Renal Flashcards by Cally Sebastian

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

Acetazolamide

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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

decreasing luminal calcium concentration

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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

decrease in sodium reabsorption

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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

hearing loss
arrhythmias
bone loss

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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

impermeable to water

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

Proximal tubule

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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

hydrochlorothiazide

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

sodium-glucose co-transport

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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

Closes sodium channels to decrease sodium reabsorption

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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

furosemide

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

Urinary calcium

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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

Membrane Damage

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

Perfusion pressure

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

Afferent vasodilation

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

Efferent vasoconstriction

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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

Liddle’s syndrome

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

Hyperchloremia

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

Tonicity

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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

The size of the ECF decreases

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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.

It decreases K+ secretion in intercalated cells.

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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

increased afferent arteriole vasodilation

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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

Cerebral edema from sodium Na+ normalization that was too quick

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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

Decreased efferent arteriole vasoconstriction resulting in a reduced GFR

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

Hypotonic

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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

increased urine osmolality and decreased urine output

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

hypervolemic, hyponatremia probably from nephrotic syndrome

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

euvolemic hyponatremia primary polydipsia

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

Indomethacin

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

Concentrated tube feedings

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

Lamotrigine

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

SIADH induced hyponatremia

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

8, 24

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

Amiloride 5 mg by mouth daily

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

sodium

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

Diuretics and Diarrhea

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

Chlorpropramide

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

Lactated Ringers

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

Hypernatremia from inadequate vasopressin release

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

0.45% NaCl

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

Magnesium glycinate 200 mg by mouth once daily

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

Hypotension

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

Cyclosporine

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

Novolin R

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

Alcoholism Omeprazole 20 mg daily

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

Torsemide

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

Triamterene 50 mg twice daily

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

Sodium zirconium cyclosilicate 10 grams by mouth daily

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

Bowel necrosis

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

Loop of Henle

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

Vitamin D deficiency

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

Lanthanum carbonate Sevelamer carbonate Calcium acetate

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

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

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

Decrease the concentration of calcium in the blood

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

Calcium carbonate Calcium citrate

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

Rapid increase in PaCO2

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

Respiratory acidosis

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

chronic respiratory acidosis with metabolic acidosis

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

Saline infusion

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

Hypercalcemia

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

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

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

Drug toxicity

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

Gentamicin

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

Hyaline casts

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

Glomerular hypertrophy

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

Men no more than 2 drinks per day

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

0.8 g/kg

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

Cardiovascular disease

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

Stage 2

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

Losartan

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

True

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

Take with meals

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

Calcium citrate

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

Desmopressin

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

Parathyroid hormone

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

Epistaxis

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

occur earlier in the day

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

hypocalcemia

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

lower levels around 8.4-9.5

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

Increased ischemic damage resulting in skin necrosis

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

Ferric citrate

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

Impaired platelet function

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

increasing the absorption of dietary calcium in the small intestines

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

Exposure to UVB light

What are the primary functions of the kidney?

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

___ delivers blood to to the glomerulus for filtration

Afferent arteriole

___ returns filtered blood from the glomerulus

Efferent arteriole

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

reabsorption

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

secretion

the proximal tubule is permeable/im-permeable to water

permeable

Parathyroid hormone regulates __ via the proximal tubule

phosphorus

__ is the major cation in extracellular fluid

sodium

__ is the major cation in intracellular fluid

potassium

Glucose reabsorption is nearly complete in the __

proximal tubule

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

ammonia phosphate

The primary function of the loop of henle is to __

establish a hyper osmotic state within the medullary interstitial fluid

What is the primary initiating event of the countercurrent flow?

