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NAPLEX > Renal Disease > Flashcards

Renal Disease Flashcards

1
Q

Drugs that Cause Kidney Disease

A
  • Aminoglycosides
  • Amphotericin B
  • Cisplatin
  • Cyclosporine
  • Loop Diuretics
  • NSAIDs
  • Polymixins
  • Radiograph contrast dye
  • Tacrolimus
  • Vancomycin
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2
Q

Dose Adjustment/Interval Increase in CKD: Anti-infectives

A
  • Aminoglycosides (interval increase)
  • Beta-lactams (except antistaphylococcal cillins and ceftriaxone)
  • Fluconazole
  • Quinolones (excluding moxifloxacin)
  • Vancomycin
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3
Q

Dose Adjustment/Interval Increase in CKD: Cardiovascular

A
  • LMWHs
  • Rivaroxaban
  • Apixaban
  • Dabigatran

Last 3 have indication-specific recommendations (A. fib)

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4
Q

Dose Adjustment/Interval Increase in CKD: GI/Other

A

GI

  • H2RAs
  • Metoclopramide

Other

  • Bisphosphonates (indication specific)
  • Lithium
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5
Q

Contraindicated CrCl < 60

A

Nitrofurantoin

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6
Q

Contraindicated CrCl < 50

A
  • TDF containing products (Atripla, Complera, Delstrigo, Stribild*, Symfi, Symfi Lo)
  • Voriconazole IV (from vehicle)

*For treated patients, don’t start if CrCl < 70

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7
Q

Contraindicated CrCl < 30

A
  • TAF containing meds (Biktarvy, Descovy, Genvoya, Odefsey, Symtuza)
  • NSAIDs
  • Dabigatran*
  • Rivaroxaban*

*Indication specific recommendations

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8
Q

Contraindicated GFR < 30

A
  • Metformin (for treated patient, don’t start if GFR < 45)

- SGLT2i

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9
Q

Other CrCl Concerns

A

Meperidine - not specified or other CrCl cut-off used

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10
Q

Aluminum-based Phosphate Binders

A
  • Ex: Aluminum hydroxide suspension
  • Risk of aluminum accumulation which can cause nervous system and bone toxicity
  • Taken TID with meals
  • Causes dialysis dementia
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11
Q

Calcium Based Phosphate Binders

A
  • Ex: Calcium Acetate (PhosLo), Calcium Carbonate (Tums)
  • First-line
  • Taken TID with meals
  • SE: Hypercalcemia (especially if taken with vit. D supplementation which increase Ca+ absorption)
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12
Q

Aluminum/Calcium Free Phosphate Binders

A
  • Iron containing (sucroferric oxyhydroxide/Velphoro or ferric citrate/Auryxia) or lanthanum carbonate (Fosrenol)
  • Taken TID with meals
  • Lanthanum MUST be chewed thoroughly
  • Iron absorption occurs with ferric citrate (may need to decrease IV iron accordingly)
  • Lanthanum SE: N/V, diarrhea, constipation
  • MOST expensive
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13
Q

Sevelamer

A
  • Non-calcium/aluminum containing phosphate binder, NOT systemically absorbed
  • Taken TID with meals
  • Carbonate = Renvela, HCl = Renagel
  • SE: N/V, diarrhea
  • Lowers total cholesterol and LDL by 15-30%
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14
Q

Vitamin D Analogs

A
  • Increase Ca+ absorption => negative feedback to parathyroid gland
  • Ex: Calcitriol (Rocaltrol), paricalcitol (Zemplar)
  • SE: Hypercalcemia
  • Monitor: Calcium
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15
Q

Calcimimetic

A
  • Reacts with parathyroid gland as Ca+ would
  • Decreases Ca+/PTH/Phos
  • Ex: Cinacalcet (Sensipar)
  • SE: Hypocalcemia (monitor)
  • Etelcalcetide (Parsabiv) can cause muscle spasms and paresthesia (pins and needles)
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16
Q

Drugs that Raise Potassium

A
  • RAAS system drugs (ACEi/ARBs/ARA/Aliskiren)
  • Canagliflozin
  • Drospirenone-containing COCs
  • K-containing fluids (PN) and supplementation
  • SMX/TMP
  • Transplant drugs (cyclosporine, tacrolimus, everolimus)
17
Q

Hyperkalemia: Stabilizing Heart

A
  • Calcium gluconate injection
  • Prevents arrhythmias
  • Works pretty much immediately (within minutes)
  • Doesn’t decrease K+, just stabilizes heart
18
Q

Hyperkalemia: Intracellular Shifts

A
  • Insulin: regular, worked in 30 minutes, given with dextrose or glucose to prevent hypoglycemia
  • Sodium bicarbonate: used if metabolic acidosis present
  • Albuterol: nebulizer, monitor for tachycardia/chest pain
19
Q

Hyperkalemia: Removes K+

A
  1. Furosemide: IV, works in 5 minutes, eliminated in urine (monitor volume)
  2. Sodium polystyrene sulfonate: oral or rectal (only rectal for acute emergencies), 1 hour to work, binds K+ in GI tract
  3. Patiromer: oral, ~7 hours, binds in GI tract, not for acute use (onset time)
  4. Sodium zirconium cyclosilicate: oral, 1 hour onset, binds in GI tract (not for acute emergencies)
  5. Hemodialysis: immediate once started, generally used in conjunction since it takes time to set-up/start dialysis
20
Q

Hyperkalemia: Other Drugs

A
  • SPS (sodium polystyrene sulfonate): oral or rectal, non-absorbed cation resin that can bind with other medications as well (check DDI)
  • Patiromer (Veltessa) - binds to other oral drugs, separate by 3 hours (before or after), warning for hypomagnesemia , SE: constipation, not for emergency use
  • Sodium zirconium cyclosilicate - can bind to other drugs, separate by 2 hours (before or after), not for emergency use

NAPLEX (59 decks)

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