretics work?

A

They block the reabsorption of Na+ in the collecting tubule so K+ is not lost

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59
Q

What are 7 ways ions/solutes can move across membranes?

A 
Convective
Simple diffusion
channel mediated diffusion
facillitated diffusion
ATP- mediated
Symport
Antiport
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60
Q

What are the 7 kinds of diuretics?

A
  1. Carbonic Anhydrase Inhibitors
  2. Loops Diuretics
  3. Thiazides
  4. Collecting Tubule Diuretics
  5. Aldosterone Antagonists
  6. Osmotic Diuretics
  7. ADH Antagonists
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61
Q

Which diuretic is the least effective?

A

Carbonic Anhydrase Inhibitors

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62
Q

Why are carbonic anhydrase inhibitors not very effective

A

Because there is so much other absorption of Na+ and H2O in the rest of the nephron

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63
Q

What class does Acetazolamide belong to?

A

CA inhibitors

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64
Q

What is the brand name of acetazolamide?

A

Diamox

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65
Q

What ions maximize the diuretic activity of diuretic?

A

Cl-, Br- CF3-, or NO2

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66
Q

What effect does the substitution of an amine have on the CA inhibitors?

A

It increases the naturetic activity

Decreases the the CA inbhibitor activity

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67
Q

What functional group is required for diuretic activity?

A 
unsubstituted Sulfamoyl (allergenic)
H2NO2S
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68
Q

By what actions does diamox work as a diuretic?

A

Decreases NaHCO3 reabsorption

Deacreases H2O reabsorption

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69
Q

What are 4 clinical uses for diamox besides a diuretic?

A

Acute Mountain Sickness
Metabolic Alkalosis
Glaucoma
Uriniary Alkanization

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70
Q

What are 3 side effects of acetazolamide?

A
  1. Drowsiness/paresthesia
  2. renal stones
  3. low potassium
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71
Q

What is a toxcicity of acetazolamide?

A
  1. hyperchloremic metabolic acidosis
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72
Q

What are 2 contraindications for acetazolamide?

A

Hepatic Cirrhosis

Sulfa allergies

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73
Q

What are 4 loop diuretics?

A
  1. Furosemide
  2. Bumetanide
  3. Ethacrynic Acid
  4. Torsemide
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74
Q

What ions do loop diuretics affect?

A

Na+, 2Cl-, K+, Mg2+, Ca2+

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75
Q

What is the name of the transport system loop diuretics inhibit?

A

Na+/2Cl-/K+ symport

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76
Q

What is the brand name of furosemide?

A

Lasix

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77
Q

What is the brand name of torsemide?

A

Demadex

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78
Q

Which of the loop diuretics is a prodrug?

A

Ethacrynic acid

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79
Q

What is the brand name of ethacrynic acid?

A

Edecrin

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80
Q

Is edecrin an electrophile or nucleophile?

A

Electrophile

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81
Q

How do loop diuretics work?

A
  • inhibit Na+/2Cl-/K+ reabsorption (also Mg+2 and Ca+2)

- increase renal blood flow through vasodialation induced by prostaglandins (this increases GFR)

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82
Q

What are some advantageous characteristics of loop diuretics?

A
  • rapid IV response

- Duration of action dependent on renal function

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83
Q

What are some side effects of loop diuretics?

A 
dehydration
dose dependent reversible ototoxicity
hypomagnesemia
hyperuricemia
Hypokalemic metabolic alkalosis
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84
Q

What patient population does hypouricemia effect?

A

Gout patients (losing H2O concentrates uric acid- deposits in joints and causes autoimmune rxn)

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85
Q

what are some clinical uses for loop diuretics?

A 
edematous conditions
acute pulmonary failure
acute hypercalcemia
hyperkalemia
acute renal failure
anion overdose
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86
Q

What part of the nephron do thiazides act on?

A

The DCT

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87
Q

What transport system do thiazides inhibit?

A

Na+/Cl- symport

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88
Q

What are the 2 kinds of DCT diuretics?

A
  1. thiazides

2. thiazide like diuretics

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89
Q

What are 3 thiazide like diuretics?

A
  1. chlorthalidone
  2. indapamide
  3. metolazone
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90
Q

What is the brand name for chlorthalidone?

A

Hygroton

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91
Q

What is the brand name for indapamide?

A

Lozol

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92
Q

What is the brand name for metolazone?

A

Diulo

Zaroxolyn

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93
Q

What are the 2 actions of thiazide diuretics?

