Lewis 51 - AKI and CKD

Question 1

MOA/Class

Insulin (regular)

Answer 1

Facilitates transport of glucose and electrolytes across cell membrane and stimulates metabolic processes

Short-acting Insulin

Tucker 38

Question 2

Side Effects

Insulin (regular)

Answer 2

hypoglycemia, lipodystrophy, hypokalemia

Tucker 38

Question 3

Nursing Considerations

Insulin (regular)

Answer 3

Regular insulin is the only insulin that may be given IV (DKA or hyperkalemia).
Give with concurrent dose of dextrose if given for hyperkalemia to prevent hypoglycemia.
General insulin considerations: Check glucose levels before administering insulin. Beta blockers may decrease/mask s/s of hypoglycemia. Insulin needs may increase with corticosteroid therapy. May require double RN verification.
Onset: 30-60 minutes; Peak: 2-4 hours; Duration: 6-12 hours

Tucker 38

Question 4

Indications

Insulin (regular)

Answer 4

Hyperglycemia; hyperkalemia

Tucker 38

Question 5

MOA/Class

sodium bicarbonate

Answer 5

neutralizes acid; promotes shift of potassium into cells

Antacid/alkalinizing agent

Tucker 57

Question 6

Side Effects

sodium bicarbonate

Answer 6

metabolic alkalosis, hypokalemia

Tucker 57

Question 7

Nursing Considerations

sodium bicarbonate

Answer 7

Observe IV site closely; monitor EKG

Tucker 57

Question 8

Indications

sodium bicarbonate

Answer 8

Acidosis; hyperkalemia

Tucker 57

Question 9

MOA/Class

calcium gluconate

Answer 9

Regulates transmission of nerve impulses and contraction of cardiac, skeletal, and smooth muscle.
Raises threshold for cardiac excitation thus decreasing risk for dysrhythmias

Electrolyte supplement

Tucker 60

Question 10

Side Effects

calcium gluconate

Answer 10

Phlebitis

Tucker 60

Question 11

Nursing Considerations

calcium gluconate

Answer 11

Observe IV site closely; monitor EKG

Tucker 60

Question 12

Indications

calcium gluconate

Answer 12

Hypocalcemia
Hyperkalemia, magnesium toxicity

Tucker 60

Question 13

MOA/Class

sodium polystyrene sulfonate (Kayexalate)

Answer 13

Exchanges sodium for potassium in the intestine

cationic exchange resin

Question 14

Side Effects

sodium polystyrene sulfonate (Kayexalate)

Answer 14

hypokalemia, constipation, fecal impaction, intestinal necrosis

Question 15

Nursing Considerations

sodium polystyrene sulfonate (Kayexalate)

Answer 15

Not to be used in emergent situations due to delayed therapeutic effects
Given PO or via enema

Question 16

Indications

sodium polystyrene sulfonate (Kayexalate)

Answer 16

Hyperkalemia

Question 17

MOA/Class

patiromer (Veltassa)

Answer 17

Increases fecal excretion of potassium by binding to potassium in the GI tract

Question 18

Side Effects

patiromer (Veltassa)

Answer 18

Hypokalemia, diarrhea

Question 19

Nursing Considerations

patiromer (Veltassa)

Answer 19

Not to be used in emergent situations due to delayed therapeutic effects

Question 20

Indications

patiromer (Veltassa)

Answer 20

hyperkalemia

Question 21

MOA/Class

lisinopril, enalapril, captopril, etc.

Answer 21

Prevents conversion of angiotensin 1 to angiotensin 2 (causing vasodilation)

Angiotensin-Converting Enzyme (ACE) Inhibitor

Tucker 43

Question 22

Side Effects

lisinopril, enalapril, captopril, etc.

Answer 22

Dry cough
Hyperkalemia
First-dose hypotension, orthostatic hypotension
Angioedema

Tucker 43

Question 23

Nursing Considerations

lisinopril, enalapril, captopril, etc.

