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PM2D > Monitoring Drug Therapy (not finished) > Flashcards

Monitoring Drug Therapy (not finished) Flashcards

1
Q

What does Urea and Electrolyte levels indicate? (4)

A
  • Renal function
  • Hydration status
  • Assess disease status
  • Identify possible ADRs
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2
Q

Give the concentration values of Hypo- and Hyper- (in mmol/L) levels of:
Sodium
Potassium
Calcium

A

Sodium:
Hypo: under 133 mmol/L
Hyper: over 146 mmol/L

Potassium:
Hypo under 3.5 mmol/L
Hyper: over 5.3 mmol/L

Calcium:
Hypo: under 2.12 mmol/L
Hyper: iver 2.65 mmol/L

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3
Q

Give the concentration values of Hypo- and Hyper- (in mmol/L) levels of:
Phosphate
Magnesium

A

Phosphate
Hypo: under 0.8mmol/L
Hyper: over 1.4 mmol/L

Magnesium
Hypo: under 0.7 mmol/L
Hyper: over 1 mmol/L

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4
Q

a) Sodium levels are mainly regulated by what system?

b) What does abnormal sodium levels reflect?
clue, water loss/imbalance or sodium loss/gain

A

a) Renin-angiotensin-aldosterone system (RAAS)

b) Water loss/imbalance

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5
Q

How can Sodium imbalance effect blood pressure?

A 
Too much (from diet)- hypertension
Too little- Hypotension
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6
Q

a) What effect does the increase of Aldosterone have on the distal tubules?
b) What effect does that have on blood pressure?

BONUS: what else in the RAAS has an effect on blood pressure and in what way?

A

a) Increases the reabsorption of water and sodium in distal
b) Increases blood pressure

BONUS: Angiotensin 2 increases blood pressure by vasoconstriction

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7
Q

Causes of Hypernatraemia (Na+ >146mmol/L) (5)

A
  • Insufficient fluid intake
  • Excessive water loss
  • Sodium retention (or too much sodium from diet)
  • Excess adrenocorticoid hormones eg aldosterone (eg. cushing syndrome)
  • Drugs eg. corticosteroids, NSAIDs, Lithium toxicity
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8
Q

Consequences (1) and side effects (6) of Hypernatraemia

A
  • CNS changes from lethargy to deep coma
  • Depends on level but >170mmol/L life threatening

Symptoms: tachycardia, fever, hypertension, dizziness, increased thirst, oedema

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9
Q

Causes of Hyponatraemia Na+

A

1) Sodium depletion from various disease states
2) Water retention: eg. SIADH
3) Pharmacological drugs: Diuretics, Carbamazepine, SSRI’s, ACEi

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10
Q

Name some disease states that cause sodium depletion (9)

some aren’t even diseases!

A 
loss from burns
severe exudative skin lesions
excessive sweating
Haemodilution (caused by cardiac/renal/hepatic failure)
vomitting and diarrhoea
infection
Aspiration
Carcinoma
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11
Q

Name 4 drugs that cause sodium depletion

A

Diuretics, Carbamazepine, ACEi, SSRI’s

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12
Q

Hyponatraemia symptoms (9)

A 
Nausea
Vomitting
Headache
Postural Hypotension
Cramps
Fatigue
Circulatory failure
Confusion
Convulsion
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13
Q

Treatment of Hyponatraemia (5)

HINT: what are the types of hyponatraemia along with their treatments)

Treatment depends on cause

A

HYPOVOLAEMIC HYPONATRAEMIA (low bv): Replacement with IV NaCl 0.9%

EUVOLAEMIC HYPONATRAEMIA (norm bv): Treat immediate cause, if not feasible, water restriction

(symptomatic: hypotonic (3%) saline infusion)

HYPERVOLAEMIC HYPONATRAEMIA (high bv): fluid restriction , diuretics, sodium restriction

CHRONIC CONDITIONS w. Mild/Moderate sodium depletion: oral supplements

(Avoid rapid correction- osmosis)

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14
Q

Potassium are mainly found intracellular and the main source is dietary

What are the mains functions of potassium in our body? (4)

A
  • Maintains muscle contractility eg. cardiac muscle
  • Maintains fluid balance
  • Maintains nerve impulse function
  • Maintains muscle function
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15
Q

Hyperkalaemia (>5.3mmol/L) causes (9)

A
  • Renal failure
  • Redistribution of K+ between ICF and ECF
  • Metabolic acidosis
  • K+ sparing diuretics
  • K+ supplements
  • ACEi, Angiotensin 2 receptor blockers, NSAID’s
  • Heparin
  • BB’s (non-selective)
  • Trimethoprim
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16
Q

Hyperkalaemia causes cardiac toxicity at >6mmol/L, what 4 cardiac problems can they cause?