A
  1. inhibit the Na+/Cl- symport

2. Enhance Ca+2 reabsorption

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94
Q

What are the clinical applications of thiazides?

A

HTN
CHF
Nephrolithiasis from idiopathic hypercalciuria
Nephrogenic Diabetes insipidus

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95
Q

What are some side effects of thiazides?

A 
hypokalemic metabolic acidosis
hyperuricemia
impaired carbohydrate tolerance
hyperlipidemia
hyponatremia
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96
Q

What is a contraindication of both loop diuretics and thiazides?

A

Sulfa allergies

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97
Q

How does thiazide diuretics treat diabetes insipidus?

A

DI- is high UOP

Thiazides use a paradoxical effect to cause less pressure naturesis in the glomerulus which decreases GFR so less UOP

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98
Q

What are diuretics that act on the CT?

A

amiloride
triamterene
spironlactone
eplerenone

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99
Q

What is the brand name of amiloride?

A

Midamor

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100
Q

What is the brand name of triamterene?

A

Dyrenium

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101
Q

What transport system does CT diuretics inhibit?

A

Na+ channel

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102
Q

How does blocking the Na+ channel of the CT affect K+ excretion?

A

it reduces K+ excretion- K+ sparing

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103
Q

What is the brand name of spironlactone?

A

Aldactone

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104
Q

What is the brand name of eplerenone?

A

Inspra

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105
Q

By what mechanism do aldactone and inspra work?

A

Aldosterone antagonistsw

106
Q

What is the clinical use of amiloride and triamterene?

A
  • Conjunctive therapy with a thiazide or loop diuretic for CHF or HTN
  • edema from CHF, hepatic cirrhosis, hyperaldosteronism or nephrotic syndrome
107
Q

What are some contraindications of amiloride and triamterene?

A

K+ supplements
ACE inhibitors
Pts prone to kidney stones- triamterene

108
Q

What are 3 side effects of triamterene and amiloride?

A

hyperkalemia

hyperchloremic metabolic acidosis

109
Q

What does AIP stand for?

A

Aldosterone Induced Proteins

110
Q

What effect does aldosterone have on Na+ and H2O

A

It increases Na+ nad H2O retention by acting as a steroid hormone on the nucleus to promote transcription of AIPs

111
Q

What are the 2 actions of spironlactone?

A

aldosterone inhibitor

inhibits 5alpha reductases

112
Q

What is the job of 5alpha reductases?

A

to create active metabolites of aldosterone

113
Q

What are the clinical uses of spironlctone?

A

Mineralcorticoid excess
primary or secondary hyperaldosteronism
HTN or CHF tx w/o other diuretics

114
Q

What are some side effects of spironlactone?

A 
hyperkalemia
hyperchloremic metabolic acidosis
gynecomastia
impotence
BPH
115
Q

For what conditions is spironlactone contraindicted?

A

K+ supplementartion
ACE inhibitors
CKD

116
Q

What is the advantage of inspra over aldactone?

A

It is more selective for the mineralcorticoid receptor

117
Q

What are some side effects of inspra?

A

Hyperkalemia

HLD

118
Q

What are the contraindications for inspra?

A 
CYP3A4 inhibitors
ACE inhibitors
K+ supplementation or sparing diuretics
diabetes associates with microalbuminuria
CKD
119
Q

What diuretic is the only one to not work by sodium loss?

A

Mannitol

120
Q

How does mannitol work?

A

It creates osmotic resistance that limits water reabsorption in the PCT, DCT and Loop

121
Q

What are the clinical applications for mannitol?

A

Increases urine volume

Reduces intracranial or intraocular pressure

122
Q

What are some side effects of mannitol?

A

Extracellular volume expansion
Dehydration
Hypernatremia

123
Q

Which diuretic is an ADH Antagonist?

A

Demeclocycline

124
Q

What is the brand name for Demeclocycline?

A

Declomycin

125
Q

What is demeclocycline a derivative of?

A

tetracycline

126
Q

What is demeclocycline indicated for?

A

SIADH

High ADH

127
Q

What are some side effects of demeclocycline?

A

nephrogenic diabetes insipidus

renal failure

128
Q

Define ESRD

A

A patient with < 15 GFR

Needs dialysis or a kidney transplant

129
Q

What are the 3 major causes of CKD?

A
  1. DM
  2. HTN
  3. Glomerulonephritis
130
Q

How does DM cause CKD?

A

Glucose is a large molecule that when at high concentrations will bend and tear the glomerular filter over time and tear up the kidney

131
Q

How does HTN cause CKD?

