Renal 2 Flashcards

1
Q

Where do Thiazides act in the kidney and what do they do?

A

Act on the distal tubule

Prevent uptake of Na and H20

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2
Q

What are the indications of Thiazides?

A

1) Cardiac Failure
2) CKD
3) Hypertension
4) Nephrotic syndrome

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3
Q

What is the possible side effect of Thiazides?

A

Hypovolaemia

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4
Q

Where does spiralactone act in the kidneys?

A

Inhibits aldosterone

Prevents the uptake of Na, Cl and H20 in exchange for K+

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5
Q

What are the indications for spiralactone?

A

Cardiac failure

Liver cirrhosis

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6
Q

What is the possible side effect of spiralactone?

A

Hyperkalaemia

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7
Q

How does amiloride act on the kidneys?

A

Inhibits sodium reabsorption in exchange for potassium

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8
Q

What are the indications of amiloride?

A

To prevent hypokalaemia

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9
Q

What is the possible side effect of amiloride?

A

Hyperkalaemia

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10
Q

What are the 6 types of drugs used in CKD?

A

1) Anti hypertensives
2) Diuretics
3) Sodium bicarbonate
4) Statins
5) Vitamin D analogues
6) Erythropoeitin

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11
Q

Alpha calcidol is an example of what kind of drug?

A

Vitamin D analogue

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12
Q

How do Vitamin D analogues work?

A

Hydroxylated in the liver to an active form

Increase uptake of phosphate and calcium from the gut

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13
Q

What are the 2 possible side effects of vit D analogues?

A

1) Hyperphosphataemia

2) Hypercalcaemia

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14
Q

What are the 2 possible side effects of the use of Epo?

A

Hypertension

Pure Red Cell aplasia

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15
Q

Why are NSAIDs potentially nephrotoxic?

A

Inhibit the formation of prostaglandins

Prostaglandins vasodilate the afferent arteriole

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16
Q

Why are ACEi and ARBs potentially nephrotoxic?

A

They inhibit Ang II which vasoconstricts the efferent arteriole to increase trans glomerular pressure

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17
Q

Penicillins are potentially nephrotoxic as they cause what kidney problem?

A

Acute interstital nephritis

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18
Q

What can accumulation of penicillins in CKD lead to?

A

Seizures

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19
Q

What can accumulation of opiods in CKD lead to and what kind of preparations should be avoided?

A

CNS side effects and respiratory depression

Slow release preparations should be avoided

20
Q

Digoxin is excreted via the kidneys, what can its accumulation lead to?

A

Bradychardia
Visual disturbances
Mental confusion
Aggravate hyperkalaemia

21
Q

Hypoglycaemic agents are also renally excreted what kind of agents should you avoid in CKD/AKI to avoid hypoglycaemia?

A

Long acting agents should be avoided

22
Q

What can accumulation of metformin (which is renally excreted lead to)?

A

Lactic acidosis

Hypoglycaemia

23
Q

What is herbal medicine Cat’s Claw indicated in causing?

A

AKI and hypotension with anti hypertensives

24
Q

What is the primary determinant in water distribution in the body?

A

Osmotic pressure

25
Q

What electrolyte mostly determines extracellular volume?

A

Na as its primarily extracellular

26
Q

By how much does total body fluid fluctuate?

A

Less than 1%

27
Q

Where is more than half of total body water contained?

A

Intracellulary

28
Q

Where is K+ primarily in the body?

A

Intracellularly

29
Q

What are routine maintenance fluids?

A

Fluids given by the IV route as the oral route is not possible
Essential electrolytes are also given to prevent depletion

30
Q

What are your daily requirements of Na, K and H2O?

A

Sodium - 50-100mmol
Potassium - 40-80mmol
Water - 1.5-2.5L

31
Q

What type of fluids are used for routine maintenance fluids?

A

Crystalloids

Dextrose/ NaCl

32
Q

Why should electrolytes be monitored when a patient is receiving routine maintenance fluids?

A

Risk of hyponatraemia if give too much water

33
Q

What are replacement fluids?

A

Assessmant of fluid loss is made and then IV fluids given to replace this loss eg. After diarrhoea/Vomiting/blood loss/burns

34
Q

What 4 electrolytes can be added to replacement fluids?

A

1) Calcium
2) Magnesium
3) Potassium
4) Phosphate

35
Q

What kind of fluids are used for replacement fluids?

A

Crystalloid fluids

36
Q

When are resuscitation fluids used?

A

When hypovolaemia is insufficient to maintain tissue perfusion

37
Q

What is the difference between true hypovolaemia and relative hypovolaemia?

A

True hypovolaemia - When there is actual fluid loss from the body - the rate of fluid loss from ECF exceeds net intake eg. Haemorrhage
Relative hypovolaemia - Decrease in effective circulating volume eg. Sepsis

38
Q

What is the difference between NaCl and Hartmann’s solution used as resuscitation fluids and what are the risks with either?

A

Hartmann’s is more physiological as contains, Na, Cl, Calcium, Lactate and Potassium
NaCl - risk of hyperchloraemic (normal anion gap) metabollic acidosis
Hartmanns - risk of hyperkalaemia

39
Q

Blood can also be used as a resuscitation fluid, after how many units of blood should clotting factors be administrated?>

A

After around 4 units

40
Q

What is the difference between crystalloids and colloids?

A
Crystalloids = water to which electrolytes have been added, low sodium disperse through intracellular and extracellular compartments, high sodium disseminate into extracellular compartments
Colloids = Fluids that contain large proteins or other similarly sized molecules, stay in intravascular space for a long period of time, used to increase intravascular volume, large volumes without free water can cause a hyperoncotic state
41
Q

What does BUFALO stand for in the surviving SEPSIS campaign?

A
B - do blood cultures and septic screen
U - assess urine output, UandE, Urine culture
F - Fluid resuscitation
A - Give IV Abx
L - Measure lactate and Hb
O - Give O2 to correct hypoxia
42
Q

What is the difference between diffusion and convection?

A
Diffusion = movement of substances due to a diffusion gradient
Convection = mass movement of solute owing to movement of fluid due to increased transmembrane pressure
43
Q

What are the 2 types of peritoneal dialysis?

A

Automated PD - machine performs PD overnight

Continuous ambulatory PD (CAPD) - Manual changes 3-4 times a day

44
Q

What is SEPSIS?

A

Systemic inflammatory response with an infective cause

45
Q

What is the treatment for hyperkalaemia in an acute setting?

A

1) Calcium gluconarate (cardio protective as stabilises myocytes) 10ml , 10%
2) Salbutamol 5mg 4x day with a nebuliser
3) Insulin and glucose (insulin drives potassium into cells and you give glucose to prevent hypoglycaemia) 50ml 50% + 10 units insulin

46
Q

What kind of hyperparathyroidism can occur in CKD?

A

Secondary