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IPCS 4 > Renal > Flashcards

Renal Flashcards

1
Q

A drug that acts on the proximal tubule, has a relatively low efficacy in blocking the reabsorption of Na, but is useful in the treatment of glaucoma, and as a prophylactic to prevent acute mountain sickness:
A. furosemide
B. acetazolamide
C. ethacrynic acid
D. hydrochlorothiazide

A

Acetazolamide

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2
Q

Thiazides can be used to prevent kidney stone primarily by ________.
A. decreasing luminal calcium secretion
B. increasing luminal calcium secretion
C. increasing luminal calcium concentration
D. decreasing luminal calcium concentration

A

decreasing luminal calcium concentration

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3
Q

A decreased concentration of Chloride in the Distal Tubule results in a/an _______________ into the cells.
A. increase in water reabsorption
B. decrease in sodium reabsorption
C. decrease in calcium reabsorption
D. increase in sodium reabsorption

A

decrease in sodium reabsorption

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4
Q

Which of the following is/are potential side effect/s of loop diuretics? (Select all that apply)
A. hearing loss
B. diarrhea
C. arrhythmias
D. bone loss

A

hearing loss
arrhythmias
bone loss

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5
Q

Which is the main reason the thick ascending limb of the Loop of Henle is referred to as the diluting segment?
A. impermeable to water
B. impermeable to sodium
C. permeable to calcium
D. permeable to potassium

A

impermeable to water

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6
Q

Phophorus reabsortion in the _____________________ is regulated by the parathyroid gland.
A. Distal Tubule
B. Collecting Tubule
C. Proximal tubule
D. Macula densa

A

Proximal tubule

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7
Q

A diuretic used for treatment of hypertension & heart failure that can decrease glucose tolerance, produce hypokalemia (in high doses), aggravate gout by interfering with uric acid secretion, and produce a small rise in LDL.
A. mannitol
B. furosemide
C. acetazolamide
D. hydrochlorothiazide

A

hydrochlorothiazide

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8
Q

The Na+-K+ electrochemical gradient facilitates ___________ ____________.
A. glucose reabsorption
B. sodium-glucose co-transport
C. potassium reabsorption
D. water-phosphate co-transport

A

sodium-glucose co-transport

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9
Q

Which of the following best describes the role of atrial natriuretic peptide?
A. Opens sodium channels to increase sodium reabsorption
B. Closes aquaporin channels to decrease water reabsorption
C. Closes sodium channels to decrease sodium reabsorption
D. Opens aquaporin channels to increase water reabsorption

A

Closes sodium channels to decrease sodium reabsorption

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10
Q

One of the most powerful “high ceiling” diuretics that has a short duration of action, inhibits the Na/K/Cl transporter, and can block reabsorption of up to 25% of filtered sodium:
A. methazolamide
B. furosemide
C. acetazolamide
D. hydrochlorothiazide

A

furosemide

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11
Q

The Distal Tubule is a major site for the regulation of _____________ __________.
A. Urinary magnesium
B. Potassium secretion
C. Sodium reabsorption
D. Urinary calcium

A

Urinary calcium

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12
Q

An increase in glomerular afferent arteriole tone can prevent glomerular _____________ from occurring when there is an increased perfusion pressure.
A. Filtration
B. Absorption
C. Membrane Damage
D. Membrane recovery

A

Membrane Damage

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13
Q

Autoregulation is a response to changes in _________________________.
A. Glomerular filtration rate
B. Blood pressure
C. Waste products
D. Perfusion pressure

A

Perfusion pressure

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14
Q

What is the role of prostaglandins when renal perfusion pressure falls?
A. Afferent vasodilation
B. Efferent vasoconstriction
C. Afferent vasoconstriction
D. Efferent vasodilation

A

Afferent vasodilation

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15
Q

What is the role of angiotensin II when renal perfusion falls?
A. efferent vasodilation
B. Efferent vasoconstriction
C. Afferent vasoconstriction
D. Afferent vasodilation

A

Efferent vasoconstriction

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16
Q

Which of the following can be treated with a diuretic?
A. Gitelman’s syndrome
B. Liddle’s syndrome
- C. Bartter’s syndrome
D. Metabolic syndrome

A

Liddle’s syndrome

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17
Q

What is an adverse effect of hypertonic saline? (Fluids 2 handout)
A. Hypokalemia
B. Hyperkalemia
C. Hypochloremia
D. Hyperchloremia

A

Hyperchloremia

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18
Q

The ability of solutes to generate a driving force is ______________________.
A. Osmolar gap
B. Osmolality
C. Tonicity
D. Diffusion

A

Tonicity

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19
Q

Dehydration is best described as which of the following alterations?
A. The size of the ECF increases
B. No change in extracellular fluid volume
C. The size of the ECF decreases
D. Total amount of Na+ decreases in the ECF

A

The size of the ECF decreases

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20
Q

Which is the correct statement about amiloride (MIDAMOR)?
A. It decreases K+ secretion in intercalated cells.
B. It increases H+ secretion in intercalated cells.
C. It decreases Na+ secretion in intercalated cells.
D. It increases K+ reabsorption in principal cells.

A

It decreases K+ secretion in intercalated cells.

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21
Q

A decrease in renal perfusion pressure results in which of the following?
A. decreased aldosterone effect in the collecting tubule
B. decreased prostaglandin release in the efferent arteriole
C. secretion of sodium in the distal tubule
D. increased afferent arteriole vasodilation

A

increased afferent arteriole vasodilation

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22
Q

A 81 yo male presents with confusion and a serum Na+ 164 mEq/L. Correction of Serum Na+ correction to 140 mEq/L occurred within 18 hours. This patient is at risk for _____________.
A. Cerebral edema from sodium Na+ normalization that was too quick
B. Cerebral edema from sodium Na+ normalization that was too slow
C. Cerebral shrinkage from sodium Na+ normalization that was too quick
D. Cerebral shrinkage from sodium Na+ normalization that was too slow

A

Cerebral edema from sodium Na+ normalization that was too quick

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23
Q

A 68 yo M with a past medical history of hypertension takes the following medications: lisinopril 20 mg daily, multi-vitamin and acetaminophen 650 mg three times a day. What potential effects will the ACE-I have on her kidney function?
A. Decreased efferent arteriole vasoconstriction resulting in a reduced GFR
B. Increased afferent arteriole dilation resulting in a reduced GFR
C. Increased efferent arteriole vasoconstriction will be constricted resulting in an increased GFR
D. Decreased afferent arteriole resulting in an increased GFR

A

Decreased efferent arteriole vasoconstriction resulting in a reduced GFR

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24
Q

TBW depletion or dehydration represents a loss of what type of fluid?
A. Hypotonic
B. Hypertonic
C. Isotonic

A

Hypotonic

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25
Q

A patient with central diabetes insipidus was administered desmopressin. Which of the following is the expected response to desmopressin by this patient?
A. increased urine osmolality and decreased urine output
B. decreased urine osmolality and increased urine output
C. decreased urine osmolality and decreased urine output
D. increased urine osmolality and increased urine output

A

increased urine osmolality and decreased urine output

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26
Q
  1. A patient with the following labs likely has _______________________.
    Na 121 Cl 98 BUN 20 BG 89 Mg 1.8
    K 3.3 CO2 21 SCr 1.3 Ca 8.8 Phos 3.0
    Serum Osm 254, Urine Osm 310, UNa 15
    A. hypovolemic, hyponatremia probably from diarrhea
    B. euvolemic hyponatremia primary polydipsia
    C. hypervolemic, hyponatremia probably from nephrotic syndrome
    D. euvolemic hyponatremia primary polydipsia
A

hypervolemic, hyponatremia probably from nephrotic syndrome

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27
Q

A patient with the following labs likely has _______________________.
Na 118 Cl 97 BUN 15 BG 92 Mg 1.9
K 3.4 CO2 22 SCr 0.9 Ca 9.1 Phos 2.6
Serum Osm 246, Urine Osm 84, UNa 14
A. hypovolemic, hyponatremia probably from diarrhea
B. hypervolemic, hyponatremia probably from nephrotic syndrome
C. hypertonic, hyponatremia from diabetic ketoacidosis
D. euvolemic hyponatremia primary polydipsia