A

High pressure in the bowmans capsule will tear up the filter over time as it pushes solutes through

132
Q

What are the CKD classifications based on?

A

Cause, GFR and Albuminuria

133
Q

What are 2 additional causes of CKD?

A

HIV nephropathy

Polcystic kidney disease

134
Q

At what GFR flow rate do we start to worry?

A

<60ml/min/1.73m^2

135
Q

What flow rate is indicated at CKD stage G3a?

A

45-59 ml/min/1.73m^2

136
Q

What flow rate is indicated at CKD stage G3b?

A

30-44 ml/min/1.73m^2

137
Q

What flow rate is indicated at CKD stage G4?

A

15-29 ml/min/1.73m^2

138
Q

What flow rate is indicated at CKD stage G5?

A

<15 ml/min/1.73m^2

139
Q

What is normal GFR?

A

> 90 ml/min/1.73m^2

140
Q

How many categories does albumenuria have?

A

A1, A2, A3

141
Q

What albumin excretion rate (AER) is present at A1?

A

< 30 mg/24 hours

142
Q

What AER is present at A2?

A

30-300 mg/24 hours

143
Q

What AER is present at A3?

A

> 300 mg/24 hours

144
Q

What kind of patients can the Crockroft Gault equation be used for?

A

Only accurate in patients with stable kidney function

CKD considered stable, AKD is not stable

145
Q

What is the Crockoft Gault equation?

A

Men: CrCl = [(140-age)IBW]/(Scr x 72)
Women: multiply CrCl by 0.85

146
Q

Does the Crockoft Gault equation over or underestimate renal function in severe CKD?

A

Overestimates because of the 10% of secretion present right after the glomerulous

147
Q

MDRD equation is used for what?

A

Categorizing CDK

148
Q

what is the MDRD equation?

A

GFR = 170 x (Scr)^-0.999 x age^-0.178 x [0.762 if female] x [1.180 if black] x [Serum nitrogen concentration]^-0.170 x albumin^0.318

149
Q

When _____ function of the kidney is compromised, metabolic acidosis occurs?

A

Maintenance of the acid balance in plasma (secreting H+ ions)

150
Q

When _____ function of the kidney is compromised, anemias occur?

A

The secretion of hormones like erythropoietin, rennin and PGAs

151
Q

When ______ function of the kidney is compromised mineral and bone disorders occur?

A

Synthesis of calcitriol and secretion of phosphate

152
Q

What are monitoring parameters for uremia?

A

BUN

Scr

153
Q

What levels of Scr and BUN make a candidate for dialysis?

A

BUN ~100

Scr ~ 10

154
Q

What effect does CKD and ESRD have on the CNS?

A

Encephalopathy

155
Q

What effect does CKD and ESRD have on the EENT?

A

Uremic fetor ( urine smelling breath)

156
Q

What effect does CDK and ESRD have on the pulmonary system?

A

Non cardiogenic pulmonary edema from volume overload

157
Q

What effect does CKD and ESRD have on the Cardiovascular system?

A

LVHF, volume overload, sodium retention

158
Q

What effect does CKD and ESRD have on the GI?

A

Anorexia, N/V, constipation, and metallic taste

159
Q

What effect does CKD and ESRD have on the musculoskeletal system?

A

Mineral and bone disorders, restless leg syndrome

160
Q

What effect does CKD and ESRD have on anermia?

A

EPO deficiency

161
Q

What effect does CDK and ESRD have on the skin?

A

formation of uremic frost

162
Q

Do you always fluid restrict a fluid overloaded patient?

A

No, not generally necessary IF Na+ levels are controlled

avoid large amounts of free water

163
Q

Will diuretics work in a stage 5 CKD patient?

A

NO, require functioning kidneys (direct correlation)

164
Q

What is a solution for loop diuretic resistance?

A

Add a thiazide

165
Q

Are thiazides effective at CrCl < 30ml/min?

A

No

166
Q

Are loops effective at CrCl < 30 ml/min?

A

yes

167
Q

Which loop diuretic can be used in sulfa allergy patients?

A

ethacryinic acid

168
Q

What is the predialysis K+ goal for ESRD patients?

A

4.5-5 mEq/L

169
Q

What are some high K+ food?

A

Tomatoes, dried fruits, salt substitutes, fresh fruits

170
Q

Is sodium bicarb used in ESRD patients?

A

No

171
Q

What term means dietary intake of Phos?

A

Phosphate

172
Q

What term means the portion of phos in the blood?