NaCl reabsorption by the thick ascending limb

The thin descending segment is permeable/impermeable to water

permeable

The thin ascending segment is permeable/impermeable to water

impermeable

The thick ascending limb is permeable/impermeable to water

impermeable

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

antidiuretic hormone

distal tubule is permeable/impermeable to water

impermeable

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

flow-dependent

Calcium reabsorption is stimulated by PTH in the __

distal tubule

___ open Na channels in the collecting duct

aldosterone

___ closes Na channels in the collecting duct

atrial natriuretic peptide

Water permeability in the collecting duct is controlled by __

vasopressin

What is an increase in urine volume?

diuresis

What is an increase in renal sodium excretion?

natriuresis

Where in the kidney do carbonic anhydrase inhibitors work?

proximal tubules some in collecting tubules

Chronic kidney disease is evidenced by __(5)

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

Staging of CKD is based on __

GFR

Stage 3a CKD has a GFR of __

45-59

Stage 3b CKD has a GFR of __

30-44

Stage 4 CKD has a GFR of ___

15-29

Stage 5 CKD has a GFR of __ or __

<15 dialysis

CKD category A1 has AER and ACR ___

<30

CKD category A2 has AER and ACR __

30-300

CKD category A3 has AER and ACR ___

>300

What are four principal causes of CKD?

-diabetes -hypertension -glomerulonephritis -polycystic kidney disease

What are predictors of CKD?

-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

What is the importance of proteinuria in CKD?

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

In diabetic glomerulopathy, the change within the kidney is __

augmentation of extracellular material thickening of glomerular basement membrane

What is first line drug therapy in T2DM DKD?

metformin SGLT2 inhibitor statin RAS blockage

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

true

What is first line drug therapy in T1DM DKD?

Statin RAS blockage

Metformin and SGLT2 inhibitors should be dose adjusted based on __

GFR

What SGLT2 inhibitors have proven benefit for DKD?

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

ACE or ARB? T1DM with macroalbuminuria

ACE

ACE or ARB? T2DM with macroalbuminuria

ARB

Potassium sparing diuretics should be used with caution in patients __

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

What are drugs that cause resistant hypertension in hemodialysis?

epoetin prednison cyclosporine NSAIDs

What are some causes of resistant hypertension in hemodialysis?

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

What are some medications that increase blood pressure?

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

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

>/=20%

Calcium and Phosphorus homeostasis is mediated through which four hormones?

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

Decreased serum calcium results in __ release

PTH

What is the most active form of vitamin D?

1, 25-dihydroxyvitamin D3 or calcitriol

Vitamin D3 __ PTH production

suppresses

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

osteoclast production

What is osteitis fibrous cystic?

overproduction of PTH leads to bones becoming soft and deformed

What is osteomalacia?

deficient bone mineralization

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

decreased kidney function high phosphorus diet

List two causes for hypocalcemia related to CKD-MBD

decreased active vitamin D elevated serum phosphorus

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

3.5-5

What is the pharmacologic treatment for CKD/MBD?

phosphate binders

Calcium __ is contraindicated because it may increase aluminum absorption

citrate

What medication(s) does sevelamer carbonate interact with?

Ciprofloxacin

What vitamins should be monitored when taking sevelamer?

D, E, K, and folic acid

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

Lanthanum carbonate

What dosage form is velphoro?

chewable tablet

What medication(s) does sucroferric oxyhydroxides interact with?

doxycycline -separate levothyroxine - do not take together

What dosage form does ferric citrate come in?

film coated

What medication(s) does ferric citrate interact with?

doxycycline - separate ciprofloxacin - separate

What are adverse effects to Alucaps or Amphogel?

-anemia -alzheimer-like mental picture -bone disease

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

2000

In CKD 5 the corrected calcium goal is __

8.4-9.5

When should calcium based phosphate binders be avoided?

hypercalcemia plasma PTH concentration <150 serum phosphorus >7

Why is vitamin D essential?

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

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

800 400

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

stage 5

What is chronic kidney disease mineral bone disorder?

abnormalities in mineral and bone metabolism

What are the monitoring parameters for CKD-MBD?

Phosphorus Calcium Ca c P iPTH

What are the available treatment options for CKD-MBD?

low phosphorus diet phosphate binders vitamin d analog calcium calcimimetic

How do calcimimetics work?

increases the sensitivity of the calcium sensing receptor

What is an oral example of a calcimimetic?

cinacalcet (Senispar)

What is an IV example of a calcimimetic?

etecalcetide (Parsabiv)

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

etecalcetide (Parsaiv)

What is renal osteodystrophy?

alteration in bone morphology in patients with CKD

What is the major regulator of renal osteodystrophy?