A

euvolemic hyponatremia primary polydipsia

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28
Q

38 yo F with nephrogenic diabetes insipidus currently takes DDAVP 20 mcg intranasally twice daily. Her serum Na+ is 151 today and urine output is 6 liters/day. What therapy could be added to her regimen for nephrogenic DI?
A. Carbamazepine
B. Indomethacin
C. Clofibrate
D. Amiloride

A

Indomethacin

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29
Q

Which is a cause of hypervolemic hypernatremia?
A. Osmotic diuresis
B. Primary polydipsia
C. Concentrated tube feedings
D. Post-operative diuresis

A

Concentrated tube feedings

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30
Q

Which of the following is associated with hyponatremia from increased arginine vasopressin sensitivity?
A. Clofibrate
B. Phenelzine
C. Lamotrigine
D. Hydrochlorothiazide

A

Lamotrigine

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31
Q

In which of the following clinical scenarios would water restriction be an appropriate initial therapy?
A. SIADH induced hyponatremia
B. Thiazide diuretic induced hyponatremia
C. Diarrhea induced hyponatremia
D. Pseudohyponatremia

A

SIADH induced hyponatremia

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32
Q

Fill in the blank: Sodium correction should be administered to increase the serum sodium no more than _______mEq/L over the first ________ hours. Illustrate the common usage and potential side effects associated with administration of intravenous fluids.
A. 8, 36
B. 10, 24
C. 6, 36
D. 8, 24

A

8, 24

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33
Q

AA is a 26 yom who takes lithium 1,200 mg daily presents to clinic with a serum sodium concentration of 150 mEq/L and complaints of excessive urination over the previous few days. The patient’s psychiatrist recommends continuing the lithium due to the patient’s treatment-resistant bipolar disorder. Which of the following is the most appropriate recommendation for this patient?
A. Sodium restriction to 4,000 mg NaCl per day
B. Indomethacin 50 mg by mouth twice daily
C. Amiloride 5 mg by mouth daily
D. Demeclocycline 300 mg by mouth three times daily

A

Amiloride 5 mg by mouth daily

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34
Q

A 34-year-old man admitted with confusion and lethargy was found to have blood glucose of 820 mg/dL. Which will be falsely altered from this patient’s elevated blood glucose?
A. potassium
B. sodium
C. urea
D. chloride

A

sodium

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35
Q

Which are associated with hypovolemic hyponatremia?
A. Polydipsia and Lithium
B. Diuretics and Diarrhea
C. Low solute intake and Hypothyroidism
D. Carbamazepine and Indomethicin

A

Diuretics and Diarrhea

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36
Q

Which drug has an anti-diuretic property?
A. Chlorpropramide
B. Lithium
C. Amphotericin B
D. Cidofovir

A

Chlorpropramide

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37
Q

Which solution does not cause a shift in water from extracellular to intracellular?
A. 0.2% NaCl
B. 0.45% NaCl
C. D5W/0.45% NaCl
D. Lactated Ringers

A

Lactated Ringers

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38
Q

Diabetes Insipidus is associated with which disorder?
A. Hypernatremia from inadequate response to vasopressin
B. Hyponatremia from excessive salt intake
C. Hypernatremia from inadequate vasopressin release
D. Hyponatremia from venlafaxine

A

Hypernatremia from inadequate vasopressin release

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39
Q

Which solution causes cells to swell?
A. 0.9% NaCl
B. Lactated Ringers
C. 0.45% NaCl
D. 3% NaCl

A

0.45% NaCl

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40
Q

A patient at your community pharmacy has a magnesium of 1.7 mEq/L and he was told by his physician to maintain a magnesium of 2.0 mEq/L. Which replacement product would be the best option for this patient? The patient has no contraindications to replacement therapy.
A. Magnesium oxide 1200 mg by mouth at bedtime
B. Magnesium glycinate 200 mg by mouth once daily
C. Magnesium hydroxide 25 mL by mouth twice daily
D. Magnesium citrate 60 mL by mouth before bedtime

A

Magnesium glycinate 200 mg by mouth once daily

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41
Q

A patient with a magnesium of 5.1 mEq/L needs to be monitored for ___________________________.
A. Hypertension
B. Hyperglycemia
C. Hypoglycemia
D. Hypotension

A

Hypotension

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42
Q

Which is a common drug-related cause of hypomagnesemia?
A. Magnesium Sulfate
B. Cyclosporine
C. Lithium
D. Magnesium Citrate

A

Cyclosporine

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43
Q

Which insulin should be administered to a patient with a potassium of 6.7 to immediately manage their potassium?
A. Tresiba
B. Lantus
C. Humulin 70/30
D. Novolin R

A

Novolin R

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44
Q

Which of the following are underlying causes for magnesium deficiency? Select all that apply.
A. Acetaminophen 500 mg twice daily
B. Alcoholism
C. Lisinopril 20 mg daily
D. Omeprazole 20 mg daily
E. Chronic Kidney Disease

A

Alcoholism
Omeprazole 20 mg daily

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45
Q

Which is a common cause of hypokalemia?
A. Cimetidine
B. Acetazolamide
C. Pantoprazole
D. Torsemide

A

Torsemide

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46
Q

TS is a 72 yo Male who was contacted to go to the hospital immediately after a routine outpatient laboratory blood tests found his potassium was 2.5 mEq/L.
Which of the following drugs could be added as adjunctive therapy to increase his potassium?
A. Metolazone 5 mg once daily
B. Bumetanide 2 mg twice daily
C. Hydrochlorothiazide 25 mg once daily
D. Triamterene 50 mg twice daily

A

Triamterene 50 mg twice daily

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47
Q
  1. Which drug should be initiated in a patient receiving spironolactone, lisinopril, and carvedilol to manage their chronic hyperkalemia?
    A. Sodium zirconium cyclosilicate 10 grams by mouth daily
    B. Triamterene 50 mg by mouth twice daily
    C. Furosemide 40 mg by mouth once a day
    D. Sodium polystyrene sulfonate 30 grams by mouth once a day
A

Sodium zirconium cyclosilicate 10 grams by mouth daily

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48
Q

Which of the following is an adverse reaction of sodium polystyrene sulfonate?
A. Bowel necrosis
B. Hypermagnesemia
C. Hyperkalemia
D. Precipitate formation in tissue

A

Bowel necrosis

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49
Q

Which segment of the kidney is responsible for a majority of magnesium reabsorption?
A. Macula densa
B. Distal tubule
C. Loop of Henle
D. Collecting tubule

A

Loop of Henle

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50
Q

Which of the following is frequently the cause of hypocalcemia?
A. Nephrotic Syndrome
B. Malignancy from breast cancer
C. Pamidronate
D. Refeeding syndrome
E. Vitamin D deficiency

A

Vitamin D deficiency

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51
Q

Which of the following is an appropriate treatment for hyperphosphatemia that would have minimal long-term side effects?
Select all that apply.
A. Lanthanum carbonate
B. Aluminum hydroxide
C. Sevelamer carbonate
D. Calcium acetate
E. Magnesium carbonate