A

Phosphorous

173
Q

Hyperphosphatemia has a direct role on ______ and an indirect role on _______?

A
  1. secondary parathyroidism

2. formation of kidney stones due to hypocalcemia

174
Q

Low vitamin D due to reduced GFR can cause what?

A

High iPTH

175
Q

What do hyperphosphtemia, hypocalcemia and low vit. D have in common?

A

High iPTH

176
Q

What is a treatment for hyperphosphatemia?

A

Give a phosphate binder with ALL MEALS

177
Q

What are 2 kinds of Calcium containing phosphate binders?

A

Calcium Carbonate –> Tums

Calcium Acetate—> PhosLo

178
Q

Calcium carbonate is ___% elemental Ca?

A

40%

179
Q

Calcium acetate is ___% elemental Ca?

A

25%

180
Q

What is the does of Tums?

A

500mg TID a meals

181
Q

What is the maximum mount of elemental calcium?

A

1500mg/day

182
Q

What is the does of calcium acetate?

A

667mg 2-3 tablets TID a meals

183
Q

When given the same elemental dose, which calcium containing phosphate binder will bind double that of the other?

A

Calcium Acetate

184
Q

Which Ca+ containing phos binder has fewer hypercalcemic events?

A

calcium acetate

185
Q

What are 5 non Ca containing phos binders?

A
  1. Sevelamer Carbonate (Renvela)
  2. Lanthanum Carbonate (Fosrenol)
  3. Sucroferric Oxyhydroxide (velphoro)
  4. auryxia (ferric citrate)
  5. Aluminum Hydroxide (Amphojel)
186
Q

Which phosphate lowers [Uric acid], LDL and A1C?

A

Sevelamer carbonate

187
Q

What are the ADE of Sevelamer carbonate?

A

GI- upset, nausea, vomiting, diarrhea

188
Q

What is the sevelamer dose for phos 5.5 < 7.5 mg/dl

A

800 mgTID

189
Q

What is the sevelamer does for phos >7.5 mg/dl ?

A

1600mg TID

190
Q

What is the dose of lanthanum carbonate?

A

250-750 mg TID

191
Q

What is the max dose of lanthanum carbonate?

A

1500-3000 mg/day

192
Q

What is a side effect of sucroferric oxyhydroxide?

A

Darkened stools from the iron

193
Q

What is the dose of sucroferric oxyhydroxide?

A

500 mg chewable tab TID

194
Q

What are 2 drug interactions with ferric citrate?

A

Levothyroxine

Paracalcitriol

195
Q

What is the Auryxia dose?

A

2 tablets TID

196
Q

Auryxia can cause dark stool true or false?

A

True

197
Q

What are 2 labs Auryxia will elevate?

A

TSAT

Ferritin

198
Q

What is the aluminum hydroxide dose?

A

300-600 mg TID

199
Q

Which Phosphate binder is used for short term use of < 4 weeks?

A

Aluminum Hydroxide

200
Q

What are side effects of Aluminum Hydroxide?

A

constipation, Al toxicity cause patients can’t secrete Al

201
Q

What level should dietary phosphorous be limited too?

A

800-1000 mg/day

202
Q

When should dietary phos be limited?

A

G5 if phos > 5.5 mg/dl

G4/G3 if phose > 4.6 mg/dl

203
Q

How does renal dysfunction cause hyperparathyroidism?

A

Hyperphosphatemia and the kidneys can’t activate vitamin D causes low Ca. Low Ca triggers the parathyroid to secrete PTH

204
Q

What is the role of PTH?

A

To Increase calcium mobilization from the bone

205
Q

How do vitamin D supplements effect PTH ?

A

Increased Vit. D –> decreased PTH

206
Q

Is cholecalciferol an inactive active form?

A

Inactive vit. D

207
Q

Is Ergocalciferol an active or inactive form?

A

inactive Vit D

208
Q

Which is the active form of Vit D?

A

Calcitriol

209
Q

Is Ergocalciferol (Calciferol) active or inactive

A

inactive

210
Q

Is cholecalciferol active or inactive?

A

inactive

211
Q

is calcitriol active or inactive?

A

active

212
Q

What is the generic and form of Rocaltrol?

A

calcitriol, PO

213
Q

What is the generic and form or Calcijex?

A

calcitriol, IV

214
Q

What is the indication for inactive vitamin D supplements?

A

CKD stage 3 and 4 patients with some renal function

215
Q

Which vitamin D supplement is approved in Peds and has the greatest risk of hypercalcemia?

A

Calcitriol

216
Q

What is the brand name of Paricalcitol?