PTH

Elevated PTH leads to __

reabsorption of bone osteoclasts immature and structurally weak bone

What are the four types of renal osteodystrophy?

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

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

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

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

no, unless other comorbidities

Statins used in CKD should be administered at __

lower doses

What are common uremic complications with CKD?

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

What medications can be used to treat uremic bleeding?

-cryoprecipitate -DDAVP (desmopressin) -conjugated estrogen

What are CNS effects that occur with uremia complication?

encephalopathy peripheral neuropathy restless leg syndrome

What are treatments for restless leg syndrome?

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

What is augmentation?

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

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

iron studies

What are treatment options for uremic pruritus?

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

What is difelikefalin (Korsuva) used for?

treatment of moderate-to-severe CKD-associated pruritus

Difelikefalin is not approved for patients receiving __

peritoneal dialysis

Difelikefalin targets the __ in the peripheral nervous system

kappa-opioid receptor

What are some GI uremic effects that can occur?

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

What are treatments for gastroparesis?

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

What are nutritional measures used in CKD?

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

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

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

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

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

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

1.2 g/kg/day

What is the recommended daily energy intake for dialysis patients?

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

What are CKD dietary considerations?

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

Metabolic acidosis is associated with increased renal __ production

ammonia

What are metabolic acidosis treatments?

sodium bicarbonate tablets baking soda fruits and vegetables

What is anemia?

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

What are typical Hgb goals?

Male: >13 Female: >12

Routine monitoring of anemia in CKD should be done when __

SCr >/=2

What are common causes of anemia?

deficiency cancer chronic kidney disease

What is mean corpuscular hemoglobin (MCH)?

hemoglobin amount per red blood cell

What is mean corpuscular volume (MCV)?

the average size of the red blood cell

What is mean corpuscular hemoglobin concentration (MCHC)?

amount go Hgb relative to size of the cell

What does serum ferritin assess?

iron deficiency or overload

What does serum transferrin saturation (TSAT) assess?

amount of readily available iron for erythopoiesis

What is total iron-binding capacity (TIBC)?

indirect measurement of iron-binding capacity of serum transferrin

Where is iron stored in the body?

liver, spleen, and bone marrow

What is normal iron content of the body?

3-4g

Absorbed iron circulates bound to __

transferrin

What is Hepcidin?

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

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

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

Erythropoiesis is regulated by __

a feedback loop

__ is the leading cause of death in patients with ESRD

heart disease

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

LVH

In concentric LVH, the wall __

thickens

In eccentric LVH, the wall __

stretches too much and becomes mishaped

Iron is critical for __ synthesis

Hgb

Low serum iron and high TIBC indicate __

anemia of chronic disease

Low serum iron and low TIBC indicate __

infection, malignancy, inflammation, liver disease, and uremia

In CKD, what should be initiate before epoetin therapy?

iron replacement

What are examples of anemia management options?

r-HuEPO Epogen Procrit Aranesp Mircera

Retacrit is indicated for

anemia in patients receiving dialysis HIV taking zidovudine cancer receiving chemotherapy

ESA is dosed (daily/weekly/monthly)

weekly

Epogen is measured in

units

Aranespt is measured in

mcg

What are common adverse effects with Aranesp?

hypertension, infection, hypotension, myalgia, diarrhea, nausea

When should dose adjustment be made in ESAs?

Hgb >11 or <8 changes of about 25%

What are factors that limit ESA response?

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

T or F: ESA therapy utilizes existing iron stores

true

What is the oral elemental iron goal per day?

65mg

What oral iron preparation contains 65mg of elemental iron?

ferrous sulfate 325mg

What are the limitations to oral iron therapy?

absorption dose to response interactions with medications side effects

Anaphylaxis may happen with which iron preparation?

iron dextran IV

What is the recommended loading dose for iron dextran?

total of 1gm divided

Which iron infusion is not recommended?

iron gluconate

What are risks and warnings associate with ESAs?

increased mortality serious CV events thromboembolic events stroke

What is the mechanism of action of Daprodustat?

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

What are the five reasons to dialyze someone?