A
  • Arrhythmia
  • Tachycardia
  • Ventricular Fibrillation
  • Asystole
17
Q

Hyperkalaemia treatment (5):

A

Non-emergency treatment:

  • Stop medication causing it
  • Restrict potassium intake

Emergency treatment: (ECG changes/ >6.5mmol/L)

  • IV calcium gluconate 10%
  • Insulin + glucose infusion
  • Ion exchange resin eg. calcium resonium
18
Q

Hypokalaemia causes

A
  • Inadequate intake
  • Loss from GI secretions (diarrhoea and vom)
  • Redistribution between ECF and ICF
  • Mineralcorticoid excess (eg. hyperaldosteronism)
  • Renal losses in renal tubular failure
  • Anaemia
  • Drugs
19
Q

Drugs that can cause Hypokalaemia (7)

A 
Diuretics
Gentamycin
Theophylline
Salbutamol
Corticosteroids
Caspofungin
Amphotericin
20
Q

Hypokalaemia symptoms

A
  • Muscular weakness
  • Tetany
  • Respiratory failure
  • Paralysis
  • Arrhythmias
  • Sudden death
21
Q

Hypokalaemia treatment (3)

hint, one is a fruit!

A
  • Potassium effervescent tab
  • IV potassium (usually mixed w. glucose or NaCl) at 20-40mmol/L
  • Bananas
22
Q

Name 3 hormones that regulate calcium homeostasis

A 
Parathyroid hormone (PTH)
Vit D metabolites (Calcifedol + Calcitriol)
Calcitonin

(PTH- stimulate Ca release from bones and uptake from kidneys) -increases
(Vit D -activated by kidneys- increases Ca uptake in intestines) -increases
(calcitonin decreases)

23
Q

Calcium is affected by albumin concentration, TRUE OR FALSE?

A

TRUE

  • 40-50% is bound to plasma proteins
  • Only FREE Calcium is active
  • Ca level must be adjusted based on albumin levels
24
Q

Hypercalcaemia causes (5)

A
  • Malignancies
  • Hyperparathyroidism
  • Dehydration
  • Bone diseases
  • Drugs
25
Q

Drugs that case Hypercalcaemia (7)

A 
Antacids
Calcium salts
Thiazides
Androgens
Levothyroxine
Lithium
Excess Vit D
26
Q

Hypercalcaemia symptoms (10)

hint: GI, mental are some

A 
GI disturbances: anorexia, nausea + vom, constipation
Mental: fatigue, depression, psychosis
Headaches
generalised muscle weakness
Polyuria and increased thirst
27
Q

Hypercalcaemia treatment (4):

A
  • Discontinue drugs promoting hypercalcaemia & correct hydration
  • Bisphosphonates
  • Steroids
  • Cinacalcet (renal dialysis patients w. parathyroid dysfunction)
28
Q

Hypocalcaemia causes (5):

typically asymptomatic

A
  • Hypoparathyroidism
  • Malnutrition
  • Renal failure
  • Inadequate Vit D production/action
  • Drugs (loops, bisphosphonates)
29
Q

Hypocalcaemia treatment (1)

A

Calcium Gluconate 10% (10-20ml) as slow bolus

30
Q

Hyperphosphataemia

A

Inadequate intake:

  • Malnourished patients
  • Interference w. absorption (eg antacids, crohns)

Excessive loss:
- diuresis, dialysis, alcoholism

Redistribution

31
Q

a) Hypophosphataemia treatment (2)

b) During treatment, It is important to check electrolytes levels but, which two specifically?

A

a) oral phosphates; IV phosphates

b) monitor all but calcium and potassium can be affected

PM2D (20 decks)

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