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NAPLEX Prep > Renal Disease > Flashcards

Renal Disease Flashcards

physiology, DIKD, CrCl, CKD, dosing, CKD complications, dialysis

1
Q

proximal tubule function

A

Na Ca and Cl are filtered into the nephron
pH regulated with H and bicarb exchange
SGLT2 transporter is here

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2
Q

where do SGLT2-i work

A

proximal tubule

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3
Q

descending LOH function

A

water reabsorption into the blood

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4
Q

ascending LOH function

A

water reabsorption via ADH (vasopressin)
~25% Na and Cl reabsorption into blood
Ca resorption

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5
Q

where do loops work and on what receptor

A

work on the ascending LOH where they block Na K pump to prevent sodium reabsorption
also block Ca reabsorption and can cause dec MBD with time

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6
Q

distal convoluted tubule function

A

K, Na, Ca, pH regulation
~5% of Na a reabsorbed into the blood here
thiazides work here and increase Ca reabsorption and are therefore bone-protective

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7
Q

collecting duct function

A

connect kidney to ureter
H2O and electrolyte final balancing via ADH and aldosterone
MRAs work here to dec Na and H2O reabsorption without affecting K

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8
Q

aldosterone function

A

increases K excretion in collecting duct

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9
Q

risk factors for DIKD

A

dec renal BF (HF, CKD, HLD, dec BP)
inc age
nephrotoxins

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10
Q

what are the major nephrotoxins

A

AGs
Amph B
loops
vanco
cisplatin
cyclosporine
NSAIDs
polymixins
radiographic contrast dye
tacrolimus

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11
Q

what is the BUN

A

amount of nitrogen in the blood that comes from urea, a waste product of protein metabolism
as renal disease progresses, kidneys are unable to filter urea out of the blood as it should
normal <20

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12
Q

what is Scr

A

waste product of muscle metabolism
norm 0.6-1.3

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13
Q

what GFR is stage 3a

A

45-59

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14
Q

what GFR is stage 3b

A

30-44

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15
Q

what GFR is stage 1

A

> /= 90

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16
Q

what GFR is stage 2

A

60-89

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17
Q

what GFR is stage 5

A

</= 15

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18
Q

what GFR is stage 4

A

15-29

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19
Q

how do we delay CKD progression

A

treat comorbidities DM and HTN
finerenone

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20
Q

first line for CKD + HTN +/- hyperalbuminuria

A

ACE or ARB

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21
Q

what is the BP target for CKD and HTN

22
Q

what is an adverse effect of ACEi/ARBs that is expected with initiation? When do we hold ACEi/ARB?

A

inc Scr </=30% from baseline

hold when SCr increases over 30% from baseline

23
Q

first line for patients with CKD + DM

24
Q

what medication prevents CKD progression? What are the criteria for starting it?

A

finerenone

start when on SGLT2-i and on max tolerated ACEi or ARB + eGFR 25+

25
which drugs require CrCl adjustments
ABX (SMX/TMP, B lactams except anti staph and CTX, AGs, fluconazole, FQ, vancomycin) Cardiac (LMWH, xarelto for afib, xarelto for afib, dabigatran for afib, most statins) H2RAs others (bisphosphonates, lithium gabapentin, metformin, morphine, pregabalin, codeine)
26
what drug(s) are CI at CrCl <60
nitrofurantoin
27
what drug(s) are CI at CrCl <50
TDF voriconazole IV
28
what drug(s) are CI at CrCl 30
TAF NSAIDs dabigatran (DVT/PE) rivaroxaban (DVT/PE) MRAs duloxetine bisphosphonates
29
what drug(s) are CI at eGFR <30
metformin SGLT2i meperidine
30
what are the complications of CKD
MBD anemia of CKD hyperkalemia metabolic acidosis
31
what is considered microalbuminuria
UA 30-300
32
what is considered macroalbuminuria
UA >300
33
what are treatment options of MBD in CKD
restrict dietary phosphate phosphate binders calcimimetics Vit D analogs
34
why do patients with MBD in CKD have inc serum phosphate, low vitamin D levels and variable Ca levels
kidney damage prevents phosphate clearance which stimulates PTH and increases bone resorption dec EPO production decreases active Vit D production and therefore dec Ca absorption from gut --> PTH overcompensates by stimulating bone resorption to inc serum Ca Ca levels vary due to dec GI absorption and increased Ca resorption from bone
35
sevelamer brand name MOA dosing ADE
Renvela non Ca-based phosphate binder that binds phos in gut and is eliminated 800-1600mg TID W MEALS ADE NVD :////
36
sevelamer is CI in
bowel obstruction
37
sevelamer effects on lipid panel
can decrease TG and LDL by 15-30%
38
what drugs does sevelamer interact with/binds them
levothyroxine FQ TTC
39
sevelamer can dec absorption of what from the gut
phos (obv) Vitamins D E K folic acid
40
what are the calcium based phosphate binders what is the concern
ca acetate ca carbonate concern for hypercalcemia
41
what are the vitamin D analogs MOA? concern?
increase Ca absorption in the gut calcitriol (Rocaltrol) calcifediol (Rayaldee) doxercalciferol hypercalcemia risk?
42
cincalcet brand MOA dosing ADE
Sensipar calcimimetic 30-180mg PO daily with food hypocalcemia risk
43
hyperkalemia K = _____ s/sx
K >5 s/sx : muscle weakness, bradycardia, arrhythmias
44
drugs that cause hyperkalemia
ACE-i ARB aliskerin SMX/TMP MRAs (aldosterone antagonists) TPN K supplements NSAIDs CYA, tacro
45
steps to treat hyperkalmenia
d/c sources of hyperkalemia stabilize cardiac membranes move it intracellularly remove it in the gut
46
how do we shift K into the cell in hyperkalemia
regular insulin + dextrose to prevent hypoglycemia sod bicarb if acidotic albuterol
47
how do we remove potassium in hyperkalemia
loops HD SPS (Kayexalate) SZC (Lokelma) patiromer
48
lokelma generic dosing administration
sodium zirconium cyclosilate 10 grams PO TID W MEALS separate other drugs by 2 hours before and after in 3tbsp of water each time
49
Kayexalate generic dosing CI administration
sodium polystyrene sulfate 15 grams PO QD-QID CI GI necrosis
50
Kayexalate can cause GI necrosis especially when combined with ___________
sorbitol
51
what characteristics of the drug / HD / PD can increase removal by dialysis
dec MW/size dec Vd dec ppb high flux (large pore size) high efficiency (inc SA) inc dialysis BF rate

NAPLEX Prep (57 decks)

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