Pharm Blessings Flashcards
Are ya ready kids?
aye aye captain
I can’t heaaarrrrr youuuuuuu
(that’s because it’s 11am on saturday and I have hardly even touched renal and I’m just a little bit burnt out by school in general but it’s okay)
oh….. AYE AYE CAPTAIN
some motivation to begin:
What electrolyte imbalance can HCTZ cause?
hypokalemia
If a person isn’t getting enough K in their diet, what GI-related issue can that cause?
dysphagia
What do you give to a person with hypokalemia?
KCl
For someone with hypokalemia and dysphagia, which form of KCl supplementation is best and why?
IV!
Because KCl tablets are the size of Necco wafers
What do people with CKD most often die from?
CVD
in people with CKD, there are 2 protective drugs that we should put almost everyone on. what are they?
ace-i (kidney)
statin (heart)
A person on a statin with hypokalemia is at a greater risk for _____________.
rhabidomylisisisisisisihatethisword
In a person with hypokalemia, which diuretics would be best to use?
amiloride [midamor]
spironolactone [aldactone]
(K-sparing)
Which K-sparing diuretic should you avoid in men?
spironolactone [aldactone]
man b00bs
SPIRONOLACTONE
[aldactone]:
what does this specific drug do for the heart?
prevents remodeleing and fibrosis
When you are trying to treat hyperphosphatemia, what might you unintentionally give a patient?
hypercalcemia
(they go hand-in-hand)
(calcium and phosphate are lovers)
What is the DOC for hyperphosphatemia?
SEVELAMER [Renagel]
What is the MOA of Sevelamer [Renagel]?
- nonhormal regular of mineral homeostasis -
^^^ lol good job paige
try #2: nonhormonal regulator of mineral homeostasis
binds phosphate in the GI tract to prevent absorption and promote excretion
Which OTC drug contributes to HTN?
*drumroll*
Ibuprofen
What do NSAIDS do to
a) Na and Water
b) prostaglandins
c) what is the overall effect
a) retain it
b) inhibit them
c) vasoconstriction
Which beta blocker (atenolol, metoprolol) is MORE excreted through the kidneys, and thus is WORSE in CKD?
atenolol
Does allopurinol need to be adjusted in a patient with CKD?
ya
In a pt with CKD and OA, would you prefer that they be on ibuprofen or acetaminophen and why?
acetaminophen
ibu can increase BP
Can you use aspirin in a patient with gout?
no
(inc uric acid levels)
How do you treat shingles?
How do you treat shingles in a pt with CKD?
Acyclovir
Less Acyclovir
What can you rx to treat the pain of shingles?
lidocaine patches
Unsure as to why all of these Maine men are out walking around in deserts, but regardless, how do you treat severe dehydration?
admit
IVF and electrolytes
If a person is severely dehydrated, will BUN/Cr be high or low?
high
Your patient has edema. What diuretic drug is C/I if she has hearing loss?
furosemide [lasix]
due to ototoxicity
What diuretic would you give to a pt with edema and hearing loss?
torsemide [demadex]
Which diuretic is just as effective PO or IV?
torsemide [demadex]
Where does furosemide [lasix] act in the kidney?
loop of henle
What diuretic do you give to a person with a sulfa allergy?
ethacrynic acid [edecrin]
what is the imaging of choice for renal artery stenosis?
duplex doppler ultrasound
Just pick one.
a) kid stone
b) kidney stone
c) kidney rock
d) kid rock
if you answered anything other than d then you’re not allowed to finish my flash cards.
also
What do you rx for hyperparathyroidism?
(there are 4 drugs)
white - calcitriol [rocaltrol]
blessington - cinacalcet [sensipar]
sevelamer [renagel]
CaCO3 [nephro-calci]
how do you restrict phosphate in your diet?
avoid beans, nuts, seeds, cheese, and dark beverages
What should you think about in a CKD patient when you see decreased Ca or increased phosphate?
secondary parathyroid d/o
what does cinacalcet [sensipar] do to PTH, Ca, and phosphate levels?
decreases both Ca and phospate levels
decreases PTH
what does selevamer [renagel] do to calcium and phosphate levels?
decreases phosphate but leaves Ca the same
which thiazide diuretics don’t lose their effectiveness at an egfr of < 30-40ml/min
metolazone [xaroxolyn]
indapamide [lozol]
What do you give to a pt who has anemia of chronic disease?
epo
What levels do you need to check before prescribing epo and why?
