Monitoring Drug Therapy (not finished)

Question 1

What does Urea and Electrolyte levels indicate? (4)

Answer 1

• Renal function
• Hydration status
• Assess disease status
• Identify possible ADRs

Question 2

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

Answer 2

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

Question 3

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

Answer 3

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

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

Question 4

a) Sodium levels are mainly regulated by what system?

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

Answer 4

a) Renin-angiotensin-aldosterone system (RAAS)

b) Water loss/imbalance

Question 5

How can Sodium imbalance effect blood pressure?

Answer 5

Too much (from diet)- hypertension
Too little- Hypotension

Question 6

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?

Answer 6

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

BONUS: Angiotensin 2 increases blood pressure by vasoconstriction

Question 7

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

Answer 7

• 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

Question 8

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

Answer 8

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

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

Question 9

Causes of Hyponatraemia Na+

Answer 9

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

Question 10

Name some disease states that cause sodium depletion (9)

some aren’t even diseases!

Answer 10

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

Question 11

Name 4 drugs that cause sodium depletion

Answer 11

Diuretics, Carbamazepine, ACEi, SSRI’s

Question 12

Hyponatraemia symptoms (9)

Answer 12

Nausea
Vomitting
Headache
Postural Hypotension
Cramps
Fatigue
Circulatory failure
Confusion
Convulsion

Question 13

Treatment of Hyponatraemia (5)

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

Treatment depends on cause

Answer 13

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)

Question 14

Potassium are mainly found intracellular and the main source is dietary

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

Answer 14

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

Question 15

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

Answer 15

• 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

Question 16

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

Answer 16

• Arrhythmia
• Tachycardia
• Ventricular Fibrillation
• Asystole

Question 17

Hyperkalaemia treatment (5):

Answer 17

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

Question 18

Hypokalaemia causes

Answer 18

• 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

Question 19

Drugs that can cause Hypokalaemia (7)

Answer 19

Diuretics
Gentamycin
Theophylline
Salbutamol
Corticosteroids
Caspofungin
Amphotericin

Question 20

Hypokalaemia symptoms

Answer 20

• Muscular weakness
• Tetany
• Respiratory failure
• Paralysis
• Arrhythmias
• Sudden death

Question 21

Hypokalaemia treatment (3)

hint, one is a fruit!

Answer 21

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

Question 22

Name 3 hormones that regulate calcium homeostasis

Answer 22

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)

Question 23

Calcium is affected by albumin concentration, TRUE OR FALSE?

Answer 23

TRUE

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

Question 24

Hypercalcaemia causes (5)

Answer 24

• Malignancies
• Hyperparathyroidism
• Dehydration
• Bone diseases
• Drugs

Question 25

Drugs that case Hypercalcaemia (7)

Answer 25

``` Antacids Calcium salts Thiazides Androgens Levothyroxine Lithium Excess Vit D ```

Question 26

Hypercalcaemia symptoms (10) | hint: GI, mental are some

Answer 26

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

Question 27

Hypercalcaemia treatment (4):

Answer 27

- Discontinue drugs promoting hypercalcaemia & correct hydration - Bisphosphonates - Steroids - Cinacalcet (renal dialysis patients w. parathyroid dysfunction)

Question 28

Hypocalcaemia causes (5): | typically asymptomatic

Answer 28

- Hypoparathyroidism - Malnutrition - Renal failure - Inadequate Vit D production/action - Drugs (loops, bisphosphonates)

Question 29

Hypocalcaemia treatment (1)

Answer 29

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

Question 30

Hyperphosphataemia

Answer 30

Inadequate intake: - Malnourished patients - Interference w. absorption (eg antacids, crohns) Excessive loss: - diuresis, dialysis, alcoholism Redistribution

Question 31

a) Hypophosphataemia treatment (2) | b) During treatment, It is important to check electrolytes levels but, which two specifically?

Answer 31

a) oral phosphates; IV phosphates | b) monitor all but calcium and potassium can be affected