Renal Disease

Question 1

afferent arteriole

Answer 1

delivers the blood

Question 2

efferent arteriole

Answer 2

blood exists

Question 3

proximal tubule

Answer 3

SGLT2 inhibitors work here

Question 4

Loop of Henle

Answer 4

• Na CL ions are reabsorbed back into the blood, water is not. Unless antidiuretic hormone (ADH) is present, water passes through the wall and is reabsorbed. ADH is also known as vasopressin
• loop diuretics inhibit the Na-K pump (less NA is reabsorbed), also cause less Ca reabsorption back into the blood (SE decrease bone density)

Question 5

Distal convoluted tubules

Answer 5

thiazide diuretics inhibit the Na-Cl pump. increase in Ca reabsorption

Question 6

collecting duct

Answer 6

potassium sparring diuretics- including aldosterone antagonists (spironolactone, eplerenone),
ultimately decrease Na and increase K

Question 7

select drugs that cause kidney disease

Answer 7

Aminoglycosides
Amphotericin B
Cisplatin
Cyclosporine
Loop diuretics
NSAIDs
Polymyxins
Radiographic contrast dye
tacrolimus
vancomycin

Question 8

cockcroft-gault equation

Question 9

ACE inhibitors and ARBs for albuminuria

Answer 9

prevent kidney disease progression,
RAAS causes efferent arteriolar dilation
by reducing pressure in the glomerulus, decreasing albuminuria, cardio protection

Question 10

CKD

Answer 10

GFR <60 and/or albuminuria (ACR or AER >=30)

Question 11

ACE/ARB increase

Answer 11

K, so monitor

Question 12

metformin and SGLT2 inhibitors

Answer 12

for pt with CKD, type 2 diabetes, and GFR> 30
SGLT2- specifically canagliflozin, dapagliflozin, and empagliflozin- demonstrated reduction in cardo event and CKD progression

Question 13

key drugs that require dose reduction or interval increase in CKD
anti-infectives

Answer 13

Aminoglycosides (increase dose interval primarily)
Beta-lactam (except antistaphylococcal and ceftriaxone)
Fluconazole
Quinolones (except moxifloacin)
Vancomycin

Question 14

key drugs that require dose reduction or interval increase in CKD
cardio drugs

Answer 14

LMWHs (enoxaparin)
Rivaroxaban* (for AF)
Apixaban* (for AF)
Dabigatran* (for AF)

Question 15

key drugs that require dose reduction or interval increase in CKD
GI

Answer 15

H2RAs (famotidine, ranitidine)
Metoclopramide

Question 16

key drugs that require dose reduction or interval increase in CKD
others

Answer 16

bisphosphonates
lithium

Question 17

Key drugs contra
CrCl <60

Answer 17

nitrofurantoin

Question 18

Key drugs contra
CrCl<50

Answer 18

Tenofovir disoproxil fumarate
Products include atripla, complera, delstrigo, stribild (don’t start if less the<70), symfi

vorconazole IV (due to vehicle)

Question 19

Key drugs contra
CrCl<30

Answer 19

tenofovir alafenamide
products include biktarvy, descovy, genvoya, odefsay, symtuza

Question 20

Key drugs contra
GFR<30

Answer 20

SGLT2 inhibitors
Metformin - dont start if GFR<45

Question 21

provide overview of Ca, PO4, vitamin D in CKD system EPO too

Question 22

Aluminum Hydroxide suspension

Answer 22

TID w/meals
SE: “Dialysis dementia”

Aluminum-based: potent phosphate binders, rarely used due to the risk of aluminum accumulation (which can cause nervous system and bone toxicity). tx max… 4 weeks

• phosphate binder

Question 23

calcium acetate

Answer 23

phoslyra, PhosLo
TID w/meals
SE: Hypercalcemia- monitor Ca avoid with vitamin D..

• calcium-based: first line phosphate binder

Question 24

calcium carbonate

Answer 24

tums, TID w/meals

SE: hypercalcemia- monitor Ca, avoid with vitamin D..

• calcium-based: first line phosphate binder

Question 25

sucroferric oxyhydroxide

Answer 25

velphoro TID w/meals SE: black feces - aluminum-free, calcium-free

Question 26

Ferric citrate

Answer 26

auryxia iron absorption with ferric citrate monitor TSAT SE: black feces - aluminum-free, calcium-free phosphate binder

Question 27

Lanthanum carbonate

Answer 27

Fosrenol TID w/meals must chew thoroughly... Avoid in GI obstruction fecal impaction ileus pts SE. N/v, diarrhea, constipation.... - aluminum-free, calcium-free phosphate binder

Question 28

Sevelamer carbonate sevelamer hydrochloride

Answer 28

Sevelamer carbonate- renvela sevelamer hydrochloride- renagel contra: bowel obstructions can lower TC and LDL - non-calcium, non-aluminum based phosphate binder that is not systemically absorbed

Question 29

phosphate binders DI:

Answer 29

separate admin from levo and antibiotics that chelate

Question 30

Calcitriol

Answer 30

Rocaltrol - vitamin D analogs: increase absorption of Ca, which provides a negative feed back to the parathyroid gland

Question 31

Calcifediol

Answer 31

Rayaldee - vitamin D analogs: increase absorption of Ca, which provides a negative feed back to the parathyroid gland

Question 32

Doxercalciferol

Answer 32

Hectorol - vitamin D analogs: increase absorption of Ca, which provides a negative feed back to the parathyroid gland

Question 33

Paricalcitol

Answer 33

Zemplar - vitamin D analogs: increase absorption of Ca, which provides a negative feed back to the parathyroid gland

Question 34

Cinacalcet

Answer 34

Sinsipar SE: Hypocalcemia -Calcimimetic: increases sensitivity of the calcium-sensing receptors on the parathyroid gland, which causes decrease PTH and decrease Ca and decrease PO4

Question 35

Etelcalcetide

Answer 35

Parsabiv SE: hypocalcemia, muscle spasms, paresthesia -Calcimimetic: increases sensitivity of the calcium-sensing receptors on the parathyroid gland, which causes decrease PTH and decrease Ca and decrease PO4

Question 36

EPO

Answer 36

kindy function declines, EPO production decreases, ESAs produce more RBCs ESA include epoetin alfa (procrit, epogen, Retacrit)... long lasting formula, darbepoetin alfa (arnesp) only used when hemoglobein <10g/dL

Question 37

select drugs that raise K levels

Answer 37

ACE inhibitors Aldosterone receptor antagonists Aliskiren ARBs Canagliflozin Drospirenone-containing COCs PN- IV fluids containing K Potassium supplements Sulfamethoxazole/Trimethoprim Transplant drugs (cyclosporine, everolimus, tacrolimus)

Question 38

Sodium polystyrene sulfonate

Answer 38

SPS, kayexalate warning: GI necrosis (increased risk with sorbitol) can bind to other meds... check monitor K, Na, Mg, Ca oral and rectal - tx of hyperkalemia

Question 39

Patiromer

Answer 39

Veltassa Warning: worsen GI motality, hypoMg binds to oral drugs, at least 3 hrs before and 3 hr after monitor K, Mg delayed onset of action... - tx of hyperkalemia

Question 40

Sodium zirconium cyclosilicate

Answer 40

Lokelma binds other drugs, separate by 2 hrs before and after fast onset of action