Pharmacology - Renal Failure

Question 1

*name of active vitamin D3

Answer 1

1,25-dihydroxyCHOLECALCIFEROL

Question 2

define CKD

Answer 2

structural/functional damage of the kidney or eGFR less than 60 for 3 or more months

Question 3

define end stage renal disease

Answer 3

CKD which needs dialysis or kidney transplant to sustain life

Question 4

**he will ask about acute vs chronic.
differentiate between the underlying cause of each

Answer 4

acute – hypoperfusion of the kidneys, heart failure, arrythmias, hemorrhage, dehydration

chronic – usually the pt has a history of diabetes or HBP

Question 5

***true or false

nephrotoxic drugs may result in acute or chronic renal failure

Answer 5

true

Question 6

differentiate between tubular dysfunction and GFR dysfunction in terms of phosphate and potassium levels

Answer 6

tubular - hypokalemia and hypophosphatemia

GFR dysfunction - hyperkalemia and hyperphosphatemia (bc doesnt filter – goes back to blood!)

Question 7

true or false

GFR dysfunction of the kidney can cause acidosis

Answer 7

trure

Question 7

is BUN/creatinine ratio higher in tubular dysfunction or GFR dysfunction?

Answer 7

GFR

Question 8

hyperparathyroidism can be caused by…

Answer 8

hypocalcemia

Question 9

how can renal dysfunction cause anemia

Answer 9

due to lack of erythropoietin production (stimulates bone marrow to produce RBC)

Question 10

*****4 examples of osmotic diuretics

Answer 10

mannitol
sorbitol
isosorbitol
urea

Question 11

what are osmotic diuretics?

Answer 11

low MW, hydrophilic compounds

they are poorly reabsorbed in the renal tubule – promote a diuretic effect by producing a hypertonic solution

Question 12

**what is used to reverse metabolic acidosis

Answer 12

sodium bicarbonate

Question 13

2 ADRs of sodium bicarbonate

Answer 13

cerebral hemorrhage
pulmonary edema

Question 14

bad effects of hyperkalemia

Answer 14

affects heart rate - can cause cardiac arrest

Question 15

name 6 things that can be used for hyperkalemia

which is an exchange resin?

Answer 15

calcium salts IV
sodium bicarb
dextrose-insulin
albuterol nebulizer
furosemide
sodium polystyrene sulfonate - exchange resin

Question 16

**which drug can be used to lower potassium?? how does it do this??

Answer 16

KAYEXALATE!!!!!!! (sodium polystyrene sulfonate)

sequesters potassium in the GI tract – binds potassium and releases it in the feces

Question 17

counseling point for a patient taking kayexalate (sodium polystyrene sulfonate)

Answer 17

take with food! to sequester the potassium and excrete in feces

Question 18

2 foods high in phosphorus

Answer 18

peanuts
cheese

Question 19

**name 2 phosphate binding agents that can be used to treat hyperphosphatemia

Answer 19

sevelamer (renagel)

lanthanum (fosrenol)

Question 20

**explain how sevelamer works to treat hyperphosphatemia

Answer 20

it is a non-absorbable polymer

contains amines – which bind phosphate in the GI tract WITHOUT AFFECTING CALCIUM!

Question 21

*explain how lanthanum works to decrease phosphate levels

Answer 21

binds dietary phosphate from food – forms an insoluble comples that gets excreted

Question 22

why are aluminum hydroxide products no longer used as phosphate binders for hyperphosphatemia

Answer 22

danger of systemic aluminum absorption

Question 23

name another phosphate binder

Answer 23

magnesium hydroxide/carbonate

(magnesium hydroxide = milk of magnesia)

Question 24

***name 2 erythropoietin stimulating agents what do they do?

Answer 24

erythropoietin and darbepoietin produce RBC -- used to treat anemia

Question 25

what is desmopressin and how does it work

Answer 25

a vasopressin analog increases cAMP in tubular cells -- resulting in the retention of water in the body used to control bleeding

Question 26

name 2 membrane stabilizing ions (they are like ___) name 1 membrane stimulating ion (like ____)

Answer 26

membrane stabilizing - potassium and magnesium (like acetylcholine) stimulating - calcium (like NE/epi)

Question 27

what does cinacalcet do

Answer 27

lowers PTH levels in pts with renal failure

Question 28

***which drug can be used to sensitize calcium

Answer 28

cinacalcet

Question 29

name of the hormone that maintains calcium levels

Answer 29

PTH