A

Zemplar

217
Q

Is paricalcitol active or inactive?

A

Active

218
Q

Which vitamin D supplement has the most favorable ADE profile and less calcemic activity?

A

parocalcitol

219
Q

Is Doxercalciferol active or inactive?

A

active

220
Q

What is the brand name of doxercalciferol?

A

hectorol

221
Q

Which vitamin D supplement is a prohormone?

A

doxercalciferol

222
Q

Where is doxercalciferol activated?

A

The lover

223
Q

Which vitamin D supplement has a higher incidence of hyperphosphatemia?

A

doxercalciferol

224
Q

Which drug that lowers PTH is in the calcimimetic class?

A

Cinacalet (Senispar)

225
Q

How does senispar work?

A

It irreversibly binds to the outside of calcium receptors on the PTG and changes the conformation so iPTH is decreased cause the gland thinks Ca is there .

226
Q

What is the danger of senispar?

A

The parathyroid can’t sense hypocalcemia any more

227
Q

Wht kind of vitamin D does a patient need if the have high Vit. D concentration and high iPTH?

A

Active

228
Q

What kind of vitamin D does a patient need if the have high iPTH and low to normal Vit D?

A

inactive

229
Q

What is the main cause of anemia in CKD patients?

A

Decreased erythropoietin production

230
Q

What effect does uremia have on anemia?

A

It decreases the lifespan of RBCs

231
Q

What kind of hemolysis is specifc to CKD patients?

A

hemolysis through the dialyzer

232
Q

What is MCV?

A

average volume of the RBC

233
Q

What kind of anemia is characterized by low MCV?

A

microcidic anemia

234
Q

What anemia is characterized by high MCV?

A

macrocidic anemia

235
Q

What is normal red cell distribution width? (RDW)

A

11.5-14.5%

236
Q

What kind of anemia does folate and B12 deficiencies cause?

A

Macrocidic anemia

237
Q

What kind of anemia does iron deficiency and aluminum toxicity cause?

A

Microcidic anemia

238
Q

What causes of anemia don’t effect MCV?

A

GI bleeding
EPO deficiency
Anemia of chronic disease

239
Q

What is the Hb goals in females? in males?

A

<13 g/dL

240
Q

According to KDIGO what are the labs that suggest iron supplementation?

A

< 30% TSAT

Serum Ferritin < 500 ng/mL

241
Q

How often should TSAT and ferritin monitored?

A

q 3 months

242
Q

How often should Hb be monitored in CKD 3 patients?

A

annually

243
Q

How often should Hb be monitored in CKD 4-5ND patients?

A

bianually

244
Q

How often should Hb be monitored in CKD 5D patients?

A

q 3 months

245
Q

Can you give oral iron to CKD 5 patients?

A

No

246
Q

What is the dose of elemental iron needed for CKD patients?

A

200 mg/day

247
Q

What is the requirements for heme iron?

A

24-36 mg/day

different absorption/sites

248
Q

What is unique about Dexferrum?

A

It is a high MW Fe–> causes more anaphalaxis

249
Q

Which IV iron agent needs a test dose?

A

Iron dextran (infed) cause the dextran can cause anaphalaxis

250
Q

what is unique about Feraheme?

A

It can cause MRI imaging problems for up to 3 months

251
Q

Which IV iron can be given to ND-CKD pts?

A

iron sucrose

252
Q

What is a precaution with ferrlicit?

A

If it is infused to quickly we can cause Oxidative stress

253
Q

What are some dangers of oxidative stress?

A

athlerosclerosis, proteinurea, renal tubular damage

254
Q

For CKD 3-5ND when is it indicated to begin ESA?

A

Hb < 10 g/dL and falling rapidly

255
Q

For CKD 5 patients when is ESA indicated?

A

When Hb is 9-10 g/dL

256
Q

What is the Hb increase limit for ESA?

A

11.5 g/dL

257
Q

What is rHuEPO?

A

recombinant human erythropoietin

258
Q

How does rHuEPO work?

A

It stimulates erythroid progenitor cells

259
Q

What are the EDE of ESA?

A

Pure red cell aplasia- Ab develop to EPO

260
Q

When is dialysis started to fix bicarb?

A

HCo3- < 20 Mer/L

261
Q

What is the recommended protein for GFR< 30mL/min?

A

0.8 g/kg/day for CKF 3-4

262
Q

What is the protein needed for ESRD patients?

A

1.2 g/kg/day

Therapeutics Spring 2015 (12 decks)

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