Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PHAR 255 > Kidney 3 > Flashcards

Kidney 3 Flashcards

1
Q

Fluid and electrolyte abnormality complications

A

Sodium and water imbalance
Metabolic acidosis
Hyperkalemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

General complications of CKD

A

CKD-mineral bone disease
Anemia
CV
GI
Neurological

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What causes a sodium and water imbalance?

A

Progressive loss of ability of the kidneys to excrete excess water and sodium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

When do we see sodium and water imbalance in CKD and what does it look like?

A

Usually stage 4 CKD
- weight gain
- hypertension
- peripheral and pulmonary edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Treatment for sodium and water imbalance

A

Sodium and water restriction
- <2g of sodium and 1-2L of fluid per day
Furosemide +/- metolazone
Stage 5: dialysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What effect does metolazone have when added to furosemide?

A

They have a synergistic effect to increase excretion of sodium because it blocks the uptake of of sodium at the distal convoluted tubule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What needs to be monitored for diuretic use?

A

Electrolytes (specifically K+)
- every 1-2 weeks initially then 3-6 months when stable
Signs and symptoms of dehydration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is metabolic acidosis?

A

Decrease in the pH of the blood and a decrease in serum bicarbonate levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What may cause metabolic acidosis?

A

Impaired excretion of acids and/or reabsorption of bicarbonate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

At what stage of CKD is metabolic acidosis most prominent?

A

Stage 4-5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the treatment for metabolic acidosis?

A

Sodium bicarbonate tablets (325-500mg BID-TID)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the concern with sodium bicarbonate tablets?

A

Possibility of sodium loading

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When would IV sodium bicarbonate be used?

A

Severe acidosis in hospitalized patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is hyperkalemia primarily due to?

A

Decreased potassium excretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the exacerbating factors for hyperkalemia?

A

Metabolic acidosis
Excessive potassium intake from diet
Potassium sparing diuretics
ACEi/ARB
NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Symptoms of mild to moderate hyperkalemia (5.1-7mmol/L)

A

Weakness, confusion, muscle & respiratory paralysis, ECG changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Symptoms of severe hyperkalemia (>7mmol/L)

A

ECG changes widened QRS complex, small amplitude P wave, sinus waves, heart block, ventricular tachycardia, sudden cardiac death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Treatment for hyperkalemia

A

Identify/correct exacerbating factors
- drugs, diet
Kayexalate (potassium binders) - for mild acute or refractory chronic hyperkalemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the formulation for kayexalate?

A

Oral powder or liquid suspension
- should not be mixed into liquid high in K+
15-60g daily-QID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the newer K+ binders available?

A

SZC
Patiromer
*they are better tolerated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How should K+ binders be taken?

A

Spaced by 3 hours from other drugs due to binding drug interactions

22
Q

Treatment for severe hyperkalemia

A

MEDICAL EMERGENCY
- Calcium gluconate IV (to stabilize myocardium)
- glucose + human regular insulin
- sodium bicarbonate IV (only if metabolic acidosis)
- salbutamol via nebulizer
- kayexalate until K+ normalized

23
Q

What is CKD-MBD

A

A systemic disorder of mineral and bone metabolism due to CKD manifested by one of a combination of there characteristics

24
Q

What are the three characteristics of CKD-MBD?

A
  • Abnormalities of calcium, phosphorus, PTH, or vitamin D meatabolism
  • abnormalities in bone turnover, mineralization, volume, linear growth, or strength
  • vascular or other soft tissue calcification
25
Q

At what stage of CKD do bone and mineral metabolism changes begin?

A

Stage 3

26
Q

What are the outcomes of CKD-MBD?

A

Bone pain, fractures, CVD, death

27
Q

What are the 4 main issues that we target with treatment for CKD-MBD?

A
  • increased serum phosphate
  • decreased serum calcium
  • decreased vitamin D
  • increased PTH
28
Q

What are the three main calcium sources in the body?

A

Kidney
Bone
Gut

29
Q

What are the three ways to look at calcium on a lab?

A

Ionized calcium (active calcium)
Total calcium (free ionized + calcium bound to albumin)
Corrected calcium (calcium adjusted for albumin levels)

30
Q

What are the types of renal osteodystrophy?

A

Hyperparathyroid bone disease
Adynamic bone disease
Osteomalacia

31
Q

Hyperparathyroid bone disease

A

High bone turnover (increased)
Increased PTH levels

32
Q

Adynamic bone disease

A

Low bone turnover (decreased)
Normal or decreased PTH levels

33
Q

Osteomalacia

A

Decreased vitamin d activity

34
Q

What is calciphylaxis?

A

Calcification and occlusion of small blood vessels
- leads to ulceration, gangrene, secondary infection (sepsis), and is associated with with a high mortality rate

35
Q

How is Hyperparathyroid bone disease treated?

A

Restrict dietary phosphate
Phosphate binders - calcium, aluminum or magniusm binders
Vitamin D - calcitriol
Parathyroidectomy

36
Q

When do phosphate binders need to be taken?

A

Within first few bites of a meal

37
Q

What are the 1st line phostphate binders?

A

Calcium carbonate (TUMS)
- 500mg elemental TID WITH MEALS

38
Q

Why is vitamin D used to treat HPT bone disease?

A

Helps suppress PTH levels
- reserved for severe and progressive HPT

39
Q

What are the antiresorptive treatments?

A

Denosumab (Prolia)
Bisphosphonates (alendronate)

40
Q

What is adynamic bone disease associated with and what is the treatment?

A

More fractures and calcification
Treatment: stop vitamin D supplementation

41
Q

Treatment for osteomalacia

A

Stop aluminum-containing phosphate binders

42
Q

What is vascular calcification?

A

Vascular smooth muscle cells change into an osteoblast-like cell

43
Q

What does anemia in CKD look like?

A

Normochromic, normocytic
Hgb < 130g/L or 120g/L
Hypo-proliferative (inadequate production) - decreased Reticulocytes

44
Q

Drug Treatment for anemia in CKD

A

Erythropoiesis stimulating agents

45
Q

Overall treatment options for anemia in CKD

A

Correct blood loss
Replace vitamin, iron deficiencies
ESA (drugs)
Dialysis to correct Uremia
Blood transfusions

46
Q

What are the ESAs?

A

Epoetin alfa (shorter half life)
Darbepoetin Alfa (longer half life)

47
Q

What might cause erythropoietin resistance?

A

Iron deficiency*
Vitamin deficiency
Bleeding
Inflammation/infection
Inadequate dialysis

48
Q

What are the contributing factors to HTN in CKD?

A

Salt and water retention
Activation of RAAS
ESA therapy
Hyperparathyroidism
Renal vascular disease

49
Q

What is the most common structural cardiac abnormality in CKD?

A

Left ventricular hypertrophy

50
Q

Treatment options for chronic pruritis/uremic pruritis

A

Difelikefalin** (when associated with HD)
Gabapentinoids
Capsaicin
Sertraline
Antihistamines
Uremol lotion

PHAR 255 (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions