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naplex > Renal disease > Flashcards

Renal disease Flashcards

1
Q

2 most common causes of renal disease

A

diabetes and hypertension

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2
Q

acute kidney injury

A

sudden loss of kidney function due to non renal condition

(ex. drugs) often reversible/ temporary, but can be permanent.

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3
Q

common cause of AKI

A

dehydration
BUN:SCR
20:1 or greater

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4
Q

chronic kidney disease (ckd)

A

progressive loss of kidney function over months or years

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5
Q

ESRD (end stage renal disease)

A

BAD! total and permanent renal failure

dialysis (or transplant) is needed to perform functions of the kidneys

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6
Q

if the glomerulus is damaged some ___ passes into the urine and this is used along with glomeular filtration rate (GFR) to determine severity of kidney disease also called ____

A

albumin

nephropathy

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7
Q

thiazides work on the

A

distal convoluted tubule

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8
Q

afferent =

A

in

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9
Q

efferent=

A

out

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10
Q

SGLT2s work at the

A

proximal tubule

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11
Q

k sparing diuretics work at the

A

collecting duct

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12
Q

loops work at the

A

ascending loop of henle

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13
Q

antidiuretic hormone (ADH) is also called

A

vasopressin

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14
Q

loops inhibit the ___ pump

A

na-k pump

sodium potassium pump

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15
Q

loops lose ___

A

calcium
so calcium is decreased
can lead to decreased bone density if used long term

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16
Q

what pump do thiazides inhibit

A

na-cl

sodium chloride pump

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17
Q

thiazides increase ___

A

calcium and have a protective effect on bones overtime

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18
Q

spironolactone and epleronone increase

A

potassium

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19
Q

must know! select drugs that can cause kidney disease

A 
aminoglycosides
amphotericin b
cisplatin
cyclosporine/tacrolimus
loops
NSAIDS
polymyxins
radiographic contrast dye
vancomycin
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20
Q

for crcl use

A

actual body weight if less than IBW

IBW if normal weight by BMI

adjusted body weight if overweight by BMI

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21
Q

BUN is

A

blood urea nitrogen and measures the amount of nitrogen in the blood that comes from urea

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22
Q

two common lab markers for kidney function

A

increased BUN- but can also be a sign of dehydration

increased SCr

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23
Q

creatinine is a waste product of ___ metabolism

A

muscle

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24
Q

normal range for SCr

A

0.6-1.3

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25
Q

GFR is calculated using which two equations

A

MDRD- modification of diet in renal disease

CKD-EPI- chronic kidney disease epidemiology collaboration

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26
Q

____ is the primary protein that is measured in the urine to assess kidney diease

A

albumin

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27
Q

___ is sometimes referred to as proteinuria

A

albuminuria

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28
Q

aces and arbs increase what electrolyte

A

potassium

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29
Q

KDIGO

A

kidney disease improving global outcomes

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30
Q

what two things are measured to determine the degree of renal impairment

what are the levels that indicate a patient has ckd and requires specific treatments

A

GFR and albumin (ACR or AER)

GFR <60
Albuminuria (ACR or AER) 30 or greater

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31
Q

it’s important to control what two things in CKD for progression of disease

A

blood pressure

blood glucose

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32
Q

when starting tx with an ace or arb the baseline scr can increase by up to ___. this is expected and treatment should not be stopped. if scr increases by greater than ___ tx should be dc and patient will be referred to a nephrologist.

A

30%

30%

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33
Q

use an __ or __ if albuminuria is present acr or aer 30 or greater

A

ace or arb

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34
Q

basic principle of med dosing with impaired renal fx

A

dose adj. may be necessary when crcl is <60

when crcl is 30 or less additional adj. may be required or may be CI

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35
Q

renal fx

A

120 (normal)
60 (1/2 normal) dose adjust
30 (1/4 normal) CI/dose adjust

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36
Q

drugs that require decrease dose or increase interval in CKD

A 
aminoglycosides
beta lactam antibiotics (except nafcillin,oxacillin etc. and ceftriaxone)
fluconazole
quinolones (except moxifloxacin)
vancomycin

LMWHs (enoxaparin, dalteparin)
apixaban
rivaroxaban
dabigatran

H2RAs (famotidine, ranitidine)
metoclopramide

Bisphosphonates
Lithium

37
Q

drugs that are CI inCKD CRCL less than 60

A

macrobid

38
Q

drugs that are CI inCKD CRCL less than 50

A

TDF products
stribild, complera, atripla, symfi, symfi lo

voriconazole IV only

39
Q

drugs that are CI inCKD CRCL less than 30

A

TAF products
genvoya, biktarvy, descovy, odesefy, symtuza

NSAIDS
Dabigatran
Rivaroxaban

40
Q

drugs that are CI inCKD GFR less than 30

A 
SGLT2 I (canagliflozin, dapagliflozin, empagliflozin)
metformin, for treated patients, do not start treatment if gfr is 45 or less

meperidine not specified

41
Q

complications that need treatment in CKD

A

high serum phosphate
anemia
hyperparathyroidism
vit d deficency

42
Q

CKD-MBD is

A

CKD mineral bone disorder

43
Q

treatment for high serum phosphate in CKD

A

1) dietary phosphate restriction

2) phosphate binders

44
Q

how are phosphate binders taken

A

prior to each meal

they bind phosphate from meals in the intestine

45
Q

if meal is skipped phosphate binder should be ___

A

skipped

46
Q

3 types of phosphate binders

A

1 aluminum based
2 calcium based (first line)
3 aluminum free-calcium free

47
Q

aluminum hydroxide suspension

A

rarely used due to risk of aluminum accumulation
can cause nervous system and bone toxicity
“dialysis dementia”

48
Q

aluminum hydroxide suspension is a ___ that is limited to how long of a treatment duration

A

phosphate binder

4 weeks

49
Q

calcium based phosphate binders are ___ ___

what are the two examples

A

first line

calcium acetate and calcium carbonate

50
Q

calcium acetate brands

A

phoslyra, phosLo

51
Q

calcium carbonate brands

A

tums

52
Q

SEs with calcium based phosphate binders

A

hypercalcemia, consipation

53
Q

what binds more dietary phosphorus calcium acetate or carbonate

A

acetate

54
Q

what vitamin increases the risk of hypercalemia when taking calcium

A

vitamin d

55
Q 
sucroferric oxyhydroxide (velphora)
ferric citrate (auryxia) 
what are these
A

aluminum free
calcium free
phosphate binders

no aluminum accumulation
less hypercalemia
but more expensive

*warnings: iron absorption occurs with ferric citrate

56
Q

lanthanum carbonate brand name

A

fosrenol

57
Q

fosrenol (lanthanum carbonate)

what is it

A

phosphate binder
aluminium free calcium free
GI obstruction! must chew tablet throughly to avoid
N/V/D/C (lots of GI)

58
Q

a non aluminium non calcium baded phosphate binder that is not systemically absorbed

A 
sevelamer carbonate (renvela)
sevelamer hcl (renagel)
59
Q

sevelamer (renvela) SEs

A

N/V/D
can lower TC and LDL by 15-30%
can reduce absorption of ADEK consider multivitamin

60
Q

phosphate binders BIND so because of this they have many __, seperate administration from ___ and ___ that chelate.

A

DI
levothyroxine
antibiotics(quinolones, tetracyclines

61
Q

calcium based phosphate binders interact with what drugs

A

quinolones
tetracyclines
bisphosphonates
thyroid products

62
Q

in general drugs to seperate from phosphate binders are

A

levothyroxine
quinolones
bisphosphonates
tetracyclines

63
Q

elevations in parathyroid hormone are treated primarily with

A

vitamin D

or calcimimetic to decrease pth

64
Q

vitamin d3

A

cholcalciferol skin and sun

65
Q

vitamin d2

A

ergocalciferol dietary source

66
Q

what is the active form of vitamin d3

A

calcitriol

67
Q

cinacalcet or senispar is only used in ___ patients

A

dialysis

68
Q

what are the vitamin d analogs

A

calcitriol
calcifediol
doxercalciferol
paricalcitol

69
Q

what do vitamin d analogs do

A

they increase intestinal absorption of calcium
which provides negative feedback to the parathyroid gland
and reduces elevations in pth

70
Q

vit d analogs SEs

A

hypercalcemia, monitor calcium

71
Q

sensipar causes hypo or hypercalcemia

A

hypo

72
Q

anemia is defined as a hgb or hemoglobin level of less than

A

13

73
Q

anemia of CKD is caused by lack of ___

A

epo

as kidney function declines, epo declines

74
Q

esas can prevent the need for ___ in CKD

A

blood transfusions

75
Q

esas include

A 
epoetin alfa (procrit, epogen)
darbopoetin alfa (aranesp)
76
Q

longer lasting esa

A

aranesp (darbopoetin alfa)

77
Q

risks with ESAs

A

high BP

thrombosis (clots)

78
Q

only use ESAs when Hgb is less than

A

10

DC if hgb exceeds 11

79
Q

ESAs require adequate ___

A

iron

80
Q

what is a normal potassium

A

3.5-5

81
Q

drugs that raise potassium

A 
aces
arbs
aliskiren
aldosterone receptor antagonists
canagliflozin
drosperinone containing OCs
bactrim
transplant drugs (cyclosporine/tacrolimus)
NSAIDs
82
Q

insulin causes potassium to shift

A

into the cells, it can treat hyperkalemia

83
Q

the most common cause of hyperkalemia is decreased renal excretion due to ___ failure

A

kidney

84
Q

patients with diabetes are at increased risk of hyperkalemia as insulin deficiency reduces the ability to shift ___ into the cells and many of these patients take aces or arbs

A

potassium

85
Q

symptoms of hyperkalemia

A

muscle weakness, bradycardia, fatal arrhythmias

86
Q

steps for treating hypercalemia acute/emergency

A

1) stabilize the heart: to prevent arrhythmias: calcium gluconate
2) move the potassium: shift it intracellulary: regular insulin, dextrose, sodium bicarb, albuterol
3) remove it: eliminate k from the body: furosemide, sodium polystyrene sulfonate

87
Q

sodium polystyrene sulfonate (kayexalate)

A 
potassium binder (non absorbed cation exchange resin)
can bind other oral meds (separate)
88
Q

metabolic acidosis can happen in CKD when to treat

A

when serum bicarb is less than 22

89
Q

treat low bicarb with

A

sodium bicarb or sodium citrate/citric acid soln and monitor sodium level and use caution in patients with hypertention and CVD

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