Answer 23

• NSAIDs may decrease therapeutic effect and contribute to kidney injury
• Monitor other medications that strongly depend on fluid/electrolyte balance (digoxin, lithium, etc.)
• Avoid potassium supplements
• Note: While ACE inhibitors have some effect on all portions of the cardiac system (“pump, pipes, and volume”), they are most effective on the “pipes” portion.

Tucker 43

Question 24

Indications

lisinopril, enalapril, captopril, etc.

Answer 24

Hypertension; Decrease cardiac workload; Prevent/limit ventricular remodeling

Tucker 43

Question 25

# MOA/Class losartan, valsartan, etc.

Answer 25

Blocks the binding of A2 to receptors | Angiotensin II Receptor Blocker (ARB) ## Footnote Tucker 43

Question 26

# Side Effects losartan, valsartan, etc.

Answer 26

Hypotension Hyperkalemia (less common than ACEIs, but still need to monitor) Less dry cough than ACEIs ## Footnote Tucker 43

Question 27

# Nursing Considerations losartan, valsartan, etc.

Answer 27

Avoid potassium supplements Like ACEIs, most important to monitor BP ## Footnote Tucker 43

Question 28

# Indications losartan, valsartan, etc.

Answer 28

Hypertension; Decrease cardiac workload; Prevent/limit ventricular remodeling ## Footnote Tucker 43

Question 29

# MOA/Class calcium acetate; calcium carbonate (Tums)

Answer 29

Neutralize stomach acid Control of hypophosphatemia (binds to phosphate within the GI tract for elimination) | Antacid/phosphate binder ## Footnote Tucker 60

Question 30

# Side Effects calcium acetate; calcium carbonate (Tums)

Answer 30

Constipation ## Footnote Tucker 60

Question 31

# Nursing Considerations calcium acetate; calcium carbonate (Tums)

Answer 31

Take with meals when used as a phosphate binder; monitor calcium and phosphate levels. ## Footnote Tucker 60

Question 32

# Indications calcium acetate; calcium carbonate (Tums)

Answer 32

Acid reflux, hyperphosphatemia ## Footnote Tucker 60

Question 33

# MOA/Class sevelamer

Answer 33

Increases fecal excretion of phosphate by binding to phosphate in the GI tract | Phosphate binder

Question 34

# Side Effects sevelamer

Answer 34

Diarrhea, vomiting

Question 35

# Nursing Considerations sevelamer

Answer 35

Used when calcium-based phosphate binders cannot be used. Take with meals. May not be taken with other medications as will impair absorption of those medications

Question 36

# Indications sevelamer

Answer 36

Hyperphosphatemia

Question 37

# MOA/Class cholecalciferol, calcitriol

Answer 37

Required for calcium absorption from the GI tract Inactive form may be used when patient has some activating function left Active form required if kidney can no longer activate vitamin D cholecalciferol (Inactive form) calcitriol (Active form) | Vitamin D analog ## Footnote Tucker 37

Question 38

# Side Effects cholecalciferol, calcitriol

Answer 38

No significant concerns ## Footnote Tucker 37

Question 39

# Nursing Considerations cholecalciferol, calcitriol

Answer 39

Ensure adequate intake of calcium through diet or supplement ## Footnote Tucker 37

Question 40

# Indications cholecalciferol, calcitriol

Answer 40

Hypocalcemia ## Footnote Tucker 37

Question 41

# MOA/Class cinacalcet

Answer 41

Increases sensitivity of calcium-sensing receptors in the parathyroid gland - Increase sensitivity decreases release of PTH in the presence of hypocalcemia - Decreased release of PTH decreases bone degeneration in CKD-MBD | Calcimimetic agent ## Footnote Tucker 37

