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Cardio-Renal I FINAL > Hughes - Fluid and Electrolytes Part 2 > Flashcards

Hughes - Fluid and Electrolytes Part 2 Flashcards

1
Q

2 general causes of hyperkalemia

A

-efflux and release of potassium out of cells

-decreased elimination

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2
Q

___glycemia can cause the efflux of potassium from cells and thus be a cause of hyperkalemia

A

hyper

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3
Q

true or false

high levels of aldosterone can lead to hyperkalemia

A

FALSE - low levels

aldosterone helps to excrete potassium

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4
Q

true or false

a patient can get hyperkalemia by consuming too much potassium

A

FALSE - not possible

pt must also have some renal impairment

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5
Q

true or false

hyperkalemia is considered asymptomatic until catastrophe

A

TRUE

dont really notice anything until ventricular fibrillation and asystole — like pulseless rhythms. die immediately

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6
Q

HOW does hyperkalemia increase the risk of arrythmias like ventricular fibrillation

A

bc the membrane potential is less negative – closer to excitatory potential

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7
Q

3 general categories of treatment for hyperkalemia

A

-agents that antagonize the cardiac effects – move FURTHER from excitatory potential

-agents that shift potassium to the intracellular space

-agents that enhance the clearance of potassium

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8
Q

as mentioned, agents that antagonize cardiac effects can be used in hyperkalemia

explain further how they work and when they’re used

A

they do NOT actually lower the potassium levels – are only used when EKG changes are present – save lives by shifting potential further from excitement

cardiac protective but do NOT actually get rid of potassium

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9
Q

name the medication that is used in hyperkalemia as a cardioprotective agent (only given when EKG changes are present)

important consideration when using

A

calcium gluconate (10% 10mL IV push) can repeat again in 5 mins if EKG doesnt resolve

only lasts for 1 hour, and also if the pt has overdosed on digoxin, it can make the cardiotoxicity worse (so use cautiously or not at all in this case)

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10
Q

name some agents that are used in hyperkalemia to shift potassium to the intracellular space

is this effect permanent?

A

insulin and glucose, b2 agonists, albuterol, sodium bicarb

NOT PERMANENT - works quick but is def temporary

ultimately in hyperkalemia - we need to give agents that ENHANCE THE ELIMINATION OF POTASSIUM - need to just get it out of the body

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11
Q

___________is best to use if the patient has hyperkalemia and metabolic acidosis

A

sodium bicarb

shifts potassium to intracellular space

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12
Q

sodium bicarb may take ___ to work

A

4 hours

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13
Q

name 4 agents that are used in hyperkalemia to enhance the clearance of potassium

A

sodium polystyrene sulfate
patiromer
sodium zirconium cyclosilicate
hemodialysis and loop diuretics

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14
Q

brand name sodium polystyrene sulfonate

A

kayexalate

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15
Q

brand name patiromer

A

veltessa

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16
Q

brand name sodium zirconium cyclosilicate

A

lokelma

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17
Q

3 agents that enhance the excretion of potassium through the GI tract that are used in hyperkalemia

A

veltessa (patiromer)
lokelma (sodium zirconium cyclosilicate)
sodium polystyrene sulfonate (kayexalate)

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18
Q

2 things used in hyperkalemia to enhance the clearance of potassium through the KIDNEYS

A

hemodialysis and loop diuretics

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19
Q

3 risks when using sodium polystyrene sulfonate for hyperkalemia

A

sodium overload
diarrhea
intestinal necrosis

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20
Q

which 2 agents that enhance the excretion of potassium are technically only indicated for chronic use and not for emergencies?

A

paritromer (veltessa)
sodium zirconium cyclosilicate (lokelma)

however, often used “off label” anyway for emergencies

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21
Q

true or false

hemodialysis is a more reliable way to remove potassium than through a loop diuretic in cases of severe renal diseas

A

true

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22
Q

99% of total body calcium is located where

A

the bone

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23
Q

calcium located where?? is actually important for things like nerves and muscle contraction

