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Renal disease > renal > Flashcards

renal Flashcards

1
Q

Aluminum hydroxide

A

AlternaGel, Amphojel

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2
Q

Calcium acetate

A

PhosLo, Phoslyra

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3
Q

Calcium carbonate

A

Tums

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4
Q

Lanthanum carbonate

A

Fosrenol

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5
Q

Sevelamer carbonate

A

Renvela

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6
Q

Sevelamer hydrochloride

A

Renagel

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7
Q

Calcitriol

A

Rocaltrol, Calcijex

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8
Q

Doxercalciferol

A

Hectorol

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9
Q

Paricalcitrol

A

Zemplar

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10
Q

Cinacalcet

A

Sensipar

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11
Q

Fludrocortisone

A

Florinef

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12
Q

Sodium polystyrene sulfonate

A

Kayexelate

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13
Q

Sodium citrate/Citric acid

A

Bicitra, Cytra-2, Oracit, Shohl’s solution

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14
Q

What are the Aluminum-based phosphate binder?

A
  1. Aluminum hydroxide (AlternaGel, Amphojel)
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15
Q

Calcium based phosphate binders = First line therapy for hyperphoshatemia of CKD

A
  1. Calcium acetate (PhosLo, Phoslyra)

2. Calcium Carbonate (Tums)

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16
Q

What are the Aluminum free/Calcium free phosphate binders?

A
  1. Lanthanum carbonate (Fosrenol)

2. Sevelamer carbonate (Renvela)

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17
Q

How to take phosphate binder?

A

Take with food TID

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18
Q

How to take Fosrenol?

A

Must Chew thoroughly to reduce the risk of serious adverse GI events

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19
Q

What is the advantage of sevelamer carbonate over sevelamer hydrochloride?

A

*Carbonate maintaing bicarbonate concentrations is good because these patient tend to be acidotic so Bicarb will neutralize the acidosis

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20
Q

Which phosphate binders can lower total cholesterol and LDL by 15 - 30%?

A

Sevelamer (Renvela, Renagel)

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21
Q

What is the contraindication for fosrenol?

A

Patient with bowel obstruction, ileus, and fecal impaction

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22
Q

What are two form of Vitamin D ?

A
  1. D3 = cholecalciferol synthesized in skin

2. D2 = ergocalciferol produced from diet

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23
Q

Vitamin D analogs used to treat secondary hyperparathyroidism

A
  1. Calcitriol ( Rocaltrol, Calcijex)
  2. Doxercalciferol (Hectorol)
  3. Paricalcitol (Zemplar)
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24
Q

Calcimimetic used to treat secondary hyperparathyroidism

A

Cinacalcet ( Sensipar) = Doesn’t affect calcium level

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25
Q

What type of EKG changes occurs with hyperkalemia?

A
  1. flattened P wave

2. Elevated T wave

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26
Q

Treatment of metabolic acidosis of CKD

A

Bicarb in the form of

  1. Sodium bicarbonate (tab, granules, powder)
  2. Sodium Citrate/Citric acid (Oracit, Shohl’s solution)
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27
Q

What are the drugs that should not be used in severe renal impairment?

A
  1. Avanafil
  2. Bisphosphonates
  3. Chlorpropamide
    4.Dabigatran
  4. Duloxetine
  5. NSAIDs
  6. Glyburide
  7. Lithium
  8. Nitrofurantoin
  9. Potasisum sparing diurectics
  10. Tadalafil
    12 Tenofovir
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28
Q

What is the duration limitation associated with aluminum based phosphate binders?

A

Limited duration to 4 weeks

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29
Q

What are the complications associated with CKD?

A
  1. Anemia
  2. Bone abnormalities [ initially due to elevation of phosphorus, to compensate for hyperphosphatemia = increases release of PTH = overtime lead to secondary hyperparathyroidism]
  3. hyperkalemia
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30
Q

What are some drugs that *increases potassium levels *?

A
  1. Potassium sparing diuretics
  2. ACEIs/ARBs
  3. NSAIDs
  4. Cyclosporin/tacrolimus
  5. Heparin
  6. canaglifozin
  7. Bactrim
  8. supplements
  9. drospairenone OC (Yaz)
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31
Q

What can be given to stabilize the cardiac tissue due to low potassium ?