A

Lanthanum carbonate
Sevelamer carbonate
Calcium acetate

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52
Q

A 55 Female with a history of mild dermatitis from laundry detergents asks you about a new vitamin for Hair and Nails. The supplement contains high doses of vitamins A and E. You check her current medications and note she takes HCTZ 25 mg/day and Lithium 450 mg twice daily.
What is your concern regarding this patient taking the hair and nail supplement?
A. Combination of current medications with this supplement increases the risk of hypercalcemia
B. Combination of current medications with this supplement increases the risk of hyperkalemia
C. No concern the OTC product is safe for this patient
D. The vitamin A in the supplement will help her prevent outbreaks of dermatitis

A

Combination of current medications with this supplement increases the risk of hypercalcemia

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53
Q

Calcitonin release acts to _____________________________
A. Decrease osteoblast production in the bone
B. Increase the concentration of Vitamin D in blood
C. Decrease the concentration of calcium in the blood
D. Increase the concentration of phosphorus in the blood

A

Decrease the concentration of calcium in the blood

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54
Q

Select all of the oral calcium products with an elemental calcium >20%.
A. Calcium gluconate
B. Calcium chloride
C. Calcium carbonate
D. Calcium citrate

A

Calcium carbonate
Calcium citrate

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55
Q

If a patient has metabolic alkalosis, how would compensation occur?
A. Slow decrease in HCO3
B. Slow decrease in PaCO2
C. Rapid increase in HCO3
D. Rapid increase in PaCO2

A

Rapid increase in PaCO2

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56
Q

How would you classify this Acid-Base disturbance?
Arterial pH: 7.3
PaCO2: 51
HCO3: 22
A. Respiratory acidosis
B. Metabolic acidosis
C. Respiratory alkalosis
D. Metabolic alkalosis

A

Respiratory acidosis

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57
Q

What is the acid-base disturbance for this patient with COPD, HTN and fatigue with an arterial blood gas of
pH 7.31
PaCO2 47
HCO3 20

A.	acute respiratory alkalosis with metabolic alkalosis
B.	chronic respiratory acidosis with metabolic acidosis
C.	acute respiratory acidosis with metabolic alkalosis
D.	chronic respiratory alkalosis with metabolic acidosis
A

chronic respiratory acidosis with metabolic acidosis

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58
Q

Which is a cause of a non-anion gap metabolic acidosis?
A. Saline infusion
B. Uremia
C. Ischemia
D. Hyperkalemia

A

Saline infusion

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59
Q

Your patient’s phosphorus is 0.9 mg/dL. Before recommending IV phosphate therapy, what electrolyte abnormality must you screen for?

A.	Hypokalemia
B.	Hypomagnesemia
C.	Hypernatremia
D.	Hypercalcemia
A

Hypercalcemia

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60
Q

Which best describes the current American Heart Association recommendations for blood pressure management in pateints with CKD?
A. Blood pressure goal of < 120/80 in patients with a CKD Stage 3
B. Blood pressure goal of < 140/90 in patients with CKD Stage 5
C. Blood pressure goal of < 130/80 in patients with diabetes and/or CKD
D. Blood pressure goal of < 140/80 in patients with an albumin creatinine ratio >30

A

Blood pressure goal of < 120/80 in patients with a CKD Stage 3

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61
Q

Which can cause initial glomerular injury?
A. Hyperfiltration
B. Proteinuria
C. Drug toxicity
D. Obesity

A

Drug toxicity

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62
Q

Which drug can cause an intrinsic AKI?
A. Acetaminophen
B. Gentamicin
C. Lisinopril
D. Prednisone

A

Gentamicin

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63
Q

Which of the following is a normal finding in a urine analysis?
A. Fatty casts
B. Hyaline casts
C. Nitrate
D. Leukocyte esterase

A

Hyaline casts

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64
Q

What type of damage occurs to the glomerulus from diabetes, atherosclerosis or hyperlipidemia?
A. Hyaline deposits/granular casts
B. Increased glomerular blood flow
C. Glomerular hypertrophy
D. Micro-aneurysm

A

Glomerular hypertrophy

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65
Q
  1. Patients with chronic kidney disease are advised to maintain a healthy lifestyle which includes which of the followi
    A. Men no more than 2 drinks per day
    B. Women no more than 3 drinks per week
    C. One serving of cold water fish per week
    D. Exercise 2x a week for 20 minutes
A

Men no more than 2 drinks per day

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66
Q

How much protein should be consumed per day in a patient with CKD Stage 4?
A. 1.2 g/kg
B. 0.8 g/kg
C. 1.4 g/kg
D. 1.0 g/kg

A

0.8 g/kg

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67
Q
  1. The most common cause of mortality in patients with CKD is from __________________________.
    A. Diabetes
    B. Obesity
    C. Cardiovascular disease
    D. Liver disease
A

Cardiovascular disease

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68
Q

Using the KDIGO AKI staging, what stage is your 120 kg patient who has a urine output of 650 mL over the past 14 hours?
A. This patient does not have AKI
B. Stage 2
C. Stage 1
D. Stage 3

A

Stage 2

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69
Q

Which of the following anti-hypertensive agents would be best to initiate in a patient with CKD Stage 3, diabetes (type 2), proteinuria, HR 72 and BP 170/94?
A. Metoprolol
B. Losartan
C. Carvedilol
D. Amlodipine

A

Losartan

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70
Q

According to the KDIGO Clinical Practice Guideline, patients receiving a statin prior to initiating dialysis can remain on the statin.
True
False

A

True

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71
Q

What is the best counseling point for patients who have been prescribed a phosphate binder?
A. Take two hours after meals
B. Take on an empty stomach
C. Take with meals
D. Take two hours prior to meals

A

Take with meals

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72
Q

Which phosphate binder is not recommended in patients with chronic kidney disease?
A. Calcium citrate
B. Aluminum hydroxide
C. Calcium acetate
D. Magnesium carbonate

A

Calcium citrate

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73
Q

Which drug is a treatment for uremic bleeding?
A. Cinacalcet
B. Ropinirole
C. Etelcalcetide
D. Desmopressin

A

Desmopressin

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74
Q

___________ demineralizes bone to release calcium.
A. Calcitonin
B. Parathyroid hormone
C. Alkaline Phosphatase
D. Estrogen

A

Parathyroid hormone

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75
Q

Which is a common sign or symptom of uremia?
A. Epistaxis
B. Retroperitoneal bleeding
C. Liver hematoma
D. Subdural hematoma

A

Epistaxis

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76
Q

Which best describes dopamine agonist symptom augmentation?
Symptoms could ___________________________.
A. increase as the drug wears off
B. occur while resting
C. decrease in severity throughout the day
D. occur earlier in the day

A

occur earlier in the day

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77
Q

Which is an adverse effect of cinacalcet?
A. osteitis fibrosa
B. hypocalcemia
C. osteomalacia
D. hypercalcemia

A

hypocalcemia

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78
Q

What is the goal corrected calcium in patients with CKD Stage 5?
A. lower levels around 8.4-9.5
B. higher levels around 9.5-10.5
C. calcium does not require monitoring in patients with CKD
D. normal levels of 8.5-10.2

A

lower levels around 8.4-9.5

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79
Q

Chronic persistent hyperphosphatemia in a patient with CKD 5D is a risk factor for which of the following?
A. Increased calcium reabsorption into bone resulting in bone overgrowth
B. Reduced bone matrix turnover from hormone suppression
C. Increased ischemic damage resulting in skin necrosis
D. Parathyroid gland suppression resulting in hypocalcemia

A

Increased ischemic damage resulting in skin necrosis

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80
Q

Which drug binds phosphorus and increases serum iron concentrations?
A. Iron sucrose
B. Sucroferric oxyhydroxide
C. Ferric citrate
D. Ferrous sulfate

A

Ferric citrate

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81
Q

Which is a common signs and symptoms of uremia?
A. Hyperglycemia
B. Metabolic alkalosis
C. Impaired platelet function
D. Hyponatremia

A

Impaired platelet function

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82
Q

Calcitriol (active vitamin D3) suppresses secretion of the parathyroid hormone by ________________.
A. decreases magnesium reabsorption in the Loop of Henle
B. indirectly by decreasing the sensitivity of the thyroid to serum calcium
C. increasing the absorption of dietary calcium in the small intestines
D. increasing alkaline phosphatase bone turnover

A

increasing the absorption of dietary calcium in the small intestines

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83
Q

Which has been demonstrated to decrease signs and symptoms of uremic pruritis in patients with CKD?
A. Valproic acid
B. Diet with at least 50% of protein from diary and nuts
C. Exposure to UVB light
D. Diphenhydramine

A

Exposure to UVB light

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84
Q

What are the primary functions of the kidney?