A

in the plasma – not in the bone

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24
Q

when looking at calcium levels, it is important to do what

A

adjust for albumin deficiencies

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25
some absorption of calcium from the GI tract requires....
vitamin D
26
3 general things that can cause hypercalcemia
-movement of calcium from the bone (ie - destruction, malignancy, hyperparathyroidism) -vitamin D toxicity -drugs
27
true or false low levels of vitamin D cause hypercalcemia
FALSE - high levels bc vitamin D helps the body to absorb calcium from the GI tract and into the blood
28
name 4 general systems affected by hypercalcemia
neurologic cardiac renal GI
29
for the treatment of hypercalcemia, we generally target...
THE CAUSE
30
name 5 drugs that can cause hypercalcemia
calcium supplements thiazides lithium estrogens tamoxifen
31
drugs that can cause hyperkalemia
ACE/ARB B-blockers lithium heparin K sparing diuretics cyclosporine tacrolimus digoxin
32
what is always done FIRST in treating hypercalcemia? is there anything to be aware of with this?
give FLUID -- 1-2 liters of IV normal saline have to be careful if the pt has renal or heart failure (fluid overload)
33
why is fluid always given 1st for hypercalcemia
most pts are volume depleted - have to expand also, giving more fluid will increase the GFR and decrease the reabsorption of calcium through the kidney
34
what is given AFTER fluids are given for hypercalcemia?
loop diuretics - to increase the release of calcium in the urine (monitor fluid loss and electrolyte disturbances!)
35
if fluid + loop diuretic dont work for hypercalcemia, what is done next?
calcitonin-salmon is given. (considered second line)
36
onset of calcitonin-salmon and any concerns with it
starts working very quickly - within hours - but has short duration also, tachyphylaxis also occurs quickly - within 1-3 days basically the body adjusts to it and it wont do anything anymore ALSO hypersensitivity concerns bc it's a protein
37
true or false thiazides cannot be used for hypercalcemia
TRUE - thiazides increase calcium ONLY LOOPS!!
38
in treating hypercalcemia, what is considered like the "bridge" for bisphosphanates
calcitonin-salmon
39
name 3 bisphosphanates that can be used for hypercalcemia
etidronate pamidronate zoledronic acid
40
true or false bisphosphanates are not very effective in treating hypercalcemia
FALSE - they're very effective in getting to normal calcium levels -- but kidney injury is possible
41
onset and redosing for bisphosphanates
onset is slow -- 2 days -- also has very long duration so can redose but after a week
42
most potent and preferred bisphosphanate for hypercalcemia
zoledronic acid
43
name 4 things that can possibly be used for hypercalcemia but are RARELY used
gallium phosphate corticosteroids NSAIDS
44
issue with gallium for hypercalcemia
causes nephrotixicity - it's a heavy metal
45
how does phosphate work in hypercalcemia any AE?
makes a complex with calcium and deposits in the bone -- given PO only -- for chronic use issue - GI adverse events
46
which potential drug class used to treat hypercalcemia can be useful if the hypercalcemia is vitamin-D induced?
CORTICOSTEROIDS - bc they impair the vitamin D-mediated absorption of calcium
47
NSAIDS are mainly used in which patients for hypercalcemia
cancer patients (PGE-mediated)
48
most phosphorus is intracellular or extracellular? specifically where?
intracellular mainly in the bone BARELY extracellular at all
49
true or false most phosphorus that we eat gets absorbed also - which foods have high phosphorus
TRUE milk, meat, veggies
50
what can REDUCE the absorption of dietary phosphorus?
Ca/Mg/Al antacids iron supplements
51
true or false hypophosphatemia due to low dietary intake is rare
TRUE -- phosphate is found in so many things
52
give a specific scenario in which hypophosphatemia can occur
refeeding syndrome -- givin a malnourished pt a high calories diet without supplementing phosphate
53
the symptoms seen in hypophosphatemia is mostly related to....
impaired cellular energy stores (the P in ATP is phosphorus!!)
54
explain the treatment for hypophosphatemia (include drug names)
may just need to eat more phosphate -- resolve on its own can also give PO supplements (potassium phosphate + sodium phosphate) "K-phos" or "neutra phos" if the hypophosphatemia is SEVERE or the patient cant take PO - use IV potassium phosphate or sodium phosphate "K-phos" = potassium phosphate
55
cautions when using K-phos, neutra-phos, etc, for hypophosphatemia
they have varying amounts of potassium and salt - be careful if either of these are a concern
56
when giving IV phosphate... be careful to consider what
each mmol of phosphate also delivers 1.5mmol of potassium!!! watch the rate of infusion
57
AE of IV phosphate
tissue calcification hypotension K/na/fluid overload
58
magnesium is mostly intracellular or extracellular?
like potassium - intracellular
59
the serum magnesium levels have _____ correlation with the total body stores
poor
60
what kind of things is magnesium important for
metabolism, RNA and DNA handling, operation of electrolyte pumps and channels
61
the dietary absorption of magnesium depends on...
the body's need for it
62
how is magnesium mainly eliminated?
kidney
63
the reabsorption of magnesium is parallel with _______
sodium
64
general causes of hypomagnesia
decreased intake diarrhea increased renal elimination increased requirements for magnesium
65
which patients have increased requirements for magnesium and are thus prone to hypomagnesium
pregnant ppl and infants
66
a lot of patients with hypokalemia also have ----
hypomagnesium
67
true or false there is no defining symptom to diagnose hypomagnesium
TRUE -- all very vague symptoms need to see CMP
68
when deciding to treat hypomagnesium, ___ is more important than ____
symptoms and EKG findings are more important than the levels themselves
69
ORAL treatment for hypomagnesium for an asymptomatic patient with mild depletion
Slow Mag (Mg chloride) -- sustained release preferred over Mg antacids, milk magnesia, mg oxide also give foods with Mg!! - vegetables, nuts, meat, fruit, etc
70
preferred parenteral route for hypomagnesium
IV preferred over IM
71
IV treatment for hypomagnesium include any concerns
Mg sulfate. around half is eliminated by the kidneys right away --- so give a prolonged infusion over SEVERAL HOURS!!!!! also, monitor for EKG changes, hypotension (due to vasodilation) and respiratory changes
72
as mentioned, giving IV Mg sulfate for hypomagnesium can cause hypotension how do you look out for this
caused by vasodilation - so watch for flushing of the skin, and warmth -- monitor
73
the cause of hypermagnesium is almost always what??
renal insufficiency + taking Mg-containing meds and supplements
74
name 2 OTC products that contain magnesium, making it easy to have too much
antacids laxatives
75
explain the presentaiton of hypermagnesium
gets worse as concentration increases starts with bad tendon reflexes, and progresses to complete heart block
76
explain the treatment for hypermagnesium
d/c mg-containing meds if pt has renal impairment -- consider hemodialysis - the kidney will get rid of excess can give loop + 0.45% NaCl to replace volume
77
if life-threatening complications from hypermagnesium occur, what should be given? (heart block, loss of tendon reflexes, quadraplegia)
IV calcium!!!! to antagonize the respiratory and cardiac effects (same as for hyperkalemia)
78

Cardio-Renal I FINAL (12 decks)

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