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Therapeutics > Kidney I > Flashcards

Kidney I Flashcards

1
Q

Normal SCr

A

0.5-1.2 mg/dL

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2
Q

Normal Cystatin C

A

0.5-1.2 mg/dL

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3
Q

BUN/SCr for decreased kidney perfusion

A

> 20:1

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4
Q

oliguria

A

UOP < 400 mL

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5
Q

anuria

A

UOP <50 mL

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6
Q

Normal albumin

A

< 30 mg/day

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7
Q

microalbuminuria

A

30-299 mg/day

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8
Q

macroalbuminura

A

> = 300 mg/day

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9
Q

What does the kidney do in hypovolemia?
What does urine volume, sodium and specific gravity look like?

A

preserve salt and water
&laquo_space;urine volume, < urine sodium, > urine specific gravity (concentrated)

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10
Q

What does the kidney do in hypervolemia?
What does urine volume, sodium and specific gravity look like?

A

eliminates salt and water
» urine volume, > urine sodium, < urine specific gravity (diluted)

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11
Q

insensible, sweat, urine, loop diuretic urine

A

hypotonic fluid loss

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12
Q

loop diuretic urine, blood, vomiting diarrhea

A

isotonic fluid loss

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13
Q

clinical presentation of hypovolemia

A

tachycardia, hypotension, poor skin turgor, slow capillary refill, dry mucus membranes, orthostasis, cool extremities, low jugular venous pressure

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14
Q

clinical presentation of hypervolemia

A

hypertension, edema, weight gain, +JVD

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15
Q

D5W

A

hypotonic

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16
Q

0.45% NaCl

A

hypotonic

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17
Q

0.9% NaCl

A

isotonic

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18
Q

3% NaCl

A

hypertonic

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19
Q

Lactated ringers

A

isotonic

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20
Q

5% albumin

A

isotonic

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21
Q

NS D5W

A

isotonic

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22
Q

NS D5W w/ 20 mEq KCl

A

hypertonic

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23
Q

1/2 NS D5W

A

hypotonic

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24
Q

1/2 NS D5W w/ 20 mEq KCl

A

hypotonic

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25
Q

1/2 NS D5W w/ 40 mEq KCl

A

hypotonic

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26
Q

What are the bolus isotonic crystalloids and what are they used for?

A

Lactated ringers, plasma-lyte A, and NS
hemodynamic instability

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27
Q

Maintenance fluids infusion rate

A

30-35 mL/kg per day

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28
Q

give less than maintenance fluids

A

CKD, chronic liver disease, HF, liver disease

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29
Q

give more than maintenance fluids

A

dehydrated, hemodynamic shock

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30
Q

hyponatremia is defined as

A

Na < 135 mEq/L

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31
Q

drugs that cause hyponatremia

A

SSRIs, carbamazepine, opiates

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32
Q

symptoms of hyponatremia

A

HA > confusion > lethargy > coma

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33
Q

hypertonic hyponatremia is due to

A

hyperglycemia- sugar diluting Na

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34
Q

hyponatremia where TBW is increased

A

isovolemic hypotonic hyponatremia

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35
Q

v2 antagonist used for isovolemic hypotonic hyponatremia due to HF, cirrhosis, or SIADH

A

tolvaptan (samsca)