A

accomplish life-sustaining tasks
excrete metabolic waste products
conserve nutrients
regulate acids and bases
endocrine function

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85
Q

___ delivers blood to to the glomerulus for filtration

A

Afferent arteriole

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86
Q

___ returns filtered blood from the glomerulus

A

Efferent arteriole

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87
Q

What is movement of solute or water from the tubular lumen to the blood or interstitium?

A

reabsorption

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88
Q

What is movement of solutes from the interstitium or cell interior to the tubular lumen?

A

secretion

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89
Q

the proximal tubule is permeable/im-permeable to water

A

permeable

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90
Q

Parathyroid hormone regulates __ via the proximal tubule

A

phosphorus

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91
Q

__ is the major cation in extracellular fluid

A

sodium

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92
Q

__ is the major cation in intracellular fluid

A

potassium

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93
Q

Glucose reabsorption is nearly complete in the __

A

proximal tubule

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94
Q

Acid secretion occurs by two mechanisms involving the titration of the urinary buffers:

A

ammonia
phosphate

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95
Q

The primary function of the loop of henle is to __

A

establish a hyper osmotic state within the medullary interstitial fluid

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96
Q

What is the primary initiating event of the countercurrent flow?

A

NaCl reabsorption by the thick ascending limb

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97
Q

The thin descending segment is permeable/impermeable to water

A

permeable

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98
Q

The thin ascending segment is permeable/impermeable to water

A

impermeable

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99
Q

The thick ascending limb is permeable/impermeable to water

A

impermeable

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100
Q

In the absence of __ the distal tubule has low permeability to water and fluid remains hypotonic throughout

A

antidiuretic hormone

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101
Q

distal tubule is permeable/impermeable to water

A

impermeable

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102
Q

Sodium transport in the loop of henle and distal tubule is __

A

flow-dependent

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103
Q

Calcium reabsorption is stimulated by PTH in the __

A

distal tubule

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104
Q

___ open Na channels in the collecting duct

A

aldosterone

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105
Q

___ closes Na channels in the collecting duct

A

atrial natriuretic peptide

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106
Q

Water permeability in the collecting duct is controlled by __

A

vasopressin

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107
Q

What is an increase in urine volume?

A

diuresis

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108
Q

What is an increase in renal sodium excretion?

A

natriuresis

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109
Q

Where in the kidney do carbonic anhydrase inhibitors work?

A

proximal tubules
some in collecting tubules

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110
Q

Chronic kidney disease is evidenced by __(5)

A

-a rise in BUN and SCr
-a decline in CrCl
-development of uremic symptoms
-abluminuria 30mg/24hr
-albuminuria creatinine ratio >30

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111
Q

Staging of CKD is based on __

A

GFR

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112
Q

Stage 3a CKD has a GFR of __

A

45-59

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113
Q

Stage 3b CKD has a GFR of __

A

30-44

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114
Q

Stage 4 CKD has a GFR of ___

A

15-29

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115
Q

Stage 5 CKD has a GFR of __ or __

A

<15
dialysis

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116
Q

CKD category A1 has AER and ACR ___

A

<30

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117
Q

CKD category A2 has AER and ACR __

A

30-300

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118
Q

CKD category A3 has AER and ACR ___

A

> 300

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119
Q

What are four principal causes of CKD?

A

-diabetes
-hypertension
-glomerulonephritis
-polycystic kidney disease

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120
Q

What are predictors of CKD?

A

-underlying causes
-GFR (1/SCr)
-Albuminuria
-age
-sex or gender
-race or ethnicity
-elevated BP
-hyperglycemia
-dyslipidemia
-smoking, obesity
-history of CVD
-ongoing exposure to nephrotoxic agents

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121
Q

What is the importance of proteinuria in CKD?

A

-marker of kidney disease
-clue to the type of CKD
-risk factors for adverse outcomes
-effect modifier for adverse outcomes

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122
Q

In diabetic glomerulopathy, the change within the kidney is __

A

augmentation of extracellular material
thickening of glomerular basement membrane

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123
Q

What is first line drug therapy in T2DM DKD?

A

metformin
SGLT2 inhibitor
statin
RAS blockage

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123
Q

T or F: all patients with diabetes should be screened for diabetic kidney disease

A

true

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124
Q

What is first line drug therapy in T1DM DKD?

A

Statin
RAS blockage

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125
Q

Metformin and SGLT2 inhibitors should be dose adjusted based on __

A

GFR

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126
Q

What SGLT2 inhibitors have proven benefit for DKD?

A

-canagliflozin 100mg
-dapagliflozin 10mg
-empagliflozin 10mg

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127
Q

ACE or ARB? T1DM with macroalbuminuria

A

ACE

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128
Q

ACE or ARB? T2DM with macroalbuminuria

A

ARB

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129
Q

Potassium sparing diuretics should be used with caution in patients __

A

GFR <30 (CKD 4 and 5)
Concomitant ACE/ARB therapy
Additional risk factors for hyperkalemia

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130
Q

What are drugs that cause resistant hypertension in hemodialysis?

A

epoetin
prednison
cyclosporine
NSAIDs

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131
Q

What are some causes of resistant hypertension in hemodialysis?

A

-nonadherence
-diet
-drug-drug interactions
-sleep apnea
-hypothyroidism
-hypercalcemia
-drug abuse

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132
Q

What are some medications that increase blood pressure?

A

Calcineurin inhibitors: cyclosporin and tacrolimus
Erythropoietin stimulating agents: erythropoietin, darbepoetin
Nicotine, metoclopramide
withdrawal from beta blocker or alpha agonists

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133
Q

In diabetes and CKD, avoid __ of total daily calories from protein

A

> /=20%

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134
Q

Calcium and Phosphorus homeostasis is mediated through which four hormones?

A

-parathyroid hormone
-25-hydroxyvitamin D
-1,25-dihydroxyvitamin D
-Fibroblast growth factor 23

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135
Q

Decreased serum calcium results in __ release

A

PTH

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136
Q

What is the most active form of vitamin D?

A

1, 25-dihydroxyvitamin D3 or calcitriol

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137
Q

Vitamin D3 __ PTH production

A

suppresses

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138
Q

PTH facilitates __ and Ca and P are released from the bone

A

osteoclast production

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139
Q

What is osteitis fibrous cystic?

A

overproduction of PTH leads to bones becoming soft and deformed

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140
Q

What is osteomalacia?

A

deficient bone mineralization

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141
Q

What is the primary cause of increased phosphorus concentrations in patients with CKD?

A

decreased kidney function
high phosphorus diet

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142
Q

List two causes for hypocalcemia related to CKD-MBD

A

decreased active vitamin D
elevated serum phosphorus

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143
Q

What is the phosphorus goal for patients with CKD stage 5?

A

3.5-5

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144
Q

What is the pharmacologic treatment for CKD/MBD?

A

phosphate binders

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145
Q

Calcium __ is contraindicated because it may increase aluminum absorption

A

citrate

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146
Q

What medication(s) does sevelamer carbonate interact with?

