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Pharm III Final > Renal > Flashcards

Renal Flashcards

1
Q

Indication/MOA for Carvedilol

A

CHF
CAD
HTN

MOA - rate and BP control

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2
Q

Indication/MOA for Lisinopril

A

CHF
CKD
HTN

MOA - RAAS inhibitor/ BP control

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3
Q

Indication/MOA for Furosemide

A

CHF

MOA - diuretic

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4
Q

Indication/MOA for Coumadin

A

A fib

MOA - “blood thinner”

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5
Q

Indication/MOA for Digoxin

A

CHF
Afib

MOA - inotrope/rate control

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6
Q

What can happen if you combine digoxin and furosemide?

A

Loop diuretics can cause hypokalemia

Hypokalemia —> increased risk of digoxin toxicity

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7
Q

What can happen if you mix digoxin and carvedilol?

A

Risk of bradycardia and AV block

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8
Q

What can happen if you mix furosemide, carvedilol, and lisinopril?

A

All can lower BP —> increased risk of hypotension

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9
Q

What does digoxin toxicity look like?

A

CARDIAC ARRHYTHMIAS

GI - anorexia, N/V/D, abdominal pain

Neuro - confusion, weakness, lethargy, fatigue, delirium, disorientation

Visual disturbances

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10
Q

What do we need to know about the pharmacodynamics of digoxin?

A

Cleared RENALLY

Half-life = 1.5-2 days, 3.5-5 days if anuric

NARROW MARGIN OF SAFETY

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11
Q

Does serum digoxin level correlate with toxicity?

A

Not necessarily

Ideally, sample should be collected >6 hours after last dose

Toxic level >2ng/mL

Possible to have the following:
• Asymptomatic pt with toxic level
• Significant toxicity with a therapeutic range serum level

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12
Q

How do you manage a digoxin-induced AKI?

A

Appropriate fluid resuscitation
Monitor I&Os
Replenish/monitor potassium

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13
Q

Why do you get hyperkalemia with ACE inhibitors?

A

B/c of decreased potassium excretion

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14
Q

What drugs can affect GFR?

A

Lisinopril and Ibuprofen

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15
Q

How do ACE inhibitors affect GFR?

A

Vasodilator Effect on the EFFERENT arteriole —> causes back up in the glomerulus

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16
Q

How do NSAIDs affect GFR?

A

Vasoconstriction of the AFFERENT arteriole —> more flow through the glomerulus

17
Q

How will you manage an ibuprofen/lisinopril induced AKI?

A 
Begin IVF with NSs
Monitor I&Os
Management of hyperkalemia (including d/c lisinopril)
Consult nephrology - dialysis?
D/c ibuprofen
18
Q

Name the stage of renal disease:

Kidney damage w/ normal or inc GFR (≥90)

A

Stage 1

19
Q

Name the stage of renal disease:

Kidney damage with normal or decreased GFR (60-89)

A

Stage 2

20
Q

Name the stage of renal disease:

Mild-mod reduced GFR (45-59)

A

Stage 3a

21
Q

Name the stage of renal disease:

Moderate to severe reduced GFR (30-44)

A

Stage 3b

22
Q

Name the stage of renal disease:

Severely reduced GFR (15-29)

A

Stage 4

23
Q

Name the stage of renal disease:

Kidney failure (<15 or on dialysis)

A

Stage 5

Add “D” if on dialysis

24
Q

What is the CURB-65 criteria?

A

For determining if you patient with PNA needs admission

Confusion
Urea >7 (or BUN >20)
Respiratory rate ≥30 
BP <90/60
65 years or older
25
Q

Would a patient with PNA be considered uncomplicated or complicated if they also have DM?

A

Complicated

26
Q

What do you need to think about when prescribing abx for a patient’s PNA if they have kidney disease/injury?

A

Allergies
Route (IV vs PO)
Renal dosing

27
Q

What do we use to determine renal dosing?

A

Use different equations to measure estimated creatinine clearance or eGFR
• CKD-EPI (newest)
• MDRD
• Cockcroft and Gault (oldest)

28
Q

What would be a good option for outpatient CAP for a diabetic patient?

A

Levofloxacin, adjusted for CrCl (if GFR<50, give q48 hours instead of qd b/c not cleared as quickly)

29
Q

What are we worried about in a patient taking metformin in the setting of kidney disease/impairment?

A

Lactic Acidosis

Advise the patient to stop taking it in cases of N/V or dehydration

30
Q

What medications for acute cystitis require renal dosing?

A

Bactrim - for CrCl <30 ml/min reduce dose by 50% (avoid in pt with CrCl <15 ml/min)

Pyridium - for CrCl 50-80 give q 12-16 hours, contraindicated if CrCl<50

Nitrofurantoin (Macrobid)

31
Q

What is the Beers Criteria?

A

Use bactrim with caution in patients with decreased kidney function who are receiving ACE/ARBs b/c elevated risk of hyperkalemia

32
Q

Common meds that require renal dosing

A 
Nitrofurantoin
Allopurinol
Acyclovir
Gabapentin
Preganglionic
Metoclopramide
Ranitidine
Rivaroxaban
Enoxaparin
Lithium
Clarithromycin
Gentamicin
Vancomycin

Pharm III Final (8 decks)

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