renal Flashcards
hypokalemia tx
replace K+ deficit
- IV K: KCl, potassium acetate
- Oral K+: KCl, potassium phosphate, potassium bicarb, or potassium citrate or potassium gluconate
hyperkalemia Tx
antagonize cardiac effects
(bradycardia, V.fib, AV block) –> IV calcium
redistribute K+ –> insulin and dextrose; can also give B2-agonist (albuterol) or bicarb (not usually recommended)
facilitate K+ elimination –> K+ losing diuretic (loop- furosemide, torsemide, bumetanide, ethacrynic acid) or thiazide diuretic; mineralcorticoid (if hypoalderosteronism), cation exchange resin, dialysis
monitor K+ intake (<60mEq/day)
Hypernatremia Tx
o If hypovolemic (sodium deficit & water deficit) àisotonic saline
o Euvolemic àhypotonic IV solutions (D5W, half-normal saline, quarter-normal saline)
Other possible tx: loop diuretics
hyponatremia Tx
No or minimal sxs àfluid restriction
Moderate sxs à vaptan or hypertonic NaCl 3% w/ fluid restriction; in seizing pts, raise it 3-4 mEq/L to stop seizure activity and then slowly raise it back to normal
Severe sxs àhypertonic NaCl 3% w/ fluid restriction
nephrogenic diabetes insipidus
if caused by lithium therapy (bipolar disorders)–> Amiloride (K+ sparing diuretic)–> blocks lithium influx into cells
if caused by anything else –> thiazides (K+ losing diuretic)
overcorrection of sodium too fast (ODS- chronic hyponatremia)
D5W (free water), DDAVP (or both), discontinuation of some therapies that are raising sodium
uncomplicated pyelonephritis in healthy pt-
first line: ciprofloxacin (7 days) + levofloxacin (5 days)
second line: TMP-SMX (14 days)
prophylaxis for UTI
first line: Nitrofurantoin
TMP-SMX
*generally, not recommended
acute uncomplicated Cystitis
First-line: MDR (fosfomycin or nitrofurantoin); non-MDR (TMP-SMX, fosfomycin or nitrofurantoin)
second-line: Amox clay, 3rd gen cephalosporin (gram - bacteria), 1st gen cephalosporin
third line: ciprofloxacin
levofloxacin
acute COMPLICATED UTI w/ critical illness waranting intensive care- Tx
imipenem, meropenem, or doripenem, PLUS -vancomycin, daptomycin, or linezolid
cystitis (penicillin-sensitive enterococci)
amoxicillin (or IV amox); PO doxycycline, linezolid, fosfomycin, or chloramphenicol
cystitis (penicillin-resistant enterococci or B-Lactam intolerance)
nitrofurantoin
doxycycline
linezolid
choramphenicol
*same as VRE cystitis minus daptomycin
cystitis (VRE)
nitrofurantoin doxycycline linezolid daptomycin chloramphenicol
candida UTI- Tx
fluconazole
catheter-assoc. UTI- only Tx if symptomatic
remove catheter and tx acute cystitis
licorice effects
glycyrrhizic acid potentiates aldosterone effect in kidneys –> dose dependent increase in systolic BP
what is the only K+ losing diuretic without sulfa allergy contraindication?
ethacrynic acid
all other loop and thiazide diuretics have sulfa allergy contraindication
urge incontinence tx
antimuscarinics, intravaginal estrogen
mirabegron
overflow incontenence tx
alpha adrenergic antagonists