A

Ciprofloxacin

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147
Q

What vitamins should be monitored when taking sevelamer?

A

D, E, K, and folic acid

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148
Q

___ is not recommended in peds because it can be incorporated into growing bone

A

Lanthanum carbonate

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149
Q

What dosage form is velphoro?

A

chewable tablet

150
Q

What medication(s) does sucroferric oxyhydroxides interact with?

A

doxycycline -separate
levothyroxine - do not take together

151
Q

What dosage form does ferric citrate come in?

A

film coated

152
Q

What medication(s) does ferric citrate interact with?

A

doxycycline - separate
ciprofloxacin - separate

153
Q

What are adverse effects to Alucaps or Amphogel?

A

-anemia
-alzheimer-like mental picture
-bone disease

154
Q

Total intake of elemental calcium (binders plus dietary) should not exceed ___ mg/day in CKD 5

A

2000

155
Q

In CKD 5 the corrected calcium goal is __

A

8.4-9.5

156
Q

When should calcium based phosphate binders be avoided?

A

hypercalcemia
plasma PTH concentration <150
serum phosphorus >7

157
Q

Why is vitamin D essential?

A

-increases absorption of Ca and P
-indirectly reduces synthesis of calcitriol
-maintains bone mineralization and turnover
-reduces PTH synthesis

158
Q

Recommended daily allowance of vitamin D for >60 is __ IU/day and <60 is __ IU/day

A

800
400

159
Q

Vitamin D replacement may not be effective in which CKD population?

A

stage 5

160
Q

What is chronic kidney disease mineral bone disorder?

A

abnormalities in mineral and bone metabolism

161
Q

What are the monitoring parameters for CKD-MBD?

A

Phosphorus
Calcium
Ca c P
iPTH

162
Q

What are the available treatment options for CKD-MBD?

A

low phosphorus diet
phosphate binders
vitamin d analog
calcium
calcimimetic

163
Q

How do calcimimetics work?

A

increases the sensitivity of the calcium sensing receptor

164
Q

What is an oral example of a calcimimetic?

A

cinacalcet (Senispar)

165
Q

What is an IV example of a calcimimetic?

A

etecalcetide (Parsabiv)

166
Q

Which drug should be used with caution in patients with a history of QT interval prolongation?

A

etecalcetide (Parsaiv)

167
Q

What is renal osteodystrophy?

A

alteration in bone morphology in patients with CKD

168
Q

What is the major regulator of renal osteodystrophy?

A

PTH

169
Q

Elevated PTH leads to __

A

reabsorption of bone osteoclasts
immature and structurally weak bone

170
Q

What are the four types of renal osteodystrophy?

A

osteitis fibrosa (high turnover)
osteomalacia (low turnover)
mixed uremic osteodystrophy
dynamic bone disorder

171
Q

What are non-CKD factors that can affect bone metabolism?

A

old age
postmenopausal status
race
vitamin d deficiency
malignancy
prolonged immobilization
sunlight exposure
anticonvulsant use

172
Q

Should statin/ezetimibe therapy be initiated in dialysis-dependent patients?

A

no, unless other comorbidities

173
Q

Statins used in CKD should be administered at __

A

lower doses

174
Q

What are common uremic complications with CKD?

A

-platelet function and aggregation
-platelet vessel wall interactions
-anemia
-fragile capillaries

175
Q

What medications can be used to treat uremic bleeding?

A

-cryoprecipitate
-DDAVP (desmopressin)
-conjugated estrogen

176
Q

What are CNS effects that occur with uremia complication?

A

encephalopathy
peripheral neuropathy
restless leg syndrome

177
Q

What are treatments for restless leg syndrome?

A

-gabapentin/pregabalin
-opioids (propoxyphene, oxycodone, methadone)
-temazepam
-dopamine receptor agonists (ropinirole, pramipexole, levodopa/carpidopa, pergolide)

178
Q

What is augmentation?

A

symptoms could increase in severity and/or could occur earlier in the day

179
Q

What study should be evaluated and corrected with restless leg syndrome?**

A

iron studies

180
Q

What are treatment options for uremic pruritus?

A

antihistamines
anti-seizure meds
capsaicin, emollients
tanning bed
cholestyramine
activated charcoal

181
Q

What is difelikefalin (Korsuva) used for?

A

treatment of moderate-to-severe CKD-associated pruritus

182
Q

Difelikefalin is not approved for patients receiving __

A

peritoneal dialysis

183
Q

Difelikefalin targets the __ in the peripheral nervous system

A

kappa-opioid receptor

184
Q

What are some GI uremic effects that can occur?

A

taste changes, N/V, anorexia
delayed GI emptying (compounded in diabetic patients)

185
Q

What are treatments for gastroparesis?

A

metoclopramide
cispride
erythromycin (short time period b/c of dyskinesia)

186
Q

What are nutritional measures used in CKD?

A

serum albumin
serum prealbumin
dietary protein intake
dietary intake for dialysis patients

187
Q

What is serum albumin? What is the goal? Why is it a limitation?

A

-a measure of visceral protein pool size and indicator of future mortality risk
->/= 4.0
-acute or chronic inflammation

188
Q

What is serum prealbumin? What is the goal? Why is it a limitation?

A

-a measure of visceral protein pool size and indicator of future mortality risk
-<30
-acute or chronic inflammation

189
Q

What is the recommended dietary protein intake for clinically stable dialysis patients?

A

1.2 g/kg/day

190
Q

What is the recommended daily energy intake for dialysis patients?

A

<60 yrs old: 35 kcal/kg/day
>60 yrs old: 30-35 kcal/kg/day

191
Q

What are CKD dietary considerations?

A

Low Na, P, K, cholesterol, and protein diet

192
Q

Metabolic acidosis is associated with increased renal __ production

A

ammonia

193
Q

What are metabolic acidosis treatments?

A

sodium bicarbonate tablets
baking soda
fruits and vegetables

194
Q

What is anemia?

A

reduction in the concentration of hemoglobin that results in reduced oxygen-carrying capacity of blood

195
Q

What are typical Hgb goals?

A

Male: >13
Female: >12

196
Q

Routine monitoring of anemia in CKD should be done when __

A

SCr >/=2

197
Q

What are common causes of anemia?

A

deficiency
cancer
chronic kidney disease

198
Q

What is mean corpuscular hemoglobin (MCH)?

A

hemoglobin amount per red blood cell

199
Q

What is mean corpuscular volume (MCV)?

A

the average size of the red blood cell

200
Q

What is mean corpuscular hemoglobin concentration (MCHC)?

A

amount go Hgb relative to size of the cell

201
Q

What does serum ferritin assess?

A

iron deficiency or overload

202
Q

What does serum transferrin saturation (TSAT) assess?

A

amount of readily available iron for erythopoiesis

203
Q

What is total iron-binding capacity (TIBC)?

A

indirect measurement of iron-binding capacity of serum transferrin

204
Q

Where is iron stored in the body?

A

liver, spleen, and bone marrow

205
Q

What is normal iron content of the body?

A

3-4g

206
Q

Absorbed iron circulates bound to __

A

transferrin

207
Q

What is Hepcidin?

A

an endogenous antimicrobial peptide excreted by the liver that regulates serum iron concentrations

208
Q

What does anemia in CKD stages 4-5 look like?

