Renal Flashcards
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
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
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
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
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
Phophorus reabsortion in the _____________________ is regulated by the parathyroid gland.
A. Distal Tubule
B. Collecting Tubule
C. Proximal tubule
D. Macula densa
Proximal tubule
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
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
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
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
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
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
Autoregulation is a response to changes in _________________________.
A. Glomerular filtration rate
B. Blood pressure
C. Waste products
D. Perfusion pressure
Perfusion pressure
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
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
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
What is an adverse effect of hypertonic saline? (Fluids 2 handout)
A. Hypokalemia
B. Hyperkalemia
C. Hypochloremia
D. Hyperchloremia
Hyperchloremia
The ability of solutes to generate a driving force is ______________________.
A. Osmolar gap
B. Osmolality
C. Tonicity
D. Diffusion
Tonicity
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
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.
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
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
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
TBW depletion or dehydration represents a loss of what type of fluid?
A. Hypotonic
B. Hypertonic
C. Isotonic
Hypotonic
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
- 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
- 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
- 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
- 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?
no
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
- 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
- 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
