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1. NAPLEX Prep > Renal disease > Flashcards

Renal disease Flashcards

1
Q

Most common causes of renal disease

A

Diabetes and HTN

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2
Q

Primary function of the nephron

A

Control the concentration of Na and water.
This regulates blood volume and BP

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3
Q

Protein bound drugs

A

Not filtered through the glomerulus, exit through the efferent arteriole. Albumin only passes through the urine if the kidney is damaged.

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4
Q

Medications that work in the proximal tubule

A

SGLT2 inhibitors

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5
Q

Medications that work in the DCT

A

Thiazides

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6
Q

Medications that work in the ascending loop of henle

A

Loop diuretics

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7
Q

Medications that work in the collecting duct

A

Potassium sparing diuretics- aldosterone antagonists (spironolactone, eplerenone

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8
Q

Select drugs that cause kidney disease

A

All Needy Cats Like Vinci Cry And Create Pee Tubs
Aminoglycosides
NSAIDs
Cisplatin
Loop diuretics
Vancomycin
Cyclosporine
Amphotericin B
Contrast
Polymyxins
Tacrolimus

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9
Q

The cockcroft gault eqn is not preferable in

A

the very young, kidney failure, unstable renal function

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10
Q

CKD=

A

GFR <60 and/OR albuminuria

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11
Q

Why are ACEi and ARBs recommended for albuminuria?

A

Prevents disease progression by causing efferent vasodialtion

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12
Q

When starting an ACE or an ARB

A

SCr can increase by up to 30%. This is expected and treatment should not be stopped.

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13
Q

Recommendations for patients with CKD, DM, and eGFR >30

A

SGLT2 inhibitor- shown to reduce CV and CKD progression
Metformin

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14
Q

Drugs CI when CrCl<60

A

Nitrofurantoin

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15
Q

Drugs CI when CrCl <50

A

TDF containing products
Voriconazole IV (d/t vehicle)

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16
Q

Drugs CI when CrCl <30

A

TAF products
NSAIDs
Dabigatran
Rivaroxaban

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17
Q

Drugs CI when GFR <30

A

SGLT2 inhibitors
Metformin

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18
Q

Key drugs that require renal dose adjustments

A

Aminoglycosides
Beta lactams
Fluconazole
Quinolones (except moxi)
Vancomycin
LWMH
Rivaroxaban, Apixaban, Dabigatran
H2RAs, Metoclopramide
Bisphosphonates
Lithium

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19
Q

Complications of CKD

A

Mineral and bone disorder- hyperphosphatemia, vitamin D deficiency and secondary hyperparathyroidism
Anemia
Hyperkalemia

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20
Q

Patients with advanced CKD require monitoring of

A

PTH, phos, Ca, vitamin D

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21
Q

Hyperphosphatemia treatment

A

Restrict dietary phos
Phosphate binders prior to each meal- Calcium acetate and calcium carbonate are first line

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22
Q

Types of phosphate binders

A

Aluminum based- aluminum hydroxide
Calcium based- Calcium acetate, calcium carbonate
Al free, ca free-sucroferric oxyhydroxide, ferric citrate, lanthanum carbonate
Sevelamer- non aluminum, non calcium, not systemically abs

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23
Q

Aluminum hydroxide

A

Aluminum based phosphate binder
Caution for dialysis dementia and aluminum toxicity

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24
Q

Calcium based phosphate binders can cause

A

Hypercalcemia, especially problematic with concomitant use of vitamin D (d/t increased ca abs)

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25
Q

Lanthanum carbonate

A

Aluminum free, Ca free phosphate binder
Must chew thoroughly to reduce severe GI AE

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26
Q

Renvela

A

Sevelamer carbonate
Non Aluminum, Non calcium, not systemically abs phos binder
Can lower total cholesterol and LDL.

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27
Q

Renagel

A

Sevelamer hydrochloride
Non Aluminum, Non calcium, not systemically abs phos binder
Can lower total cholesterol and LDL.

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28
Q

Calcium based phosphate binders interact with

A

quinolones, tetracyclines, oral bisphosphonates, thyroid products

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29
Q

After controlling hyperphosphatemia, elevations in PTH are treated with

A

Vitamin D

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30
Q

Why does vitamin D deficiency occur in kidney disease?

A

Kidney is unable to hydroxylate vitamin D to its active form, 1,25-dihydroxy vitamin D

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31
Q

Vitamin D3

A

Cholecalciferol- from the skin

32
Q

Vitamin D2

A

Ergocalciferol- from plants

33
Q

Why are vitamin D analogs used in CKD?

A

Increase Ca absorption
Inhibit PTH

34
Q

What is the active form of D3?

