Kidney Flashcards

1
Q

What are the key drugs that should be decreased in dose or increased in interval in patients with CKD?

A
  • aminoglycosides
  • beta-lactam antibiotics (most)
  • fluconazol
  • quinolones (except moxi)
  • vancomycin
  • LMWH
  • rivaroxaban (for afib)
  • H2RAs (famotidine, ranitidine)
  • metoclopramide
  • biphosphonates
  • lithium
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2
Q

Which key drug is contraindicated in CrCl < 60 mL/min?

A

nitrofurantoin

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3
Q

Which key drug is contraindicated in CrCl < 50 mL/min?

A
  • tenofovir disoproxil fumurate containing products
    • Stribild: CI in current patients at this CrCl; if patient is new to this rx, CI in CrCl < 70
  • voriconazole IV
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4
Q

Which key drug is contraindicated in CrCl < 30 mL/min?

A
  • tenofovir alafenamide containing products
  • NSAIDs
  • dabigatran (DVT/PE)
  • rivaroxaban (DVT/PE)
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5
Q

Which key drug is contraindicated in GFR < 30 mL/min/1.73m^2?

A
  • SGLT2 inhibitors

- metformin

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6
Q

What is a key drug to take into consideration with renal issues?

A

meperidine; no specifics in naplex book

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7
Q

What are the classes of phosphate binders?

A
  • aluminum based
  • calcium based
  • aluminum and calcium free
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8
Q

Which class of phosphate binders is used as first line?

A

calcium based

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9
Q

What is the aluminum based phosphate binder?

A

aluminum hydroxide suspension

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10
Q

aluminum hydroxide pearls

A
  • 300-600mg TID with meals
  • rarely used b/c risk of aluminum accumulation -> nervous system and bone toxicity*
  • limit to 4 weeks
  • dialysis dementia*
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11
Q

What are the calcium based phosphate binders?

A
  • Phoslyra, PhosLo (calcium acetate)

- Tums (calcium carbonate)

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12
Q

calcium acetate dosing (not underlined)

A
  • 1334mg PO TID with meals
  • titrate based on PO4 levels
  • tablet, capsule, solution
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13
Q

calcium carbonate dosing (not underlined)

A
  • 500mg PO TID with meals
  • titrate based on PO4 levels
  • tablet, chewable tablet
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14
Q

calcium based phosphate binder pearls

A
  • total daily calcium should < 2g
  • hypercalcemia*, constipation, nausea
  • increased Ca w/ use of vit D*
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15
Q

What are the calcium free and aluminum free phosphate binders?

A
  • Velphoro (sucroferric oxyhydroxide)
  • Auryxia (ferric citrate)
  • Fosrenol (lanthanum carbonate)
  • Renvela (sevelamer carbonate)
  • Renagel (sevelamer hydrochloride)
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16
Q

Which calcium free and aluminum free phosphate binders are not systemically absorbed?

A

sevelamer

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17
Q

Calcium free and aluminum free phosphate binders (that are systemically absorbed) pearls

A
  • iron absorption with ferric citrate
  • N/V/D, constipation
  • must Fosrenol chew tablet thoroughly
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18
Q

Calcium free and aluminum free phosphate binders (that are systemically NOT absorbed) pearls

A
  • N/V/D
  • can lower total and LDL cholesterol by 15-30%
  • can maintain bicarbonate concentrations
  • can reduce absorption of some vitamins
19
Q

Where does loop diuretics work and MOA?

A
  • ascending limb of loop of henle
  • inhibit Na/K pump
  • cause less Ca reabsorption
20
Q

Where does thiazide diuretics work and MOA?

A
  • distal convoluted tubule
  • inhibit Na/Cl pump
  • increases Ca reabsorption
21
Q

Where does aldosterone antagonists work and MOA?

A
  • collecting duct & distal convoluted tubule
  • inhibit aldosterone
  • under normal conditions, aldosterone increase Na and water reabsorption and decrease K reabsorption
22
Q

After initiating ACEi or ARB, baseline SCr can increase by how much?

23
Q

ACEi or ARB MOA

A
  • inhibit renin-angiotensin-aldosterone system (RAAS) causing efferent arteriolar dilation
  • this reduces pressure in glomerulus which decreases albuminuria
24
Q

phosphate binder drug interactions

A

separate administration from levothyroxine and antibiotics that chelate

25
Q

How is secondary hyperparathyroidism treated?

A
  • vitamin D

- calcimimetic

26
Q

What are the vitamin D analogs?

A
  • Rocaltrol (calcitriol)
  • Rayaldee (calficediol)
  • Hectorol (doxercalciferol)
  • Zemplar (paricalcitol)
27
Q

vitamin D analogs pearls

A

ADE: hypercalcemia

28
Q

What are the calcimimetics?

A
  • Sensipar (cinacalcet)

- Parsabiv (etelcalcetide)

29
Q

calcimimetics pearls

A
  • hypocalcemia

- Parsabiv (etelcalcetide): muscle spasms, paresthesia

30
Q

anemia is hbg level of what?

31
Q

What are the erythropoiesis stimulating agents (ESA)?

A
  • epoetin alfa: Procrit, Epogen, Retacrit

- darbepoetin alfra (Aranesp)

32
Q

ESA risks

A
  • HTN

- thrombosis

33
Q

When should you use ESA in anemia?

A
  • when hbg < 10 g/dL

- D/C when hbg > 11 g/dL

34
Q

What effect does insulin have on potassium?

A

shifts potassium into the cell

35
Q

What are symptoms of high K levels?

A
  • muscle weakness
  • bradycardia
  • fatal arrhythmias
36
Q

key drugs that increase K levels

A
  • ACEi/ARBs
  • aldosterone antagonist
  • aliskiren
  • canagliflozein
  • drospirenone-containing oral contraceptive
  • bactrim
  • cyclosporine
  • everolimus
  • tacrolimus
37
Q

What are the steps to treating hyperkalemia?

A
  1. stabilize heart
  2. shift K intracellularly
  3. enhance K elimination
38
Q

Hyperkalemia: which drug stabilizes the heart?

A

calcium gluconate

39
Q

Hyperkalemia: which drugs shifts K intracellularly?

A
  • regular insulin
  • dextrose
  • sodium bicarbonate
  • albuterol
40
Q

Hyperkalemia: enhances K elimination?

A
  • furosemide
  • sodium polystyrene sulfonate
  • patiromer
  • sodium zirconium cyclosilicate
  • HD
41
Q

sodium polystyrene sulfonate pearls

A
  • can bind to other oral medications

- do not use oral for emergency; can use rectal for emergency

42
Q

patiromer pearls

A
  • hypomagnesemia
  • can bind to oral drugs; separate by 3 hours
  • ADE: constipation
  • delayed onset (7h) -> do not use in emergency
43
Q

sodium zirconium cyclosilicate pearls

A
  • can bind to oral drugs; separate by 2 hours

- delayed onset (1h) -> do not use in emergency

44
Q

bicarbonate in relation to CKD progression

A
  • ability to reabsorb bicarbonate decreases as CKD progresses
  • leads to metabolic acidosis
  • treatment initiated when bicarb serum < 22 mEq/L