(other than H/H)
serum Fe, B12, folate
need to have adequate levels before rxing epo
Your patient has a BP of 150/100
He is taking HCTZ [microzide] for HTN
his eGFR is 25mL/min
What’s going on/what will you do?
HCTZ is no longer working at such a low eGFR
Switch to indapamide [lozol]
What substance can indapamide [lozol] increase in the body?
uric acid
(watch out for da gout monster)
Sasha/Blessington keeps saying this so
if CC = peripheral edema
what drug should you automatically think to give
metolazone [zaroxolyn]
Which thiazide diuretic do you use with a sulfa allergy?
trick question
none
Patient with HF comes into ER with hypovolemia and dehydration. He’s on a boatload of meds. What do you do?
hold all meds while you replace fluid volume
but it ends up being kind of a weird situation where you’re giving fluids but draining excess fluids at the same time
Your patient has acute gout! (so many gout cases… please go back to MSK where you belong)
He also has CKD.
What drugs are C/I?
How will you treat?
C/I: NSAIDs and Colchicine
Rx: oral prednisone
The dude with gout is taking ASA. Whatcha gonna do about that?
Switch to Clopidogrel [Plavix]
Why can’t you put a CKD pt with gout on allopurinol?
increases the risk for toxic epidermal necrosis
please list 3 drug categories that increase uric acid
thiazides
asa
loop diuretics
what are 2 major renal complications of gout?
nephrolithiasis
chronic urate nephropathy
What level should Hgb be less than to prescribe epo?
Hgb < 10
someone gave a CKD patient (eGFR 35) a CT with contrast and now she has all this swelling in her legs. what’s going on? what do you do?
it’s from the dye
give furosemide [lasix]
What else could you give to the CKD patient with contrast dye to better hydrate the kidneys during this?
isotonic fluids
What does cyclosporin do to the vessels?
systemic and renal vasoconstriction
should you use NSAIDs in chf?
no - blocks dilation
“knock knock”
“who’s there”
“kid”
“kid who”
Which is better, having 1 kidney working at 100% or having two kidneys working at 50%?
well either one would suck.
but having 1 kidney fully functioning is better
even though eGFR will be about the same
what electrolyte abnormality can spironolactone [aldactone] cause?
hyperkalemia
What’s the big risk with hyperkalemia?
cardiac arrhythmias
What is an adjunct K sparing diuretic?
Triamterene [Dyrenium]
What are the reasons that we would put someone with HF on spironolactone [aldactone]
decreases heart fibrosis and remodeling
What is the big side effect of amlodipine?
peripheral edema!
If your pt has decreased or normal serum Ca and high phosphate, which drug should you start with?
CaCO3 [nephro-calci]
What if your pt has decreased serum Ca and you have no information about phosphate, then what’s the DOC?
Calcitriol [rocaltrol]
What if you have elevated serum Ca and elevated serum phosphate? what’s the DOC?
sevelamer [renagel]
as our kidneys don’t function as well, what conversion becomes harder for us?
Vit D –> active Vit D
What does active Vit D do?
helps facilitate absorption of Ca in the gut and bone reabsorption
What is CaCO3 typically used for?
lowering phosphate!
When taking phosphate binding drugs, how much oral calcium can you take?
1500mg
what is the MOA of cinacalcet [sensipar]?
- nonhormonal regulator of mineral homeostasis -
reduces PTH secretion and lowers phosphate
which patients do you usually give cinacalcet [sensipar] to?
dialysis patients
(we really don’t prescribe this drug)
what motivational words should you tell your patients with kidney stones?
“this too shall pass”
someone with low K is on a K supplement and isn’t responding. What levels should you check?
Mg! Probably low
What do you start if someone has hypomagnesemia?
MgCl [slomag]
What’s the MOA of triamterene [dyrenium]
inhibits Na influx in DCT and CCT
Should you prescribe K supplements and K sparing diuretics at the same time?
No
If Calcium Phosphorus Product test is one of the answers, should you pick?
yes and nobody really knows the context
just pick it
Which Ca-P drug is only used in dialysis patients?
cinacalcet
Which Ca-P drug is super expensive?
sevelamer [renagel]
when do you dose adjust allopurinol?
stage 4 and 5 CKD
What is another name for a kidney stone?
a) nephrolithiasis
b) renal calculi
c) urolithiasis
d) a kid rock
answer: d
obviously
here’s a reminder that you are cool (but not as cool as kid rock) as you finish the cards you rated 1-4:
does metolazone lose its effectiveness below a GFR of 20?
no
