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PT > Fluid & Electrolyte Imbalance > Flashcards

Fluid & Electrolyte Imbalance Flashcards

1
Q

What is the brand name for Conivaptan

A

Vaprisol

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2
Q

MOA for Conivaptan

A

• Dual vasopressin (ADH) receptor antagonist. It blocks V1A and V2 receptor found in the collecting duct of kidneys

 prevents vasopressin from binding to this receptor

 excretion of free water

 increases plasma sodium level

 decreases symptoms of hyponatremia

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3
Q

Conivaptan dosage range:

A

Initial, 20 mg IV infusion over 30 minutes, followed by 20 mg as a continuous IV infusion over 24 hours for an additional 1-3 days. Max dose = 40 /d

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4
Q

What do you monitor while a pt is on vaprisol?

A
  • Rate of Na increase
  • Serum osmolarity
  • BP & volume status, urine output Efficacy
  • injection site reaction
  • potassium level
  • Improvement s/sx of hyponatremia (headache, dizziness, confusion, nausea, and fatigue)
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5
Q

What is brand Tolvaptan?

A

Samsca

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6
Q

MOA for Tolvaptan

A

Selective V2 vasopressin (ADH) receptor antagonist found in the collecting duct of the kidney

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7
Q

What should you counsel a pt on, on Samsca therapy

A

Maintain adequate hydration (ingest fluid in response to thirst), especially during the first 24 hours of therapy, to prevent dehydration and hypovolemia.

Patient should not drink grapefruit juice while taking this drug

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8
Q

S&S of hypernatremia

A

FRIED:

FEVER

RESTLESSNESS

INCREASE FLUID RETENTION and INCREASED BLOOD PRESSURE

EDEMA

DECREASED URINE OUTPUT, DRY MOUTH

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9
Q

What are some causes for hypernatremia?

A

 Water deficit (Example: Diabetes insipidus)

 Excessive sodium (Example: sodium intake, 
aldosterone)

 Loss of water > loss of sodium (Example:
diuretic, diarrhea)

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10
Q

How do you tx hypernatremia?

A

IV lactated Ringer’s or 0.9% NaCl at a rate of 1,000 mL or 20 mL/kg given over 30 minutes until hemodynamic stability is restored

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11
Q

What are some common SE of Tolvaptan?

A

Hyperglycemia, Hypernatremia , Increased thirst, dry mouth, polyuria

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12
Q

What are some causes of hypernatremia?

A

Water deficit

Excessive sodium from diet or aldosterone

Diuretics

Diarrhea

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13
Q

What is the normal range for potassium?

A

Normal : 3.5-5.0 mEq/L

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14
Q

Potassium function:

A

Function
 Electrical action potential (cardiac conduction)
 Maintain blood pressure

Homeostasis
 Diet intake
 Eliminated by kidney (↑Aldosterone ↑ K excretion)

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15
Q

Complications in hypokalemia

A

 ↑ mortality in CKD or heart failure patients

 Worsening of hypertension and ↑ risk for stroke

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16
Q

What are the clinical presentations of hypokalemia?

A

Clinical presentations
 Mild: Asymptomatic

 Moderate: cramping, weakness, myalgias

 Severe: Arrhythmias (e.g. heart block, atrial
flutter, ventricular fibrillation)  ST SEGMENT DEPRESSION, T wave inversion in ECG

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17
Q

What can cause hypokalemia?

A

 Drug induced: diuretics, beta 2 agonists

 Diarrhea and/or vomiting

 Hypomagnesemia

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18
Q

TorF: For those with low Mg and low K, it is imperative to correct Mg level first

A

True

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19
Q

Klor-Con M

Klor-Con Sprinkle

Micro- K

A

Controlled-release microencapsulated tablet

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20
Q

TorF: Pt have fewer GI erosions on micro encapsulated tablets like Klor-Con M

A

True

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21
Q

KCL elixir brand name is:

A

K-sol

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22
Q

KCL effervescent tab for solution brand name is

A

K-Vescent

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23
Q

Klor-Con generic is

A

Wax matrix ER tablet AKA K-tab

24
Q

IV K should be prepared in ___________

A

saline-containing solutions

0.9% normal saline

25
Q

Potassium Chloride

A

Read PP

26
Q

Causes of hyperkalemia:

A

 ↑ K intake (CKD patients not adherent to diet restriction)

 ↓ K excretion

 Drug induced: ACEI, ARBs, direct renin inhibitors, K sparing diuretics

27
Q

Hyperkalemia Clinical Presentations

A

Mid- Moderate

Non-specific

 Generalized weakness

 Fatigue

 Nausea

 Vomiting

 Intestinal colic

 Diarrhear

SEVERE:

(K>6.5 mEq/L) 
 Cardiac arrhythmias
 Peaked T waves 
 Widen QRS complex
 Muscle paralysis
28
Q

Treatment of Acute Hyperkalemia: ACUTE TREATMENT→ when EKG changes, or K level > 6.5 mEq/L, USE:

A

Use calcium gluconate/ chloride to stabilize myocardiocytes EXCEPT if pt is on ______

Digoxin

29
Q

Treatment of Acute Hyperkalemia

A 
Other options
 Insulin and glucose
 Albuterol
 Sodium bicarbonate
 Exchange resins
 Furosemide
 Hemodialysis
30
Q

What is Kayexalate used for:

A

HYPERKALEMIA

31
Q

Kayexalate generic:

A

Sodium polystyrene sulfonate

32
Q

Kayexalate MOA:

A

Removes potassium by exchanging sodium ions for potassium ions in the intestine (especially the large intestine) before the resin is passed from the body

33
Q

Kayexalate

A

Dosage

Oral: 15g 1 to 4 times daily

Rectal: 30-50 g every 6 hours

Administer orally or via NG tube with patient in an upright position at least 3 hours before or 3 hours after other medications

  • DO NOT mix in orange juice or in any fruit juice known to contain potassium
  • Shake the suspension well prior to administration. Chilling the oral mixture will increase palatability.
  • Sodium polystyrene sulfonate suspension may also be added to the patient’s food
34
Q

Patiromer brand name is:

A

Veltassa

35
Q

Valtessa

A

Patiromer works by binding free K+ ions in the gastrointestinal tract and releasing Ca+2 ions for exchange, thus lowering the amount of K+ available for absorption into the bloodstream and increasing the amount of K+ that is excreted via the feces

36
Q

Normal ranges for calcium?

A

Normal: 8.6-10.2 mg/dL (iCa 4.25-5.25 mg/dL)

37
Q

TorF: 99% of calcium is combined with phosphorous and concentrate in bone and teeth

A

True

38
Q

What is calcium’s function?

A

Function

 Neuromuscular activity
 Maintain cardiac contraction
 Formation of bone and teeth
 Blood clots

39
Q

TorF: Extracellular calcium is moderately bound to albumin (60%)

A

False. 40%

40
Q

Hypocalcemia level:

A

LESS THAN 8.5 mg/dL

41
Q

Causes of hypocalemia

A

 Elderly malnourished patients taking sodium phosphate

 Vitamin D deficiency

 Hypomagnesemia

 Hypoparathyroidism (Hungry bone syndrome)

42
Q

S&S of hypocalcemia:

A

Tetany – paresthesias around the mouth and extremities (Chevokstok’s sign) (Trousseau’s
sign)

 Muscle spasms and cramps

 Prolonged QT interval in ECG

43
Q

TorF: Calcium chloride is generally preferred over calcium gluconate for peripheral venous administration because calcium chloride is less irritating to veins

A

FALSE. Calcium GLUCONATE IS LESS IRRITATING TO VEINS. Calcium gluconate is generally preferred over calcium chloride for peripheral venous administration because calcium gluconate is less irritating to veins.

44
Q

TorF: Calcium should not be infused at a rate greater than 60-mg elemental calcium per minute because severe cardiac dysfunction

A

True

45
Q

TorF: Pts on calcium gluconate or calcium chloride tx should be monitored for ECG levels

A

True. ECG monitoring is required!

46
Q

Normal phosphate level

A

Normal: 2.7-4.5 mg/dL

47
Q

hyperphosphatemia causes and symptoms:

A

Causes

 Acute kidney injury

 Chronic renal failure

 Exogenous phosphate source: sodium phosphate (Fleet Phospho-Soda) can also result in severe and life-
threatening hyperphosphatemia, especially in patients with moderate-to-severe CKD

Symptoms

Acute symptoms include GI disturbances, lethargy, obstruction of the urinary tract, and rarely seizures.

Symptoms associated with chronic hyperphosphatemia include “RED EYE” and PRURITUS.

48
Q

The elevated calcium-phosphate product results in precipitation in arteries, joints, soft tissues, and the viscera. This can result in tissue necrosis, termed __________ or ____________.

A

calciphylaxis or calcemic uremic arteriopathy.

49
Q

Renagel is the brand for what medication?

A

Sevelamer

50
Q

Sevelamer MOA:

A

Phosphate binder

Binds phosphate within the intestinal lumen, limiting absorption and decreasing serum phosphate concentrations

51
Q

Causes for hypophosphatemia

A

Causes

 Decrease GI absorption

 Decrease renal reabsorption

 Chronic alcohol use, chronic ingestion of antacids

52
Q

Normal magnesium level

A

Normal: 1.7-2.3 mg/dL

53
Q

Causes of hypomagnesemia

A

Causes
 Small bowel syndromes
 Proton-pump inhibitors (long term use)
 Vomiting, excessive laxative use

54
Q

Hypomagnesemia Treatment

A

 IM administration may be very painful

 Slower IV infusion allow greater retention of Magnesium

55
Q

Magnesium to SE:

A

SE: flushing, sweating, warm sensation

PT (1 decks)

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