Acid/base Electrolytes Intoxication O- Fluid overload Uremia

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

reabsorption and secretion of ingested substances endocrine function

What is the goal of dialysis in AKI?

renal support volume management administration of IV fluids and nutrition

What is the goal of dialysis in CKD?

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

What is an arteriovenous fistula?

surgical joining of an artery and vein

What is an arteriovenous graft?

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

When are AV grafts preferred over AV fistulas?

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

What are the two types of catheters used for dialysis?

subclavian vein insertion internal jugular vein insertion

How is thrill assessed?

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

How is bruit assessed?

listen with stethoscope whoosh of blood through access site

Dialysate does not contain __

phosphorus, urea, creatinine

What are examples of hemodialysis complications?

hypotension hypovolemia and excessive ultrafiltration pruritis muscle cramps infection

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

midodrine alpha-1 agonist

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

high

Some possible causes of dialysis disequilibrium syndrome are __

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

What are contraindications to peritoneal dialysis?

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

Dialysate is mostly a __ containing solution

glucose

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

lactate

What is icodextrin (Extraneal)?

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

Dialysate choice and glucose concentration is based on __

volume removal goal

What is the clinical presentation of PD associated peritonitis?

cloudy dialysate abdominal pain abdominal tenderness fever nausea

What are the most common organisms associated with PD peritonitis?

Staphylococcus epidermis Staphylococcus aureus

What is empiric treatment for PD related peritonitis?

heparin cefazolin and ceftazidime

PD exit site infections are usually caused by which bacteria?

Gram positive Staph epi or aureus

How is a PD exit site infection treated?

cephalosporin for 14 days

What are advantages to hemodialysis?

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

What are advantages to peritoneal dialysis?

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

What are disadvantages of hemodialysis?

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

What are disadvantages of peritoneal dialysis?

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

What are key CKD dialysis issues?

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

What are risks for drug-induced nephrotoxicity?

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

What is the presentation of drug-induced nephrotoxicity?

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

What is SCr dependent on?

muscle mass

What are clinical clues of drug-induced nephrotoxicity?

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

What can cause a decrease in intraglomerular pressure?

ACE/ARB dehydration CHF

What can cause a decrease in renal blood flow?

dehydration CHF

What can cause vasoconstriction of the afferent arteriole?

NSAIDs

What can cause vasodilation of the efferent arteriole?

ACE/ARB

How can you prevent ACE/ARE-induced nephrotoxicity?

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

Is renal failure from NSAIDs reversible?

yes, if recognized early

What are dose-related problems with cyclosporine and tacrolimus?

vasoconstriction and injury

Triamterene with HCTZ is __

reversible

Triamterene with Indomethacin may induce __

renal ischemia

What can cause pseudo-renal failure?

fever pregnancy corticosteroid and tetracycline therapy

What is pseudo-renal failure?

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

What is acute tubular necrosis?

inability to concentrate urine

What are risk factors for aminoglycoside nephrotoxicity?

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

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

radio-contrast-induced nephropathy

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

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

How can CIN be prevented?

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

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

cisplatin

Cisplatin and Carboplatin cause __ losses. Examples

electrolyte losses hypomagnesemia hypocalcemia hypokalemia

What can be done to prevent AmphoB nephrotoxicity?

limit cumulative dose avoid concomitant nephrotoxins hydration damage may be irreversible

What are some clinical indicators of allergic interstitial nephritis?

pyuria eosinophilia tubular dysfunction hematuria oliguria

What medications can cause allergic interstitial nephritis?

PPIs penicillins sulfa NSAIDs cox-2 inhibitors

What should be done if someone develops AIN?

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

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

aristolochic acid

How is papillary necrosis caused?

excess consumption of combinations of analgesics Phenacetin Caffeine combination analgesics

Nephrocalcinosis can be caused by what medications?

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

Nephrocalcinosis is related with what electrolyte imbalance?

hyperphosphatemia

Intratubular precipitation can be caused by what medications?

