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Coexisting Diseases > Renal > Flashcards

Renal Flashcards

1
Q

Aldosterone does what with Na?

A

increased Na reabsorption

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2
Q

______________ causes increased H2O reabsorption in the collecting duct

A

Vasopressin

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3
Q

Reduced SNS and _____________ release enhances vasodilation and filtered Na with Hypervolemia

A

angiotensin II

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4
Q

Normal auto-regulation of RBF and GFR is between _____-_____mmHg

A

80-180

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5
Q

Any decrease in RBF causes a release of _____________ which will cause renal vasoconstriction

A

Renin

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6
Q

Why should Tordal not be used in patients with renal disease?

A

It will inhibit the prostaglandin production via enzymes phospolipase A2 & cyclooxygenase and leave the kidney more prone to ischemic damage

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7
Q

________________ oppose the actions of angiotensin II, SNS, ADH to balance a decrease in RBF produced by physiological stress and increase UO

A

prostaglandins

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8
Q

__________ has inotropic effects with diuretic activity.

A

Dopamine

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9
Q

Dopamine can be used at doses of ________________ for renal protection

A

1-2mcg/kg/min

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10
Q

Why would you avoid spinal/ epidural anesthesia in a renal pt?

A

If they are in full renal failure and can’t receive fluid boluses to help with blood pressure drop and depend on RBF for function.

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11
Q

A ____-_____ sympathectomy will decrease release of catecholamines, renin, and vasopressin

A

T4 – T10

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12
Q

The concern with volatile agents and renal function is due to the production of ______________.

A

Free Flouride Ions

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13
Q

The most renally toxic to least (5) are:

A

Enflurane>sevo>Iso>Des>Halothane

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14
Q

Sevoflurane produces _______________ and you should do what to prevent renal injury?

A

Compound A

increase FGF >2L

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15
Q

What effect does positive pressure ventilation have on RBF?

A

The greater the PIP & PEEP, the greater the decrease in RBF, GFR, and UO

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16
Q

How do you overcome the changes on RBF during Positive Pressure Ventilation?

A

Give hydration to increase the preload

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17
Q

What is the definition of preoperative oliguira?

A

UO

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18
Q

Pre-renal causes of oliguria are:

A

Hypovolemia

Decreased CO

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19
Q

Renal causes of periop oliguria include:

A

Acute Tubuluar Necrosis: renal ischemia, nephrotoxic drugs, Release of Hbg or myoglobin (MH, transfusion reaction, ect)

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20
Q

Careful with Halothane and renal failure b/c……

A

Renal failure pt’s usually have higher K+’s and Halothane causes cardiac irritability

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21
Q

2 drugs that are absolutely contraindicated bc they are eliminated by the kidney unchanged are:

A

gallamine and phenobarbital

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22
Q

Renal pt’s will often need more or less in terms of dosing?

A

less - d/t anemia and decreased plasma proteins

23
Q

The best opioid to use in Renal failure is:

A

fentanyl

24
Q

The opioid that MUST be avoided in renal failure is:

A

Meperidine (normeperidine metabolite)

25
Q

_____________ & ______________ are opioids with active metabolites that you’ll only give 1 time doses to pt’s in renal failure

A

Morphine and Hydromorphone

26
Q

Which induction medications are highly protein bound and therefore RF pt’s will require a lower dose with?

A

Thiopental, Dexmedetomidine, Midazolam

27
Q

Which 3 muscle relaxants must you avoid in RF?

A

D-tubocurarine, metocurine, gallamine

28
Q

Which 3 muscle relaxants do you probably want to avoid in RF?

A

Pancuronium, Pipecurium, doxacurium

29
Q

Which 2 muscle relaxants are okay to give in single doses to pt’s in RF?

A

Vecuronium & Rocuronium

30
Q

Which 3 muscle relaxants are most appropriate for RF patients?

A

cisatracurium, atracurium, mivacurium

31
Q

What are you concerned about with Sch and RF patients?

A

caution with K+, single dose OKAY if K+ is normal. Has active metabolite, succinylmonocholine

32
Q

______________ is the most common cause of death in RF patients

A

infection

33
Q

Your patient in RF requires atropine and or glycopyrrolate, what should you do?

A

Decrease dose d/t potential for accumulation

34
Q

Anesthetic considerations with scopolamine and RF?

A

DO NOT give it d/t CNS effects

35
Q

H2 blockers and RF?

A

Do not give reglan, it will accumulate. H2 blockers are highly dependent on renal excretion

36
Q

Which induction drug is the safest to use in RF?

A

Etomidate

37
Q

Which induction drug do you probably want to avoid in RF?

A

Ketamine - HTN (and these pt’s are usually already Hypertensive)

38
Q

How much does Sch usually increase the K+ by in a normal healthy person?

A

.5 - 1mEq/l

39
Q

You want to be careful with positioning and RF pt’s why?

A

Hypocalcemia (fracture risk)

neuropathies (median and common peroneal most common)

40
Q

__________ is in IHA causes an increase in K & acidosis & can lead to myocardial irritability

A

halothane

41
Q

which two inhalational agents should you certainly avoid in RF?

A

Halothane and enflurane

42
Q

Which two inhalational agents are safest for RF pt’s d/t no dependence on kidney for elimination?

A

Iso and Des

43
Q

What is the concern with RF and reversal agents?

A

They are primarily excreted renally and will have a prolonged half life.

44
Q

Under anesthesia, if your RF patient needs diuresis, how much lasix should you give?

A

very small doses!! 5mg

45
Q

Your RF pt is coming in for a AV fistula shunt placement. Would regional be a good choice? why and why not?

A

Yes - for vasodilation

No - coagulapathy and more at risk for seizure with toxicity

46
Q

Would you rather use alpha or beta adrenergic agents for hypotension in your RF patient?

A

Beta - does not result in renal vasoconstriction but increases myocardial irritability

47
Q

Which GI prophylaxis med would i want to avoid in my RF patient?

A

Reglan

48
Q

To give Regional anesthesia for a cystoscopy, I would want to do sensory level at _____ block but would know that the __________ nerve would not be blocked.

A

T10

Obturator

49
Q

What is TURP syndrome?

A

systemic absorption of irrigating fluid in venous sinuses around prostate leads to hyponatremia

50
Q

To help prevent TURP syndrome, what are 2 important things we can do?

A
  • limit the height of the fluid bags to less than 40cm above prostate
  • limit resection time to less than 1hr
51
Q

What are the ESWL shock waves timed to?

A

20ms after the R wave ( Ventricular refractory period)

52
Q

Would you want to use GA or RA for a ESWL?

A

Light GA with muscle relaxant to control diaphragmatic excursion (want it decreased)

53
Q

If you did a regional anesthetic on your ESWL patient, what level of blockade would you require?

A

T6 - and this is very uncomfortable because they can’t feel their respirations.

54
Q

How would you describe the desired respirations during a ESWL procedure?

A

Short, frequent, small TV’s (jet ventilation can be helpful)

Coexisting Diseases (4 decks)

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