Renal And Heptic Dysfunction

Question 1

What is loading dose based on?

Answer 1

Volume of distribution

Question 2

When is a loading dose required?

Answer 2

1. drug has a long half-life

2. need to rapidly achieve the desired steady-state concentration

Question 3

Maintenance dose is based on what?

Answer 3

Drug clearance

Question 4

Goal for maintenance dose?

Answer 4

Maintain therapeutic steady-state drug concentration

Question 5

Process of eliminating a drug from the body?

Answer 5

Drug excretion

Question 6

Drugs excrete in urine are (3)

Answer 6

1. Water-soluble
2. Polarized (charged)
3. Small particle size

Question 7

Clearance significantly is what in presence of renal insufficiency?

Answer 7

Diminished

Question 8

GA may reduce renal blood flow up to what % in pts?

Answer 8

50%

Question 9

Lipid soluble drugs are not readily removed by kidneys and require what?

Answer 9

Hepatic metabolism to increase water solubility

Question 10

CKD stage 1 GFR:

Answer 10

> 90

Question 11

CKD stage 2 GFR:

Answer 11

60-89

Question 12

CKD stage 3a GFR:

Answer 12

45-59

Question 13

CKD stage 3b GFR:

Answer 13

30-44

Question 14

CKD stage 4 GFR:

Answer 14

15-29

Question 15

CKD stage 5 GFR:

Answer 15

<15

Question 16

What is the primary equation employed both to estimate kidney function in drug development and to direct subsequent dosing recommendation?

Answer 16

Cockcroft-Gault (CG)

Question 17

Which equation is most accurate estimation of GFR but documentation of its utility for drug dosing is limited?

Answer 17

CKD-EPI

Question 18

What is the bottomline key to renal drug dosing?

Answer 18

Measure renal function and adjust dose according to package insert recommendations

Question 19

Which 2 additional drugs are administered cautiously bc of potential for the accumulation of active metabolite?

Answer 19

Diazepam and midazolam

Question 20

Which 3 drugs have no effect with renal impairment?

Answer 20

Alfentanil
Remifentanil
Sufentanil

Question 21

Which during should you avoid if you have renal impairment?

Answer 21

Meperidine

Question 22

AKI is defined as what 3 things?

Answer 22

1. Increase in SCr >.3mg/dL within 48hrs
2. Increase in SCr >1.5 times baseline which is known or have occurred within 7 days
3. Urine volume

Question 23

AKI consider critically ill pt whose SCr acutely changes form 1 mg/dL to what overnight?

Answer 23

2 mg/dL

Question 24

What equation is used to diagnosis and estimate renal function for AKI?

Answer 24

Jelliffe’s

Question 25

Prehepatic bilirubin?

Answer 25

Increased unconjugated fraction

Question 26

Intrahepatic and posthepatic bilirubin?

Answer 26

Increased conjugated fraction

Question 27

Increase of what, causing normal drug dose to have toxic effect in hepatic dysfunction?

Answer 27

Levels of bioavailable drug

Question 28

Drug levels and effects for an individual drug are what and do not correlate well with the type of liver injury, its severity, or liver function test results?

Answer 28

UNPREDICTABLE

Question 29

What are the 3 major parameters that determine drug elimination by the liver?

Answer 29

1. Blood flow through the liver 2. Free drug level (NOT protein bound) 3. Intrinsic ability of hepatic enzymes to metabolize the drug

Question 30

Impact of hepatic dysfunction on drug disposition is related to what 2 things?

Answer 30

1. Type and severity of liver disease | 2. Physiochemical and pharmacokinetic characteristics of drug

Question 31

What kind of protein binding is more likely to be affected?

Answer 31

Highly bound

Question 32

Clearance dependent on intrinsic activity of metabolizing enzymes

Answer 32

Low extraction ratio

Question 33

Hepatic clearance dependent on hepatic BF; drug removed from blood rapidly as it is presented to the liver

Answer 33

High extraction ratio

Question 34

Child Pugh class: proceed with surgery; monitor and treat encephalopathy, coagulopathy, metabolic and electrolyte derangements

Answer 34

A or B

Question 35

Child-Pugh class: prefer non surgical treatment options; defer necessary elective surgery until improvement

Answer 35

C

Question 36

Child-Pugh class: defer elective surgery until clinical improvement

Answer 36

Acute hepatic dysfunction

Question 37

What kind of induction doses with liver disease?

Answer 37

Smaller

Question 38

Which NMB are safest for liver disease?

Answer 38

Cisatracurium and atracurium

Question 39

What kind of dosage for roc and vec with liver disease?

Answer 39

Reductions

Question 40

What is the plasma cholinesterase in advanced liver disease when considering sux?

Answer 40

Decreased

Question 41

Opiates doses and intervals in liver disease?

Answer 41

Lower doses and longer dosing intervals

Question 42

Which is the safest opiate with liver disease?

Answer 42

Remifentanil

Question 43

Which 2 opiates have minimal affect by the liver function?

Answer 43

Alfentanil and fentanyl

Question 44

Which opiate should be avoided in liver disease?

Answer 44

Meperidine

Question 45

What are the 2 primary determinants of benzodiazepine elimination?

Answer 45

Protein binding and hepatic metabolism

Question 46

Doses of midazolam in liver disease?

Answer 46

Reduced doses and titrate to effect