A

reduced RBC lifespan
RBS are destroyed during HD
chronic inflammation/infection
platelet dysfunction
hyperparathyroidism
water soluble vitamins
decreased erythropoiesis

209
Q

Erythropoiesis is regulated by __

A

a feedback loop

210
Q

__ is the leading cause of death in patients with ESRD

A

heart disease

211
Q

Anemia treatment has resulted in partial regression of __ in CKD patients

A

LVH

212
Q

In concentric LVH, the wall __

A

thickens

213
Q

In eccentric LVH, the wall __

A

stretches too much and becomes mishaped

214
Q

Iron is critical for __ synthesis

A

Hgb

215
Q

Low serum iron and high TIBC indicate __

A

anemia of chronic disease

216
Q

Low serum iron and low TIBC indicate __

A

infection, malignancy, inflammation, liver disease, and uremia

217
Q

In CKD, what should be initiate before epoetin therapy?

A

iron replacement

218
Q

What are examples of anemia management options?

A

r-HuEPO
Epogen
Procrit
Aranesp
Mircera

219
Q

Retacrit is indicated for

A

anemia in patients receiving dialysis
HIV taking zidovudine
cancer receiving chemotherapy

220
Q

ESA is dosed (daily/weekly/monthly)

A

weekly

221
Q

Epogen is measured in

A

units

222
Q

Aranespt is measured in

A

mcg

223
Q

What are common adverse effects with Aranesp?

A

hypertension, infection, hypotension, myalgia, diarrhea, nausea

224
Q

When should dose adjustment be made in ESAs?

A

Hgb >11 or <8
changes of about 25%

225
Q

What are factors that limit ESA response?

A

iron deficiency
blood loss
infection/inflammation
aluminum overload
renal osteodystrophy
hyperparathyroidism
malignancy
water soluble vitamins dialyzed
patient compliance

226
Q

T or F: ESA therapy utilizes existing iron stores

A

true

227
Q

What is the oral elemental iron goal per day?

A

65mg

228
Q

What oral iron preparation contains 65mg of elemental iron?

A

ferrous sulfate 325mg

229
Q

What are the limitations to oral iron therapy?

A

absorption
dose to response
interactions with medications
side effects

230
Q

Anaphylaxis may happen with which iron preparation?

A

iron dextran IV

231
Q

What is the recommended loading dose for iron dextran?

A

total of 1gm divided

232
Q

Which iron infusion is not recommended?

A

iron gluconate

233
Q

What are risks and warnings associate with ESAs?

A

increased mortality
serious CV events
thromboembolic events
stroke

234
Q

What is the mechanism of action of Daprodustat?

A

orally active hypoxia-inducible factor prolyl hydroxylase (HIF-PH) inhibitor

235
Q

What are the five reasons to dialyze someone?

A

Acid/base
Electrolytes
Intoxication
O- Fluid overload
Uremia

236
Q

Renal replacement therapy doesn’t replace which physiologic roles of the kidney?

A

reabsorption and secretion of ingested substances
endocrine function

237
Q

What is the goal of dialysis in AKI?

A

renal support
volume management
administration of IV fluids and nutrition

238
Q

What is the goal of dialysis in CKD?

A

minimize side effects related to: uremia (waste build up), electrolytes, and volume

239
Q

What is an arteriovenous fistula?

A

surgical joining of an artery and vein

240
Q

What is an arteriovenous graft?

A

surgical implantation of an endogenous or artificial blood vessel to join an artery and a vein

241
Q

When are AV grafts preferred over AV fistulas?

A

Pts blood vessels are too mall for a fistula
-ex. elderly or pre-existing DM

242
Q

What are the two types of catheters used for dialysis?

A

subclavian vein insertion
internal jugular vein insertion

243
Q

How is thrill assessed?

A

feel with hands or fingers
vibration of blood pulsing through access site

244
Q

How is bruit assessed?

A

listen with stethoscope
whoosh of blood through access site

245
Q

Dialysate does not contain __

A

phosphorus, urea, creatinine

246
Q

What are examples of hemodialysis complications?

A

hypotension
hypovolemia and excessive ultrafiltration
pruritis
muscle cramps
infection

247
Q

What is a medication that can be used for dialysis-associated hypotension?

A

midodrine
alpha-1 agonist

248
Q

Risk for dialysis disequilibrium syndrome is greatest in patients with __ serum osmolality

A

high

249
Q

Some possible causes of dialysis disequilibrium syndrome are __

A

rapid change in osmolality of blood compared to CNS
rapid removal of fluid from CNS

250
Q

What are contraindications to peritoneal dialysis?

A

peritoneal adhesions from previous surgery
ostomy, blindness, or quadriplegic
physical handicap
mental handicaps or learning disabilities

251
Q

Dialysate is mostly a __ containing solution

A

glucose

252
Q

What is common buffer added to peritoneal dialysate to control acidosis?

A

lactate

253
Q

What is icodextrin (Extraneal)?

A

colloid osmotic agent
high molecular weight glucose polymer
alternative osmotic agent to glucose

253
Q

Dialysate choice and glucose concentration is based on __

A

volume removal goal

254
Q

What is the clinical presentation of PD associated peritonitis?

A

cloudy dialysate
abdominal pain
abdominal tenderness
fever
nausea

255
Q

What are the most common organisms associated with PD peritonitis?

A

Staphylococcus epidermis
Staphylococcus aureus

256
Q

What is empiric treatment for PD related peritonitis?

A

heparin
cefazolin and ceftazidime

257
Q

PD exit site infections are usually caused by which bacteria?

A

Gram positive
Staph epi or aureus

258
Q

How is a PD exit site infection treated?

A

cephalosporin for 14 days

259
Q

What are advantages to hemodialysis?

A

higher solute clearance
low technique failure
close patient monitoring
IV access during HD

260
Q

What are advantages to peritoneal dialysis?

A

increased hemodynamic stability
increased large molecule clearance
residual renal clearance
elderly and very young
less blood loss per treatment
no systemic heparin

261
Q

What are disadvantages of hemodialysis?

A

3x week at dialysis center
hypotension and muscle cramps
faster decline of residual renal function
vascular access frequently associated with infection and thrombosis
dialysis filter-membrane reactions
UFH is required

262
Q

What are disadvantages of peritoneal dialysis?

A

increased protein and amino acid losses
reduced appetite
abdominal fullness
risk of peritonitis
patient burnout and high rate of technique failure
catheter malfunction, exit site, and tunnel infection

263
Q

What are key CKD dialysis issues?

A

access
control signs and symptoms of uremia
anemia
bone disease
dialysis related complications

264
Q

What are risks for drug-induced nephrotoxicity?

A

elderly
female
dehydration
high drug dose
comorbid disease
recent hospitalization
concomitant use of nephrotoxic agents
chronic kidney disease
electrolyte imbalances

265
Q

What is the presentation of drug-induced nephrotoxicity?

A

decline in GFR
decrease in urine output
malaise, anorexia, vomiting
change in urine color, foam, frequency, amount

266
Q

What is SCr dependent on?

A

muscle mass

267
Q

What are clinical clues of drug-induced nephrotoxicity?

A

fluid overload
acid-base abnormalities
electrolyte imbalances
urine sediment abnormalities
urine abnormalities

268
Q

What can cause a decrease in intraglomerular pressure?

A

ACE/ARB
dehydration
CHF

269
Q

What can cause a decrease in renal blood flow?

A

dehydration
CHF

270
Q

What can cause vasoconstriction of the afferent arteriole?

A

NSAIDs

271
Q

What can cause vasodilation of the efferent arteriole?

A

ACE/ARB

272
Q

How can you prevent ACE/ARE-induced nephrotoxicity?

A

initiate with a low dose and titrate up gradually
monitor renal function and serum K
avoid dehydration

273
Q

Is renal failure from NSAIDs reversible?

A

yes, if recognized early

273
Q

What are dose-related problems with cyclosporine and tacrolimus?

A

vasoconstriction and injury

273
Q

Triamterene with HCTZ is __

A

reversible

274
Q

Triamterene with Indomethacin may induce __

A

renal ischemia

275
Q

What can cause pseudo-renal failure?

