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Renal Exam 2 > Pharmacotherapy of AKI > Flashcards

Pharmacotherapy of AKI Flashcards

1
Q

Define anuria

A

Less than 100 mL/d

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2
Q

Define oliguria

A

100-400 mL/d

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3
Q

Define non-oliguria

A

> 400 mL/d

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4
Q

Goals of therapy are

A 
Prevention of AKI
Avoid or minimize renal insults
Survive the acute insult
Provide supportive measures
Regain life-sustaining renal function
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5
Q

High risk patients are:

A 
preexisting renal prob
CHF
Cirrhosis
DM
Advancing age
Dehydration
Nephrotoxic drugs
IV contrast dye
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6
Q

Nephrotoxic agents include

A

AG, amp B, cisplatin

IV contrast

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7
Q

Agents that have impact on renal blood flow:

A

NSAIDs
ACE-i
cyclosporine
tacrolimus

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8
Q

Benefits of volume expansion

A

Maintain renal perfusion
Flush out toxins
Decreased RAAS activation
Minimize the decreases in NO and prostacycline (dilators)

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9
Q

Goal of therapy of volume expansion

A

> 150 mL/hr

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10
Q

In a patient who is critically ill what volume expansion would you use:

A

isotonic crystalloids

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11
Q

Volume expansion for contrast dye administration

A

NS (0.9% NaCl)

Sodium bicarbonate

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12
Q

NS dose

A

1.0-1.5 mL/kg/hr for 3-12 hours before and 6-12 hours after

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13
Q

Sodium bicarbonate

A

3 mL/kg/hr for 1 hour prior to dye administration, then 1 mL/kg/hr for 6 hours after

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14
Q

Aminoglycosides

A

Use only when necessary
QD dosing in appropriate pts
Monitor levels and adjust accordingly

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15
Q

Amp B

A

Use only when necessary

Lipid formulation preferred

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16
Q

N-acetylcystein (Mucomyst) oral

A

Adjunct to isotonic crystalloids
Inexpensive, few side effects, well tolerated
MOA: scavengers free oxygen radicals

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17
Q

N-acetylcystein (Mucomyst) oral dose

A

600-1200 mg BID before and after contrast

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18
Q

Drugs that are not recommended

A

Theophylline
Ascorbic Acid
Statins
Fenoldopam

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19
Q

Define oliguria

A

100-400 mL/d

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20
Q

Define non-oliguria

A

> 400 mL/d

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21
Q

Goals of therapy are

A 
Prevention of AKI
Avoid or minimize renal insults
Survive the acute insult
Provide supportive measures
Regain life-sustaining renal function
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

High risk patients are:

A 
preexisting renal prob
CHF
Cirrhosis
DM
Advancing age
Dehydration
Nephrotoxic drugs
IV contrast dye
23
Q

Nephrotoxic agents include

A

AG, amp B, cisplatin

IV contrast

24
Q

Benefits of volume expansion

A

Maintain renal perfusion
Flush out toxins
Decreased RAAS activation
Minimize the decreases in NO and prostacycline (dilators)

25
Q

Goal of therapy of volume expansion

A

> 150 mL/hr

26
Q

In a patient who is critically ill what volume expansion would you use:

A

isotonic crystalloids

27
Q

Volume expansion for contrast dye administration

A

NS (0.9% NaCl)

Sodium bicarbonate

28
Q

NS dose

A

1.0-1.5 mL/kg/hr for 3-12 hours before and 6-12 hours after

29
Q

Sodium bicarbonate

A

3 mL/kg/hr for 1 hour prior to dye administration, then 1 mL/kg/hr for 6 hours after

30
Q

Aminoglycosides

A

Use only when necessary
QD dosing in appropriate pts
Monitor levels and adjust accordingly

31
Q

Amp B

A

Use only when necessary

Lipid formulation preferred

32
Q

N-acetylcystein (Mucomyst) oral

A

Adjunct to isotonic crystalloids
Inexpensive, few side effects, well tolerated
MOA: scavengers free oxygen radicals

33
Q

N-acetylcystein (Mucomyst) oral dose

A

600-1200 mg BID before and after contrast

34
Q

Drugs that are not recommended:

A 
Theophylline
Ascorbic Acid
Statins 
Fenoldopam
Dopamine
Diuretics
35
Q

Goals of therapy for AKI

A

Remove offending agent
Treat underlying cause
Limit exposure to subsequent nephrotoxic events
Speed up recovery of renal function

36
Q

Treatment of Postrenal AKI

A

Removal of obstruction
Electrolyte management
Fluid management

37
Q

Treatment of Prerenal, intrinsic AKI

A 
Electrolyte management (Na/K)
Maintain blood pressure and CO
Carefully anuric and oliguric
38
Q

Treatment of Prerenal, intrinsic AKI

A 
Electrolyte management (Na/K)
Maintain blood pressure and CO
Carefully anuric and oliguric
39
Q

Hypovolemic Treatment

A

250-500 mL over 15-20 minutes, then reassess

40
Q

Hypervolemic treatment

A

Reduce IV fluids to keep vein open

Concentration of IV meds and tube feeds

41
Q

Diuretics

A

Reserved for hypervolemic patients who make adequate urine in response to diuretics

42
Q

What are the loop diuretics

A

Furosemide (lasix)
Torsemide (demadex)
Bumetanide (bumex)
Ethacrynic acid (edecrin)

43
Q

Furosemide dose

A

40-80 mg IV/PO, increase 20-40 mg/dose Q6-8 hrs

44
Q

Torsemide dose

A

10-20 mg IV/PO, double dose Q2 hours if necessary

45
Q

Torsemide dose

A

10-20 mg IV/PO, double dose Q2 hours if necessary

46
Q

Loop diuretic resistance MOA

A

They increase delivery of sodium to distal tubule and collecting ducts and in time the kidney gets used to this and increases the reabsorption there

47
Q

Causes of diuretic resistance

A 
Excessive sodium intake 
Inadequate dose or drug regimen
Reduced bioavailability
Nephrotic syndrome
Reduced renal blood flow
Increased Na reabsorption
48
Q

Thiazides work where?

A

Distal convoluted tubule

49
Q

Where do loops work?

A

Thick ascending limb

50
Q

Metolazone (zaroxoxlyn) is good when

A

CrCl is

51
Q

Renal Replacement Therapy

A 
Acid-base abnormalities
Electrolyte imbalance
Intoxication
Fluid overload
Uremia
52
Q

Pre-renal cause

A

Decreased blood flow to the kidney or issue getting blood to the kidney

53
Q

Intrinsic cause

A

damage to the kidney itself

54
Q

Postrenal cause

A

obstruction that keeps blood from flowing from the kidney

Renal Exam 2 (10 decks)

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