Sulfonamides and sulfadiazine methotrexate acyclovir ascorbic acid calcium carbonate triamterene foscarnet

Patients with declining renal function are more likely to:

co-morbidities multiple medications OTC medications nutritional supplements herbal remedies

What are the changes in absorption in CKD?

uremic gastritis gastroparesis alkaline pH decreased liver metabolism

What are the changes in distribution in CKD?

lower serum albumin, decreased protein binding alterations in tissue binding

__ has an increased VD in patients with CKD

Cefazolin

__ has a decreased VD in patients with CKD

Digoxin

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

protein binding

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

Digoxin Morphine Meperidine Lithium Phenytoin Antineoplastic agents (Methotrexate)

What are examples of concentration-dependent antibiotics?

ahminoglycosides amphotericin B fluoroquinolones

What are examples of time-dependent antibiotics?

penicillins cephalosporins carbapenems vancomycin oxazolidinones macrolides

What are the three dose-adjustment methods?

interval extension dosage reduction both

Drug half-life is dependent on __ and __

volume of distribution drug elimination/clearance

Schedule drug administration before or after hemodialysis session

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

What is the most common inflammatory arthritis in the US?

gout

What are the two types of gout?

over-producer under-excreter

Solubility of uric acid is dependent on __ and __

concentration body temperature

What are tophi or microtophi?

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

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

inflammatory

Uric acid crystals diminish activity of __

osteoblasts

What are risk factors for high uric acid and gout?

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

What are drugs associated with hyperuricemia?

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

What are the treatments for an acute gout attack?

NSAIDs colchicine glucocorticoids anakinra

Should rate lowering therapy be started during an acute attack?

NSAIDs increase __ and __ retention

sodium water

Avoid colchicine in __ and __ impairment

renal hepatic

What glucocorticoids can be used?

triamcinolone IA Prednisone oral

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

a rebound attack

What class is anakinra?

recombinant IL-1 receptor antagonist

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

cold

Corticotropin requires intact __

pituitary adrenal axis

Rate-lowering agents are indicated in patients with __

recurrent acute attacks arthropathy top or radiographic changes of gout

Serum uric acid goal is __

6 mg/dL

What medications are xanthine oxidase inhibitors?

allopurinol febuxostat

What medications are uricosurics?

probenecid sulfinpyrazine

Dose reduction of allopurinol is necessary in __

renal insufficiency

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

xanthine oxidase inhibitors uricosurics

Allopurinol has a risk of __

bone marrow suppression

Febuxostat has a risk of

CV related mortality

What is the preferred antihypertensive in gout?

losartan

What are the different types of renal calculi?

calcium oxalate calcium phosphate struvite urate cystine

Stone formation happens when the urine becomes __

supersaturated

What are electrolyte/diet risk factors for calcium stones?

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

What are disease/surgery risk factors for calcium stones?

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

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

indinavir triamterene

What drugs cause calcium stone formation?

antacids loop diuretics

What drugs cause uric acid stone formation?

salicylates probenecid

What drugs can cause xanthine stone formation?

allopurinol

What are symptoms of renal calculi?

severe flank pain hematuria nausea/vomiting

What medications are used for pain control for nephrolethiasis?

ketorolac morphine meperidine

What antiemetics are used for nephrolethiasis?

metoclopramide promethazine prochlorperazine hydroxyzine

What drugs relax pelvic musculature to in nephrolethiasis?

desmopressin nifedipine tamsulosin

What is used for infection prophylaxis in kidney stones?

Bactrim DS

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

Amphotericin B and carboplatin

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

free drug

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

30 minutes after a hemodialysis session

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

no change to the dose or interval

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

Maculopapular rash with fever and eosinophilia

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

Cyclosporine and lithium

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

Tetracycline because it can cause pseudo renal failure

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

increased half-life

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

Hemodynamically mediated

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

Methotrexate

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

Indomethacin

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

Nausea

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

Low sucrose and fructose diet

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

Desmopressin

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

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

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

Ketorolac IV 30 mg every 8 hours

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

history of liver disease

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

Rebound gout attack when prednisone is stopped

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

allopurinol

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

decreases inflammation during an acute gout attack

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

Low urine volume along with a diet high in dietary sodium

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

Hydrochlorothiazide

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

Febuxostat 40 mg po once daily

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

Calcium Channel Blocker

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

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