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NAPLEx > Kidney > Flashcards

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
How is secondary hyperparathyroidism treated?
- vitamin D | - calcimimetic
26
What are the vitamin D analogs?
- Rocaltrol (calcitriol) - Rayaldee (calficediol) - Hectorol (doxercalciferol) - Zemplar (paricalcitol)
27
vitamin D analogs pearls
ADE: hypercalcemia
28
What are the calcimimetics?
- Sensipar (cinacalcet) | - Parsabiv (etelcalcetide)
29
calcimimetics pearls
- hypocalcemia | - Parsabiv (etelcalcetide): muscle spasms, paresthesia
30
anemia is hbg level of what?
< 13 g/dL
31
What are the erythropoiesis stimulating agents (ESA)?
- epoetin alfa: Procrit, Epogen, Retacrit | - darbepoetin alfra (Aranesp)
32
ESA risks
- HTN | - thrombosis
33
When should you use ESA in anemia?
- when hbg < 10 g/dL | - D/C when hbg > 11 g/dL
34
What effect does insulin have on potassium?
shifts potassium into the cell
35
What are symptoms of high K levels?
- muscle weakness - bradycardia - fatal arrhythmias
36
key drugs that increase K levels
- ACEi/ARBs - aldosterone antagonist - aliskiren - canagliflozein - drospirenone-containing oral contraceptive - bactrim - cyclosporine - everolimus - tacrolimus
37
What are the steps to treating hyperkalemia?
1. stabilize heart 2. shift K intracellularly 3. enhance K elimination
38
Hyperkalemia: which drug stabilizes the heart?
calcium gluconate
39
Hyperkalemia: which drugs shifts K intracellularly?
- regular insulin - dextrose - sodium bicarbonate - albuterol
40
Hyperkalemia: enhances K elimination?
- furosemide - sodium polystyrene sulfonate - patiromer - sodium zirconium cyclosilicate - HD
41
sodium polystyrene sulfonate pearls
- can bind to other oral medications | - do not use oral for emergency; can use rectal for emergency
42
patiromer pearls
- hypomagnesemia - can bind to oral drugs; separate by 3 hours - ADE: constipation - delayed onset (7h) -> do not use in emergency
43
sodium zirconium cyclosilicate pearls
- can bind to oral drugs; separate by 2 hours | - delayed onset (1h) -> do not use in emergency
44
bicarbonate in relation to CKD progression
- ability to reabsorb bicarbonate decreases as CKD progresses - leads to metabolic acidosis - treatment initiated when bicarb serum < 22 mEq/L

NAPLEx (13 decks)

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