Pharmacology

Question 1

What adjustments must be made in insulin doses for patients with stage 3, 4 and 5 CKD?

Answer 1

Stages 3 & 4 = 25% reduction, Stage 5 = 50% reduction

Question 2

What three functions determine the kidney’s ability to excrete drugs?

Answer 2

The combination of GFR, Tubular Secretion, and Tubular Reabsorption.

Question 3

What physiologic mediators or drugs dilate the afferent arterioles?

Answer 3

NO, PGE2/PGI2, Dopamine, Caffeine (adenosine antagonist)

Question 4

What physiologic mediators or drugs constrict the afferent arterioles?

Answer 4

Ang II, Norepinephrine, Adenosine, NSAIDs (dec PGE2/PGI2)

Question 5

What physiologic mediators or drugs constrict the efferent arterioles?

Answer 5

Ang II, Norepinephrine

Question 6

What physiologic mediators or drugs dilate the efferent arteriole?

Answer 6

ACE-i and ARBs (via dec Ang II)

Question 7

What oral or injected diabetes treatments must be adjusted in stage 3/4 CKD, and why?

Answer 7

Oral: Glyburide (half life prolonged) Metformin (Use NOT recommended with Scr > 1.5) Insulin (Half-life prolonged)

Question 8

What three hypertension treatments must be modified in stage 3/4 CKD?

Answer 8

Diuretics, ACEi/ARBs, Betablockers

Question 9

What sort of changes must be made to diuretics in patients with stage 3/4 CKD?

Answer 9

Thiazides may lose effectiveness and should be coupled with loop diuretics, Potassium sparing diuretics must be avoided.

Question 10

What must be monitored in patients with CKD and taking ACEi/ARBs?

Answer 10

Patients should be monitored for hyperkalemia and elevated Scr, May cause Acute Renal Failure in hypovolemic patients

Question 11

What are three major, systemic side effects of CKD?

Answer 11

Anemia, Renal-osteodystrophy, and Hyperkalemia

Question 12

How is anemia from CKD treated?

Answer 12

Anemia can be treated with Epoetin or Darbepoetin (EPO replacements) or iron supplements