A

Calcitriol

35
Q

Drugs for the treatment of secondary hyperparathyroidism

A

Vitamin D analogs
Calcimimetic

36
Q

Vitamin D analogs agents and AE

A

Calcitriol, calcifediol
-Hypercalcemia

37
Q

Calcimimetics MOA

A

Increase sensitivity of calcium receptor on parathyroid gland.
Causes decreased PTH, decreased Ca, decreased phosphate

38
Q

Sensipar

A

Cinacalcet
Calcimimetic- causes HYPOcalcemia

39
Q

Risks of ESAs

A

Elevated BP
Thrombosis

40
Q

When should ESAs be used?

A

When Hgb <10
D/C once Hgb exceed 11

41
Q

Key drugs that raise K levels

A

ACEi
ARAs
Aliskiren
ARBs
Canagliflozin
Drospirenone
K containing fluids
SMX/TMP
Cyclosporine, tacrolimus

42
Q

S/S of hyperkalemia

A

Muscle weakness, bradycardia, fatal arrhythmias

43
Q

What is used to stabilize the heart in hyperkalemia?

A

Calcium gluconate

44
Q

What pushes K intracellularly?

A

Dextrose + insulin
Sodium bicarb
Albuterol

45
Q

What removes K from the body?

A

Furosemide
Sodium polystyrene sulfonate
Patiromer
Sodium zirconium cyclosilicate
Hemodialysis

46
Q

Which potassium binder is the quickest?

A

Sodium zirconium cyclosilicilate
1 hr

47
Q

Kayexalate

A

SPS
Warning for GI necrosis

48
Q

______molecules are more readily removed by dialysis

A

Smaller

49
Q

Drugs with a _______Vd are less likely to be removed by dialysis

A

larger

50
Q

_______protein bound drugs are less likely to be removed by dialysis

A

Highly

51
Q

_______________HD filters remove more substances

A

High-flux (large pore size) and high-efficiency (large SA)

52
Q

________dialysis blood flow rate increase drug removal

A

higher

53
Q

Preferred HCV treatment regimens consist of

A

2-3 DAAs with different mechanisms for 8-12 weeks

54
Q

NS3/4A Protease Inhibitors

A

-Previr
P for PI
Must be taken with food
Examples- glecaprevir, grazoprevir

55
Q

NS5A replication complex inhibitors

A

-Asvir
A for NS5A
Examples- Elbasvir, ledipasvir

56
Q

NS5B polymerase inhibitors

A

-Buvir
B for NS5B
-Dasabuvir, sofosbuvir

57
Q

BBW for all DAAs

A

Risk of reactivating HBV
Must be tested for HBV before starting a DAA

58
Q

Sofosbuvir containing DAAs

A

Do NOT USE Amiodarone
Serious symptomatic bradycardia has been reported

59
Q

Which DAAs are pan-genotypic

A

Epclusa and Mavyret

60
Q

Mavyret

A

DAA for HCV
Glecaprevir/Pibrentasvir for 8 weeks WF

61
Q

Epclusa

A

DAA for HCV
Sofosbuvir/velpatasvie for 12 weeks
DO NOT use amiodarone
Dispense in original container

62
Q

DDI for all DAAs

A

Strong inducers of 3A4
PORCS PR
Phenobarbital
Oxcabazepine
Rifampin
Carbamazepine
St. Johns Wort
Phenytoin
Rifabutin

63
Q

Harvoni, Epclusa, and Vosevi interact with

A

antacids, H2RAs, and PPIs
Decrease conc of ledipasvir and velpatasvir

64
Q

Do not take _______with Epclusa

A

PPIs

65
Q

Viekira Pak DDI

A

Ethinyl estradiol

66
Q

When is ribavirin used in HCV?

A

in combo with other drugs. NOT MONO

67
Q

Aerosolized ribavirin is used for

A

RSV

68
Q

Ribavirin BBW

A

Teratogenic
Hemolytic anemia

69
Q

Interferon alfa BBW

A

Neuropsychiatric, autoimmune, ischemic, or infections disorders

70
Q

Treatment of HBV

A

Interferon alfa preferred
NRTIs- TDF, TAF, entecavir, and lamivudine can be used

71
Q

BBW for NRTIs

A

hepatomegaly and lactic acidosis
Exacerbations of HBV if d/c’d

72
Q

Viread

A

TDF

73
Q

Vemlidy

A

TAF

74
Q

Baraclude

A

Entecavir

75
Q

Natural products for cirrhosis

A

Milk thistle

76
Q

Drugs with BBW for liver damage

A

APAP
Amiodarone
Isoniazid
Ketoconazole oral
MTX
Nefazodone
Nevirapine
NRTIs
PTU
Valproic acid

1. NAPLEX Prep (15 decks)

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