A

IV calcium

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32
Q

What are the options to lower potassium levels?

A
  1. remove sources of potassium intake
  2. enhance potassium uptake by the cells [ via Insulin + glucose=stimulate insulin secretion/prevent hypoglycemia]
  3. if pt has metabolic acidosis = Sodium bicarb
  4. nbeulized abluterol
  5. increase renal excretion w/ furosemide or fludrocortisone (Florinef)
  6. Cation exchange resin (Kayexolate /SPS)
  7. Emergeny dialysis
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33
Q

what are the most common causes of CKD

A

DM and HTN

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34
Q

what are complications that can arise due to CKD

A

anemia, bone and mineral metabolism, acid-base and electrolyte disturbances

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35
Q

what are the two types of dialysis

A

Hemodialysis and peritoneal dialysis

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36
Q

what are the factors that affect drug removal during dialysis

A

molecular size,
protein binding (highly protein bound drugs will generally not be removed),
plasma clearance (will not remove highly hepatic drugs),
volume of distribution (drugs with a large Vd will not be effectively removed), and the
dialysis membrane

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37
Q

what are some things that can be used to gauge the severity of kidney damage

A

SCr, albumin in the urine, BUN

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38
Q

what must you take into account when using SCr to estimate kidney function

A

degree of muscle mass and metabolism in the patient

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39
Q

what are some other things that affect the BUN

A

level of hydration, protein consumption BUN increases with renal impairment

40
Q

what is used as a marker of renal function in various estimating equations

A

serum creatinine

41
Q

what measures the amount of nitrogen that comes from the waste product urea

A

BUN

42
Q

what is mainly reabsorbed at the descending limb of the loop of henle

A

water

43
Q

what is primarily reabsorbed at the ascending limb of the loop of henle

A

Na, Cl

44
Q

what effect do loop diuretics have on calcium

A

they increase calcium absorption and long-term use of thiazide diuretics have a protective effect on bone

45
Q

where do loop diuretics act

A

inhibit Na/K pumps of ASCENDING limb of loop of henle

46
Q

where do TZD act

A

inhibit Na-Cl pump in distal tubule

47
Q

the collecting duct is primarily affected by

A

aldosterone and ADH

48
Q

what is the primary effect of aldosterone

A

increase Na, water retention and to lower K+

49
Q

what are drugs that are aldosterone antagonist (name the generic)

A

spironolactone, eplerenone, amiloride These block the effects of aldosterone and can cause an increase in serum potassium.

50
Q

what is the normal range for SCr

A

0.6 - 1.2 mg/dL

51
Q

when is the Cockcroft-Gault equation not preferabele

A

in young children, ESRD, when renal status is rapidly changing

52
Q

CrCL of what indicates dialysis

A

< 15

53
Q

when making an adjustment to a drug regimen based on CrCl what are your options

A

changing the dose (decreasing) or changing the dosing interval (extending)

54
Q

if a patient has poor renal clearance and they are on a aminoglycoside and quinolone what should you do

A

change the dosing interval since they have concentration dependent killing properties

55
Q

if a patient has poor renal clearance and they are on a Beta lactam what should you do

A

change the dose since they have time dependent killing properties

56
Q

if a patient has CKD and proteinuria what medication should they be on regardless of whether they also have DM

A

ACE-I or ARB they decrease proteinuria

57
Q

what are the main benefits of ACE-I/ARBs in CKD pt

A

preserve renal function, decrease proteinuria, and provide cardiovascular protection

58
Q

what may you see once you begin a CKD pt on an ACE-I or ARB

A

a 30% increase in their SCr (d/c if > 30% increase)

59
Q

what electrolyte is effected by ACE-I/ARBs and how

A

potassium, they increase serum K

60
Q

how long should a CKD patient be monitored when starting an ACE-I or ARB and what are you monitoring

A

monitor SCr and K for 1-2 weeks after initiation of therapy

61
Q

why do CKD patients become anemic

A

kidney produces EPO which declines as kidney function declines

62
Q

what are some foods high in phosphorous

A

dairy products, dark colored sodas, chocolate, nuts

63
Q

what type of phosphate binders are 1st line

A

calcium based such as calcium acetate and carbonate (PhosLo)

64
Q

what are the aluminum based phosphate binders

A

Alternagel. Should only be used short term to decrease phosphorous

65
Q

how do you initially treat hyperphosphatemia

A

dietary restrictions

66
Q

why must phosphate binders be taken with food

A

they only bind the phosphate coming from your diet. don’t take it after you eat, there is no point.

