Lecture 3

Question 1

Cockcroft-Gault

Answer 1

calculated measurement of CrCl
(M): (140 - age) x IBW in kg / 72 kg x Sir in mg/dL
(F): (CrCl Male) x 0.85
assumes stable renal function and normal mm mass

Question 2

Creatinine clearance

Answer 2

Measured

Question 3

nephrotoxic agents

Answer 3

should be avoided in pt’s at high risk for AKI

ahminoglycosides, amphotericin B, Radiocontrast agents, Cyclosporin/Tacrolimus, ACE inhibitors/ARBs and NSAIDs

Question 4

kidney functions

Answer 4

excretory (fluid, electrolytes and solutes), metabolic (vit D and some drugs like insulin and B-lactams), endocrine (erythropoietin)

Question 5

Diuretic classes

Answer 5

thiazides, carbonio anhydrase inhibitors, K sparing, osmotic, loop

Question 6

important thiazide diuretics

Answer 6

chlorothiazide, hydrochlorothiazide, indapamide, metolazone and chlorthalidone

Question 7

chlorothiazide

Answer 7

relative potency of 0.1, least potent

Question 8

hydrochlorothiazide

Answer 8

relative potency of 1

Question 9

indapamide

Answer 9

relative potency of 20, most potent, may be used if CrCl < 30

Question 10

metolazone

Answer 10

relative potency of 10, may be used if CrCl <30

Question 11

chlorothalidone

Answer 11

relative potency of 1

Question 12

carbonic anhydrase inhibitors

Answer 12

limited usefulness as diuretic , open-angle glaucoma

Question 13

K sparing diuretics

Answer 13

usually administered with K-losing thiazides (helps minimize K loss)

Question 14

Na channel inhibitors (K sparing)

Answer 14

amiloride and triamterene

Question 15

aldosterone antagonists (K sparing)

Answer 15

Spironolactone: CrCl 10-50 administer q24hr
CrCl < 10 avoid use
SE: gynecomastia and impotence

Question 16

glycerine, isosorbide and urea

Answer 16

osmotic diuretic, little clinical use

Question 17

loop diuretics

Answer 17

most potent diuretics, individualize therapy
4 agents available both PO and IV
adverse effects: ototoxicity (tinnitus, deafness, vertigo - reversible) and hyperuricemia (rarely gout) and hyperglycemia

Question 18

Furosemide (Lasix)

Answer 18

excellent bioavailability (good oral abs)
acute pulm edema: start at 40 mg IVP over 1-2 min, then 80 mg IVP if no response
Metolazone (thiazide) can be added for pt's refractory to furosemide (synergistic effect) - double dose q24hr to desired response

Question 19

diuretic ceiling effect

Answer 19

inability of drug to prod additional effects above a certain max effective dose

Question 20

torsemide

Answer 20

preferred in its with persistence fluid retention despite high doses of other loops

Question 21

urinary acidifying agent

Answer 21

ammonium chloride

Question 22

urinary alkalinizing agent

Answer 22

inc elimination fo Aspirin

Na bicarb and K citrate

Question 23

phosphate binders

Answer 23

PO4 is retained, (Ca x PO4) pdt > 40 may precipitate (metastatic calcification aka stones in tissue) need for these

Question 24

first line phosphate binding agents

Answer 24

Ca Carbonate (Tums), Ca Acetate (PhosLo), Sevelamer HCl (Renagel) and Sevelamer Carbonate (Renvela)

Question 25

second line phosphate binding agents

Answer 25

Lanthanum Carbonate (Fosrenol)

Question 26

Ca Acetate

Answer 26

target serum PO4 < 6 mg/dL
mild hypercalcemia is >10.5 –> constipation, anorexia and N/V
severe hypercalcemia >12 –> delirium, stupor and coma
normal is 8.4-10.2
first line

Question 27

Sevelamer (Renagel)

Answer 27

may red vit D, E, K and folate abs
anion - exchange resin 
may induce metabolic acidosis in pt's on HD
target PO4 level < 6 
try after Ca Acetate

Question 28

Na Polystyrene Sulfonate (Kayexalate)

Answer 28

K-binding agent
SE: hypocalcemia, hypokalemia, hypomagnesium, N/V
monitor EKG and electrolytes listed

Question 29

oral Fe for CKD anemia

Answer 29

give 200 mg elemental Fe

titrate dose to minimize GI upset

Question 30

IV Fe

Answer 30

Ferric Gluconate and Fe Sucrose

Question 31

Ferric Pyrophosphate Citrate

Answer 31

water-sol complex Fe salt
added to hemodialysate sol
adv: progressive Fe accumulation doesn’t occur, red use of costly ESAs, inexpensive ($61/50 mL ampule so can tx multiple pt’s)

Question 32

Epoetin Alfa (Epogen, Procrit)

Answer 32

Recombinant Human Erythropoietin 
Non Dialysis CRF dose: 75-150 units/kg/wk
Dialysis CRF dose: 75 units/kg 3 x week 
round doses to nearest 1000 units
ESA

Question 33

Darbepoetin alfa

Answer 33

1/2 life is 3 x that of epoetin alfa
to convert from epoetin, add weekly units
ESA

Question 34

tx of Benign prostatic hyperplasia

Answer 34

a1 antagonists or 5a-reductase inhibitors

Question 35

Tamsulosin (Flomax)

Answer 35

adverse effects: orthostatic hypotension (16% at 0.4 mg, 19% at 0.8 mg)

Question 36

5a reductase

Answer 36

catalyzes conversion of testosterone to DHT

type II mainly in prostate and hair follicles