A

fever
pregnancy
corticosteroid and tetracycline therapy

276
Q

What is pseudo-renal failure?

A

Increase in the SCr or BUN concentration from baseline suggestion a decline in renal function

277
Q

What is acute tubular necrosis?

A

inability to concentrate urine

278
Q
A
279
Q

What are risk factors for aminoglycoside nephrotoxicity?

A

dosing
prolonged therapy
recent AMG therapy
Synergistic nephrotoxicity (cyclosporine, amphoB, vancomycin, diuretics)
related to predisposing condition

280
Q

What is the third leading cause of hospital-acquired AKI?

A

radio-contrast-induced nephropathy

281
Q

What is the clinical presentation of radio contrast-induced nephropathy?

A

initial transient osmotic diuresis
followed by volume depletion and vasoconstriction
SCr risk and peaks in 2-5 days

282
Q

How can CIN be prevented?

A

identify high risk patients
lower osmolar nonionic
prior to admin:
-discontinue potential nephrotoxic agents
-NS administration
-correct and prevent dehydration
-maybe N-acetylcysteine administration

283
Q

Cisplatin or Carboplatin? Which has a higher risk of drug-induced nephrotoxicity?

A

cisplatin

284
Q

Cisplatin and Carboplatin cause __ losses. Examples

A

electrolyte losses
hypomagnesemia
hypocalcemia
hypokalemia

285
Q

What can be done to prevent AmphoB nephrotoxicity?

A

limit cumulative dose
avoid concomitant nephrotoxins
hydration
damage may be irreversible

286
Q

What are some clinical indicators of allergic interstitial nephritis?

A

pyuria
eosinophilia
tubular dysfunction
hematuria
oliguria

287
Q

What medications can cause allergic interstitial nephritis?

A

PPIs
penicillins
sulfa
NSAIDs
cox-2 inhibitors

288
Q

What should be done if someone develops AIN?

A

stop administration of offending agent
Prednisone 1mg/kg for 4 weeks

289
Q

Chinese herb nephropathy is caused by __, a contaminant found in a weight loss product

A

aristolochic acid

290
Q

How is papillary necrosis caused?

A

excess consumption of combinations of analgesics
Phenacetin
Caffeine combination analgesics

291
Q

Nephrocalcinosis can be caused by what medications?

A

oral sodium phosphate solution (OSPS)
ACE/ARB, diuretic use

292
Q

Nephrocalcinosis is related with what electrolyte imbalance?

A

hyperphosphatemia

293
Q

Intratubular precipitation can be caused by what medications?

A

Sulfonamides and sulfadiazine
methotrexate
acyclovir
ascorbic acid
calcium carbonate
triamterene
foscarnet

294
Q

Patients with declining renal function are more likely to:

A

co-morbidities
multiple medications
OTC medications
nutritional supplements
herbal remedies

295
Q

What are the changes in absorption in CKD?

A

uremic gastritis
gastroparesis
alkaline pH
decreased liver metabolism

296
Q

What are the changes in distribution in CKD?

A

lower serum albumin, decreased protein binding
alterations in tissue binding

297
Q

__ has an increased VD in patients with CKD

A

Cefazolin

298
Q

__ has a decreased VD in patients with CKD

A

Digoxin

299
Q

Changes in free drug concentration in CKD are due to alterations in __

A

protein binding

300
Q

What are examples of medications that need dose adjusted for kidney clearance?

A

Digoxin
Morphine
Meperidine
Lithium
Phenytoin
Antineoplastic agents (Methotrexate)

301
Q

What are examples of concentration-dependent antibiotics?

A

ahminoglycosides
amphotericin B
fluoroquinolones

302
Q

What are examples of time-dependent antibiotics?

A

penicillins
cephalosporins
carbapenems
vancomycin
oxazolidinones
macrolides

303
Q

What are the three dose-adjustment methods?

A

interval extension
dosage reduction
both

304
Q

Drug half-life is dependent on __ and __

A

volume of distribution
drug elimination/clearance

305
Q

Schedule drug administration before or after hemodialysis session

A

before
except drugs too large to fit through dialyzer (EPAs)

306
Q

What is the most common inflammatory arthritis in the US?

A

gout

307
Q

What are the two types of gout?

A

over-producer
under-excreter

308
Q

Solubility of uric acid is dependent on __ and __

A

concentration
body temperature

309
Q

What are tophi or microtophi?

A

monosodium urate crystals can for painless nodular deposits in joint spaces and distal extremities

310
Q

Gout is an __ response to the UA crystals in joint spaces

A

inflammatory

311
Q

Uric acid crystals diminish activity of __

A

osteoblasts

312
Q

What are risk factors for high uric acid and gout?

A

age
male
obese
alcohol use
HCTZ, loops, aspirin, niacin
HTN, diabetes, hyperlipidemia, HF

313
Q

What are drugs associated with hyperuricemia?

A

thiazide diuretics
niacin
pyrazinamide
cyclosporine and tacrolimus
aspirin (higher doses)

314
Q

What are the treatments for an acute gout attack?

A

NSAIDs
colchicine
glucocorticoids
anakinra

315
Q

Should rate lowering therapy be started during an acute attack?

A

no

316
Q

NSAIDs increase __ and __ retention

A

sodium
water

317
Q

Avoid colchicine in __ and __ impairment

A

renal
hepatic

318
Q

What glucocorticoids can be used?

A

triamcinolone IA
Prednisone oral

319
Q

Patients with with prior gout attacks are at a higher risk of __ once the steroid is stopped

A

a rebound attack

320
Q

What class is anakinra?

A

recombinant IL-1 receptor antagonist

321
Q

Should cold or heat be applied to joints of gout patients?

A

cold

322
Q

Corticotropin requires intact __

A

pituitary adrenal axis

323
Q

Rate-lowering agents are indicated in patients with __

A

recurrent acute attacks
arthropathy
top or radiographic changes of gout

324
Q

Serum uric acid goal is __

A

6 mg/dL

325
Q

What medications are xanthine oxidase inhibitors?

A

allopurinol
febuxostat

326
Q

What medications are uricosurics?

A

probenecid
sulfinpyrazine

327
Q

Dose reduction of allopurinol is necessary in __

A

renal insufficiency

328
Q

Which class is good in overproduction and under excretion? just underexcretion?

A

xanthine oxidase inhibitors
uricosurics

329
Q

Allopurinol has a risk of __

A

bone marrow suppression

330
Q

Febuxostat has a risk of

A

CV related mortality

331
Q

What is the preferred antihypertensive in gout?

A

losartan

332
Q

What are the different types of renal calculi?

A

calcium oxalate
calcium phosphate
struvite
urate
cystine

333
Q

Stone formation happens when the urine becomes __

A

supersaturated

334
Q

What are electrolyte/diet risk factors for calcium stones?

A

lower volume
higher calcium
lower citrate
higher pH
higher oxalate
Low fluid intake
Low Ca and K diet
High protein diet
High sodium, frustose, and sucrose diet
High vitamin C

335
Q

What are disease/surgery risk factors for calcium stones?

A

medullar sponge kidney
horshoe kidney
gastric bypass
primary hyperparathyroidism
gout
obesity
DM
hypocitraturia
renal tubular acidosis 1
hyperoxaluria

336
Q

What drugs cause abnormal crystal precipitation in the renal collecting system?

A

indinavir
triamterene

337
Q

What drugs cause calcium stone formation?

A

antacids
loop diuretics

338
Q

What drugs cause uric acid stone formation?

A

salicylates
probenecid

339
Q

What drugs can cause xanthine stone formation?

A

allopurinol

340
Q

What are symptoms of renal calculi?

A

severe flank pain
hematuria
nausea/vomiting

341
Q

What medications are used for pain control for nephrolethiasis?