67
Q

what are the SE of using an aluminum based phosphate binder

A

constipation, osteomalacia, poor taste, intoxication (neurotoxicity)

68
Q

why are aluminum based phosphate binders not used much

A

accumulation b/c its renally cleared and potential for osteomalacia and aluminum intoxication

69
Q

what are the calcium based phosphate binders Brand (Generic)

A

PhosLo, Phoslyria (calcium acetate)

Tums (calcium carbonate- although calcium acetate binds more phosphorus than Tums)

70
Q

what are the SE of using a calcium based phosphate binder

A

constipation, hypercalcemia, nasea

71
Q

what are the aluminum and calcium free phosphate binders Brand (Generic)

A 
sevelamir (Renvela, Renagel),
 lanthinum carbonate (Fosrenol)
72
Q

elevation in PTH is primarily treated with

A

Vitamin D

73
Q

what form of Vit D is given to CKD patients

A

Calcitrol

74
Q

what is the effect of active Vit D3

A

increase calcium absorption from the gut, increase serum calcium concentrations, and inhibits PTH secretion

75
Q

how do calcimimetics works

A

increase sensitivity of calcium sensing receptor on PT gland therefore decreasing Ca, PTH, PO4 and preventing progression of bone disease

76
Q

calcimimetics are used to treat what condition

A

secondary hyperparathyroidism

77
Q

what is an example of a calcimimetic Brand (generic)

A

Sensipar (Cinacalcet)

78
Q

what is the normal range of potassium

A

3.5 - 5 meq/L

79
Q

what is the most abundant intracellular cation

A

potassium

80
Q

what is the most abundant extracellular cation

A

sodium

81
Q

what are some things that increase K+ excretion

A

diuretics (strongly loops, weakly TZD), aldosterone agonist, bicarbonate

82
Q

what effect does insulin have on potassium

A

causes it to shift inside the cells

83
Q

what is the most common cause of hyperkalemia

A

decrease renal excretion due to renal failure

84
Q

why are diabetics at a higher risk of having hyperkalemia

A

insulin deficiency

85
Q

what are some SSx a patient may experience when hyperkalemic

A

muscle weakness, bradycardia, fatal arrhythmias, paresthesias may occur

86
Q

why is calcium given to patients with hyperkalemia

A

to stabilize cardiac tissues therefore help prevent arrhythmias

87
Q

what can be given to enhance K+ uptake by cells

A

glucose + insulin

88
Q

why is glucose given along with insulin when treating hyperkalemia

A

to prevent hypoglycemia

89
Q

a patient is suffering from hypoaldosteronism and is now hyperkalemic what can you give them

A

fludrocortisone (Florinef)

90
Q

what cation exchange resin can be used to treat hyperkalemia

A

Kayexelate (SPS) can reduce K+ by 2 mEq/L

91
Q

what dosage forms does Kayexelate come in and what precaution must be taken with one of them

A

rectal (preferred in emergencies) and oral, don’t give sorbitol when giving orally due to risk of GI necrosis

92
Q

what are common side effects of kayexelate

A

decrease appetite, constipation, nausea, vomiting

93
Q

serum bicarbonates levels of what indicate starting treatment of metabolic acidosis

A

< 22 mEq/L

94
Q

what effect does sevelamer have on cholesterol

A

decreases ldl and cholesterol

95
Q

Which beta-lactam antibiotics are not adjusted for renal issues

A

Nafcillin
Oxacillin
Dicoloxacillin

Renal disease (1 decks)

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