Question 42

# Side Effects cinacalcet

Answer 42

Nausea/vomiting Dysrhythmias, prolonged QT interval ## Footnote Tucker 37

Question 43

# Nursing Considerations cinacalcet

Answer 43

Monitor calcium levels and EKG ## Footnote Tucker 37

Question 44

# Indications cinacalcet

Answer 44

Secondary hyperparathyroidism (often due to CKD) ## Footnote Tucker 37

Question 45

# MOA/Class epoetin alfa; darbapoetin alfa

Answer 45

Mimics effects of erythropoietin to stimulate bone marrow production of RBCs | Erythropoiesis Stimulating Agents ## Footnote Tucker 49

Question 46

# Side Effects epoetin alfa; darbapoetin alfa

Answer 46

Hypertension, thromboembolism, rash ## Footnote Tucker 49

Question 47

# Nursing Considerations epoetin alfa; darbapoetin alfa

Answer 47

Contraindicated when Hgb level >10 g/dL or with uncontrolled HTN May require increased intake/supplement iron and/or folic acid ## Footnote Tucker 49

Question 48

# Indications epoetin alfa; darbapoetin alfa

Answer 48

anemia ## Footnote Tucker 49

Question 49

# MOA/Class Ferrous fumarate, ferrous sulfate (PO) Iron dextran, ferrous gluconate, iron sucrose (IV or IM)

Answer 49

Required for RBC production | Supplement ## Footnote Tucker 49

Question 50

# Side Effects Ferrous fumarate, ferrous sulfate (PO) Iron dextran, ferrous gluconate, iron sucrose (IV or IM)

Answer 50

Dark stool; constipation ## Footnote Tucker 49

Question 51

# Nursing Considerations Ferrous fumarate, ferrous sulfate (PO) Iron dextran, ferrous gluconate, iron sucrose (IV or IM)

Answer 51

PO absorbed best with vitamin C; avoid giving with calcium products (causes decreased absorption) Ingest PO liquid formulations with straw to prevent staining of teeth Remain upright for 30 minutes after injection to prevent heartburn IM given Z-track Food sources: red meats, legumes, dark leafy green vegetables, whole-grain and enriched breads and cereals, beans ## Footnote Tucker 49

Question 52

# Indications Ferrous fumarate, ferrous sulfate (PO) Iron dextran, ferrous gluconate, iron sucrose (IV or IM)

Answer 52

iron deficiency ## Footnote Tucker 49

Question 53

# MOA/Class atorvastatin, simvastatin, rosuvastatin

Answer 53

Decreased cholesterol production by the liver | HMG-Co-Enzyme A (HMG-CoA) Reductase Inhibitor (Statin) ## Footnote Tucker 47

Question 54

# Side Effects atorvastatin, simvastatin, rosuvastatin

Answer 54

Hepatotoxicity, myopathy/rhabdomyolysis, GI upset ## Footnote Tucker 47

Question 55

# Nursing Considerations atorvastatin, simvastatin, rosuvastatin

Answer 55

Avoid grapefruit juice Monitor LFTs May be most effective when taken at bedtime ## Footnote Tucker 47

Question 56

# Indications atorvastatin, simvastatin, rosuvastatin

Answer 56

Hypercholesterolemia (may be part of stroke or MI prophyaxis regimen) ## Footnote Tucker 47

Question 57

# MOA/Class fenofibrate, gemfibrozil

Answer 57

Inhibits synthesis of triglycerides in the liver. Activates enzymes responsible for breaking down cholesterol. | Fibrate/Fibric acid derivative ## Footnote Tucker 47

Question 58

# Side Effects fenofibrate, gemfibrozil

Answer 58

GI upset, rash, increased PT, hepatotoxicity, myalgia/rhabdomyolysis ## Footnote Tucker 47

Question 59

# Nursing Considerations fenofibrate, gemfibrozil

Answer 59

May increase bleeding risk when used with anticoagulants ## Footnote Tucker 47

Question 60

# Indications fenofibrate, gemfibrozil

Answer 60

Hypercholesterolemia ## Footnote Tucker 47