A

ketorolac
morphine
meperidine

342
Q

What antiemetics are used for nephrolethiasis?

A

metoclopramide
promethazine
prochlorperazine
hydroxyzine

343
Q

What drugs relax pelvic musculature to in nephrolethiasis?

A

desmopressin
nifedipine
tamsulosin

344
Q

What is used for infection prophylaxis in kidney stones?

A

Bactrim DS

345
Q

Which of the following drugs is associated with acute tubular necrosis?
A. Triamterene and ampicillin
B. Amphotericin B and carboplatin
C. Cyclosporine and lithium
D. Cisplatin and tacrolimus

A

Amphotericin B and carboplatin

346
Q

Drug removal during hemodialysis requires that _________________ be in the vasculature.
A. non-ionized drug
B. large molecular weight drugs > 6,500 daltons
C. free drug
D. protein-bound drug

A

free drug

347
Q

What is the best time to administer a drug with a Vd 0.1 L/kg and Protein binding of 22% to a patient receiving hemodialysis 3 times a week?
A. Administration timing does not matter for this drug
B. 30 minutes after a hemodialysis session
C. During a hemodialysis session
D. 60 minutes prior to a hemodialysis session

A

30 minutes after a hemodialysis session

348
Q

Which drug dosage adjustment do you anticipate making for a patient with CKD Stage 5D taking a drug that is 12% renally eliminated?
A. decrease the drug dose
B. no change to the dose or interval
C. increase the dosing interval
D. increase the dosing interval and decrease the drug dose

A

no change to the dose or interval

349
Q

Which are common signs and symptoms of allergic interstitial nephritis?
A. Maculopapular rash with fever and eosinophilia
B. Hypokalemia with hematuria and edema
C. Hematuria with hypernatremia and hypotension
D. Fever with hypophosphatemia and confusion

A

Maculopapular rash with fever and eosinophilia

350
Q

Which of the following drugs is associated with chronic interstitial nephritis?
A. Cyclosporine and lithium
B. Radio contrast dye and aspirin plus caffeine
C. Naproxen and tacrolimus
D. Ascorbic acid and ampicillin

A

Cyclosporine and lithium

351
Q

Which drug may increase a patient’s BUN but have no effect renal function?
A. Atorvastatin because it can cause cholesterol emboli
B. Amoxicillin because it can cause an allergic interstitial nephritis
C. Tetracycline because it can cause pseudo renal failure
D. Indomethacin because it can cause hemodynamically mediated kidney injury

A

Tetracycline because it can cause pseudo renal failure

352
Q
  1. Which pharmacokinetic changes do you anticipate in a patient with CKD Stage 3B taking a drug that is 80% renally eliminated?
    A. decreased half-live
    B. increased half-life
    C. increased non renal clearance
    D. decrease volume of distribution
A

increased half-life

353
Q

A decrease in intraglomerular pressure describes which type of drug-induced nephrotoxicity?
A. Acute tubular necrosis
B. Pseudo-renal failure
C. Hemodynamically mediated
D. Chronic interstitial nephritis

A

Hemodynamically mediated

354
Q

Alkaline urine decreases the risk of tubular crystal formation from this drug.
A. Naproxen sodium
B. Methotrexate
C. Indinavir
D. Vitamin C

A

Methotrexate

355
Q

SJ reports to the emergency department with an acute gout attack. Which drug is best to resolve his condition?
A. Indomethacin
B. Febuxostat
C. Allopurinol
D. Probenecid

A

Indomethacin

356
Q

What is a major adverse effect of colchicine?
A. Nausea
B. Urine discoloration
C. QT prolongation
D. Severe hiccups

A

Nausea

357
Q

All the following are major risk factors for kidney stones except?
A. Low calcium and potassium diet
B. Low sucrose and fructose diet
C. High animal protein diet
D. High sucrose and fructose diet

A

Low sucrose and fructose diet

358
Q

PL has been diagnosed with nephrolithiasis (kidney stones). The physician is considering treatment options to help relax the pelvic muscles and facilitate stone passage. Which of the following medications is most appropriate for this purpose?
A. Desmopressin
B. Furosemide
C. Epinephrine
D. Cefepime

A

Desmopressin

359
Q

Which of the following is likely the cause of gout? Select all that apply
A. Deposition of urate crystals in joints
B. Increase in uric acid production
C. Kidneys cannot store uric acid appropriately in the body
D. Increase in uric acid excretion

A

B. Increase in uric acid production
C. Kidneys cannot store uric acid appropriately in the body

360
Q

Which would be the best choice for pain control for a patient trying to pass a 7mm kidney stone?
A. Ketorolac IV 30 mg every 8 hours
B. Oxycodone 5 mg every 8 hours by mouth
C. Ibuprofen 800 mg three times daily by mouth
D. Morphine 10 mg every 8 hours by mouth

A

Ketorolac IV 30 mg every 8 hours

361
Q

A patient with a/an _________________ should avoid the use of colchicine for the treatment of gout?
A. history of hypertension
B. history of Crohn’s disease
C. history of liver disease
D. active duodenal ulcer

A

history of liver disease

362
Q

JM is receiving prednisone for an acute gout attack. He has had 2 previous gout attacks in the past 18 months treated with prednisone. Which best describes risk factors with JM’s current gout treatment?
A. Increased risk of treatment resistant gout
B. Cartilidge damage from steroids
C. Weight gain
D. Rebound gout attack when prednisone is stopped

A

Rebound gout attack when prednisone is stopped

363
Q

Which drug for gout prophylaxis is associated with rash and gastrointestinal symptoms?
A. naproxen
B. allopurinol
C. probenecid
D. prednisone

A

allopurinol

364
Q

Which best describes treatment with Anakinra, a recombinant IL-1 receptor antagonist?
A. prevention of struvite stone formation
B. a xanthine oxidase inhibitor which decreases the frequency of gout attacks
C. decreases inflammation during an acute gout attack
D. increases the elimination of uric acid by a non-renal pathway

A

decreases inflammation during an acute gout attack

365
Q

Which best describes risk factors for the formation of kidney stones?
A. A diet that consists of animal protein 1.1 grams/kg/day plus 80 ounces of water
B. A diet high in fruits and vegetables plus 68 ounces of water per day
C. Low urine volume along with a diet high in dietary calcium
D. Low urine volume along with a diet high in dietary sodium

A

Low urine volume along with a diet high in dietary sodium

366
Q

Which drug therapy has shown a benefit in patients with a history of calcium oxalate or calcium-based kidney stones?
A. Furosemide
B. Lisinopril
C. Allopurinol
D. Hydrochlorothiazide

A

Hydrochlorothiazide

367
Q

Which agent is indicated for antihyperuricemic gout prophylaxis in patients that are either uric acid overproducers or underexcretors?
A. Probenecid 250 mg po twice daily
B. Febuxostat 40 mg po once daily
C. Colchicine 1.2 mg po once a week
D. Triamcinolone acetonide 60 mg IM once a week

A

Febuxostat 40 mg po once daily

368
Q

Which drug class helps decrease muscle spasms in the ureter in patients with kidney stones?
A. Alpha-blocker
B. Calcium Channel Blocker
C. Narcotic
D. NSAID

A

Calcium Channel Blocker

369
Q
  1. Which best describes the use of Tamsulosin for nephrolithiasis?
    A. Causes spontaneous stone passage in up to 85% of patients
    B. Relaxes the musculature in the lower urinary tract to potentiate stone passage
    C. Reduces oxalate production to prevent kidney stone formation
    D. Anti-inflammatory properties reduce the need for additional analgesics
A

Relaxes the musculature in the lower urinary tract to potentiate stone passage

370
Q
A

IPCS 4 (5 decks)

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