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Su. Pharm 2 > Renal And Heptic Dysfunction > Flashcards

Renal And Heptic Dysfunction Flashcards

1
Q

What is loading dose based on?

A

Volume of distribution

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2
Q

When is a loading dose required?

A
  1. drug has a long half-life

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

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3
Q

Maintenance dose is based on what?

A

Drug clearance

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4
Q

Goal for maintenance dose?

A

Maintain therapeutic steady-state drug concentration

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5
Q

Process of eliminating a drug from the body?

A

Drug excretion

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6
Q

Drugs excrete in urine are (3)

A
  1. Water-soluble
  2. Polarized (charged)
  3. Small particle size
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7
Q

Clearance significantly is what in presence of renal insufficiency?

A

Diminished

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8
Q

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

A

50%

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9
Q

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

A

Hepatic metabolism to increase water solubility

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10
Q

CKD stage 1 GFR:

A

> 90

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11
Q

CKD stage 2 GFR:

A

60-89

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12
Q

CKD stage 3a GFR:

A

45-59

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13
Q

CKD stage 3b GFR:

A

30-44

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14
Q

CKD stage 4 GFR:

A

15-29

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15
Q

CKD stage 5 GFR:

A

<15

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16
Q

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

A

Cockcroft-Gault (CG)

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17
Q

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

A

CKD-EPI

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18
Q

What is the bottomline key to renal drug dosing?

A

Measure renal function and adjust dose according to package insert recommendations

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19
Q

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

A

Diazepam and midazolam

20
Q

Which 3 drugs have no effect with renal impairment?

A

Alfentanil
Remifentanil
Sufentanil

21
Q

Which during should you avoid if you have renal impairment?

A

Meperidine

22
Q

AKI is defined as what 3 things?

A
  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
23
Q

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

A

2 mg/dL

24
Q

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

A

Jelliffe’s

25
Q

Prehepatic bilirubin?

A

Increased unconjugated fraction

26
Q

Intrahepatic and posthepatic bilirubin?

A

Increased conjugated fraction

27
Q

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

A

Levels of bioavailable drug

28
Q

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?

A

UNPREDICTABLE

29
Q

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

A
  1. Blood flow through the liver
  2. Free drug level (NOT protein bound)
  3. Intrinsic ability of hepatic enzymes to metabolize the drug
30
Q

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

A
  1. Type and severity of liver disease

2. Physiochemical and pharmacokinetic characteristics of drug

31
Q

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

A

Highly bound

32
Q

Clearance dependent on intrinsic activity of metabolizing enzymes

A

Low extraction ratio

33
Q

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

A

High extraction ratio

34
Q

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

A

A or B

35
Q

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

A

C

36
Q

Child-Pugh class: defer elective surgery until clinical improvement

A

Acute hepatic dysfunction

37
Q

What kind of induction doses with liver disease?

A

Smaller

38
Q

Which NMB are safest for liver disease?

A

Cisatracurium and atracurium

39
Q

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

A

Reductions

40
Q

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

A

Decreased

41
Q

Opiates doses and intervals in liver disease?

A

Lower doses and longer dosing intervals

42
Q

Which is the safest opiate with liver disease?

A

Remifentanil

43
Q

Which 2 opiates have minimal affect by the liver function?

A

Alfentanil and fentanyl

44
Q

Which opiate should be avoided in liver disease?

A

Meperidine

45
Q

What are the 2 primary determinants of benzodiazepine elimination?

A

Protein binding and hepatic metabolism

46
Q

Doses of midazolam in liver disease?

A

Reduced doses and titrate to effect

Su. Pharm 2 (6 decks)

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