36
Q

side effects of tolvaptan

A

thirst, polyuria, constipation

37
Q

BBW tolvaptan

A

hepatotoxicity

38
Q

V1/V2 antagonist given IV for acute isovolemic hypotonic hyponatremia

A

conivaptan

39
Q

hyponatremia with high Na and very high TBW

A

hypervolemic hypotonic hyponatremia

40
Q

hyponatremia with very low NA and low TBW

A

hypovolemic hypotonic hyponatremia

41
Q

HYPO x3 (hyponatremia) is treated with

A

0.9% NS

42
Q

maximum correction rate for hypo x3

A

6-8 mEq/L/day, up to 12 if acute
0.25-0.5 mEq/L/hr

43
Q

Goal Na for hyponatremia

A

135-145 mEq/L

44
Q

hypernatremia with lots of of TBW loss relative to Na

A

hypovolemia hypernatremia

45
Q

hypernatremia with TBW loss while Na is the same

A

euvolemic hypernatremia

46
Q

hypernatremia with very high Na with high TBW

A

hypervolemic hypernatremia

47
Q

furosemide name brand

A

lasix

48
Q

bumetanide name brand

A

bumex

49
Q

torsemide name brand

A

demadex

50
Q

ethacrynic acid name brand

A

edecrin

51
Q

loop diuretics

A

furosemide, bumetanide, torsemide, ethacrynic acid

52
Q

furosemide IV and PO dose
DOA

A

IV 20
PO 40
6hr

53
Q

bumetanide IV and PO dose
DOA

A

IV 1
PO 1
4-8hr

54
Q

torsemide IV and PO dose
DOA

A

IV 20
PO 20
6-12 hr

55
Q

ethacrynic acid IV and PO dose
DOA
clinical pearl

A

IV 50
PO 50
6-8 hr
No sulfa

56
Q

side effects of loops

A

hypokalemia, metabolic alkalosis, renal injury, ototoxicity, sulfa reaction

57
Q

goal for acute diuretic dosing

A

UOP >= 500 mL in 6 hours

58
Q

thiazide diuretics

A

HCTZ, chlorothiazide, chlorthalidone, metolazone, indapamide

59
Q

side effects of thiazides

A

hyperuricemia, hypercalcemia, hypokalemia

60
Q

K sparing diuretics

A

spironolactone, eplerenone, amiloride, triamterene

61
Q

side effects of K sparing

A

hyperkalemia, metabolic acidosis

62
Q

carbonic anhydrase inhibitor

A

acetazolamide

63
Q

side effect of acetazolamide

A

metabolic acidosism

64
Q

mild hypokalemia

A

3-3.5 mEq/L

65
Q

moderate hypokalemia

A

2.5-3 mEq/L

66
Q

Severe hypokalemia

A

< 2.5 mEq/L

67
Q

causes of hypokalemia

A

GI losses, diuretics, hypomagnesemia

68
Q

drugs causing hypokalemia

A

diuretics, steroids, insulin, glucose, B agonists…

69
Q

presentation of hypokalemia

A

cramping, weakness, fatigue, arrhythmias, ECG abnormalities

70
Q

side effects of KCL supplement

A

IV- thrombophlebitis, hyperkalemia, pain/burning
PO- GI irritation & erosion

71
Q

peripheral KCl infusion rate

A

10-20 mEq/100mL over 1 hour

72
Q

central KCl infusion rate

A

40 mEq/100 mL over 1 hour

73
Q

hyperkalemia is characterized by

A

K > 5.5 mEq/L

74
Q

causes of hyperkalemia

A

increased dietary K, decreased renal K excretion, renal tubule unresponsive to aldosterone, etc.

75
Q

drugs that cause hyperkalemia

A

ACE, ARB, RIs, B-blockers, aldosterone antagonists, K sparing diuretics, etc.

76
Q

clinical presentation of hyperkalemia

A

palpitations and ECG changes (arrhythmias)

77
Q

sodium polystyrene sulfonate (SPS)
use and dose

A

chronic treatment of hyperkalemia, also in emergent hyperkalemia
15-30 mg PO QW to TID

78
Q

side effects of SPS

A

GI upset, intestinal necrosis

79
Q

patiromer (veltassa)
use and dose

A

chronic treatment of hyperkalemia
8.4 g QD titrated to 25.2 g QD

80
Q

side effects of patiromer

A

GI, hypomagnesemia
administer 3 hrs away from other meds

81
Q

sodium zirconium cyclosilicate (lokelma)
use and dose

A

chronic treatment of hyperkalemia
10 g PO TID x48hrs then 10 g QD

82
Q

side effects of lokelma

A

edema
administer 2 hrs away from other meds

83
Q

emergent hyperkalemia is characterized by

A

K > 7 mEq/L OR
K 5.5-6.9 mEq/L with ECG changes

84
Q

treatment for ECG change in emergent hyperkalemia

A

1g IV calcium gluconate

85
Q

therapy to shift K into cells in emergent hyperkalemia

A

regular insulin 10U IV + 25g dextrose if euglycemic
50-100 mEq IV Na Bicarb if acidotic
albuterol nebulizer if cannot get IV access

86
Q

treatment removing excess K in emergent hyperkalemia

A

sodium polystyrene sulfonate 15-30 mg PO
IV loop
emergent hemodialysis

Therapeutics (20 decks)

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