[PHARMA] CKD

Question 1

stage 1 CKD

Answer 1

kidney damage w/ normal or increased GFR
<90

Question 2

stage 5 CKD

Answer 2

kidney failure GFR <15 or dialysis indicated

Question 3

aim of TTT

Answer 3

Delay the progression
Treat manifestations
prevent ARF

Question 4

delaying the progression of CKD includes (6)

Answer 4

managing:
1-underlying cause
2-BP
3-Glycemic control
4-Proteinuria
5-Dyslipidemia
6-Subclinical hypothyroidism

Question 5

Stage 1 CKD can be diagnosed by

Answer 5

US
CT
Proteinuria

Question 6

preventing ARF includes

Answer 6

1-avoid dehydration
2-nephrotoxins
3-UTI

Question 7

nephrotoxins include (6)

Answer 7

1-aminoglycosides
2-NSAIDs
3-IV contrast media
4- Amphotericin B
5-Cyclosporine
6-Tacrolimus
Discontinue ACEIs/ARBs

Question 8

target BP

Answer 8

<140/90

Question 9

which bp is more important to control

Answer 9

Systolic BP

Question 10

if BP target is not reached then add

Answer 10

loop diuretics ± Non DHP CCBs, BBs, Vasodilators

Question 11

administering anti-HTN TTT at bedtime leads to

Answer 11

decreased CVS risks

Question 12

blood pressure control

Answer 12

ACEIs/ARBs, loop diuretics
if BP target not reached: loop diuretics ± , Non DHP CCBs, BBs, Vasodilators

Question 13

BP control strategy

Answer 13

-ACEIs/ARBs
-measure Creatinine & K+ baseline levels before TTT
-monitor serum Creatinine, K+
-if BP target not reached: loop diuretics ± Non DHP CCBs, BBs, Vasodilators

Question 14

discontinuing ACEIs/ARBs results in

Answer 14

return of renal function to baseline levels

Question 15

glycemic control (7)

Answer 15

1-insulin
2-oral metformin
3-DPP4 inhibitors
4-Glipzide
5-Gliclazide
6-Repaglinide
7-Thiazoldindione

Question 16

oral metformin elimination

Answer 16

renal

Question 17

thiazoldindione eliminiation

Answer 17

hepatic

Question 18

risk of using thiazoldindione

Answer 18

salt & water retention–> EDEMA

Question 19

thiazoldindione CI in

Answer 19

CHF

Question 20

why must oral metformin be avoided/ adjust its dose

Answer 20

renally eliminated–>risk of lactic acidosis

Question 21

proteinuria control (3)

Answer 21

ACEIs/ARBs
Non DHP CCBs
Mineralocorticoid anatgonists

Question 22

if creatinine levels >30% of baseline w/ ACEIS, ARBs

Answer 22

DISCONTINUE

Question 23

all patients w/ proteinuria regardless of BP should receive

Answer 23

ACEIs/ARBs

Question 24

risk of using mineralocorticoid antagonists

Answer 24

Hyperkalemia

Question 25

DOC in diabetic patients w/ proteinuria

Answer 25

Non DHP CCBs

Question 26

Non DHP CCBs mechanism of action in proteinuria control

Answer 26

decrease protein excretion in diabetic patients related to reductions in BP

Question 27

CVS risks management

Answer 27

Statin + Ezetimibe

Question 28

edema management

Answer 28

1-avoid dehydration
2-Loop diuretics
3-Thiazide diuretics

Question 29

A.DOC in treating edema?
B. Why?

Answer 29

Loop diuretics
effective even w/ low GFR

Question 30

why are thiazide diuretics not the DOC in edema treatment

Answer 30

ineffective when used alone in GFR<30

Question 31

diuretic therapy prevents

Answer 31

volume overload

Question 32

anemia mechanism

Answer 32

↑hepcidin= ↓iron availability
↓Erythropoietin
↓RBCs lifespan 70-80d
concomitant blood loss w/ dialysis

Question 33

anemia management

Answer 33

1-ESA: epoetin α, darbepoetin
2-iron supplements
3-Folic acid & Vit B12

Question 34

A. iron supplements preferred route of administration?
B. Why?

Answer 34

parenteral
oral route absorption can be impaired dt gastric mucosal edema

Question 35

ESA adverse effects

Answer 35

HTN
seizures

Question 36

target Hb levels

Answer 36

11-12g/dL

Question 37

Hb levels >13 g/dL can effect

Answer 37

renal functions

Question 38

renal osteodystrophy management (4)

Answer 38

1-Active Vit D: calcitrol, alfacalcidol, paricalcitol
2- Phosphate binders + restrict dietary Phosphate
3-Cinacalcet
4-Parathyroidectomy

Question 39

Cinacalcet lowers PTH by

Answer 39

↑receptor sensitivity to extracellular Ca++
↓PTH

Question 40

dialysis indications (8)

Answer 40

1-severe metabolic acidosis
2-Hyperkalemia
3-intractable volume overload
5-pericarditis, encephalopathy (uremia signs)
6-peripheral neuropathy
7-intractable GIT symptoms
8-asymptomatic adults w/ GFR 5-9

Question 41

drug therapy w/ dialysis (7)

Answer 41

1-erythropoietin
2-iron supplements
3-Phosphorous binders
4-active Vit D
5-Folic acid + B12
6- Vit E
7- antihistamines