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NAPLEX > Renal Disease > Flashcards

Renal Disease Flashcards

1
Q

Drugs that cause Kidney Disease 10

A
  1. Ags
  2. Ampho B
  3. Cisplatin
  4. Cyclosporine
  5. Loop Diuretics
  6. NSAIDs
  7. Polymxyins
  8. Radiographic contrast dye
  9. Tacrolimus
  10. Vancomycin
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2
Q

Select drugs that need decreased dose or increased dosing interval 4 groups

A
  1. Antiinfectives
    1. AGs, increase dosing interval mostly
    2. Beta-lactams
    3. FLuconazole
    4. Quinolones (except moxifloxacin)
    5. Vanco
  2. CV drugs
    1. LMWH
    2. Rivaroxaban for A fib
  3. GI drugs
    1. Ranitidine famotidine
    2. Metoclopramide
  4. Others
    1. Bisphosphanates
    2. Lithium
  5. 1.
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3
Q

Drugs that are contraindicated in CKD with cut off < 60

A

Nitrofurantoin (macrobid, macrodantin)

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4
Q

Drugs that are contraindicated in CKD with cut off < 50

2

A
  1. Tenofovir diso (stribild, complera, atripla, symfi, symfi lo)
  2. Voriconazole IV due to vehicle
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5
Q

Drugs that are contraindicated in CKD with cut off < 30 4

A
  1. Tenofovir alfenamide (Genvoya, biktarvy, descovy, odefesey, symtuza)
  2. NSAIDs
  3. Dabigatran
  4. Rivaroxaban
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6
Q

COntraindiacted GFR < 30

A
  1. SGLT2 inhibitors
    1. Canagliflozin, dapagliflozin, empagliflozin
  2. Metformin

Other meperidine

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7
Q

Both ____ and ____ cause increase release of?

A

Both high PO4 and low Ca cause increase PTH release

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8
Q

Key drugs that raise potassium levels 8

A
  1. ACE
  2. ARB
  3. Aldosterone receptor antagonists
  4. Aliskeren
  5. Canagliflozin
  6. Droperinone containt COCs
  7. Bactrim
  8. Transplant meds (cyclosporin, everlimus, tacrolimus)
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9
Q

Steps for treating severe hyperkalemia

A
  1. Stabalize the heart with calcium gluconate
  2. Move it
    1. Regular insulin
    2. Dextrose
    3. Sodium bicarb if metabolic acidosis is present
    4. Albuterol
  3. REmove it:
    1. Furosemide
    2. Sodium polystyrene sulfonate: binds K in GI tract rectal has much faster onset (use in emergency)
    3. Patiromer: not for acute emergency, binds in GI tract
    4. Sdium zerconium not for acute
    5. Hemodiaylsis: takes hours to set up
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10
Q

Phosphate binders

A

Aluminum Hydroxide Suspension

  1. Aluminum based: effecetive but bone toxicity limits use, dialysis dementia
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11
Q

What should you do if you miss a dose of phosphate binder?

A

SKip and resume normal dosing because it is used to block the absorption of dietary phosphate

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12
Q

How is hyperphosphatemia treated in CKD patients?

A

First dietary restrictions and then phosphate binders are likely required

If you miss a phosphate binder dose you should skip it

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13
Q

What are the 3 types of phosphate binders?

A
  1. Aluminum based
  2. Calcium-based
  3. aluminum free, calcium free agents
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14
Q

Aluminum based phosphate binders

How long is treatment limited and why?

A

Potent but rarely used to due to aluminum accumulations which can cause nervous system and bone toxicities

Treatment is limited to 4 wks

SIDE effects: dialysis dementia

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15
Q

Calcium based phosphate binders

A

First line:

SIde effects: Hypercalemia

Monitor Ca

Hypercalemia can be even more problematic when Vitamin D is used

Tums, PhosLo

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16
Q

Aluminum free calcium free binders, less side effects more expensive

3 types brand and generic

A

Iron absoprtion occurs with ferric citrate and IV iron may need to be reduced

Sucroferric (velphoro), Ferric citrate (Auryxia)

Lanthanum (foserenol)

17
Q

Lanthanum

WHat should you tell your parents?

A

Chew all the way to reduce GI adverse effects

Al free Ca free

SEs: N/V/D/constipation

18
Q

Sevelamer Brand name?

Where is it absorbed?

What other added benefits does it have?

A

Renvela

  • Carbonate better than hydrocholoride in maintaining bicarb
  • Not systemiccally aborbed phosphate binder also reduces cholesterol and LDL by 15-30%
    • SEs: N/V/D > 20% very common
  • Reduce dietary absorption of vitamins DEK and folic acid
19
Q

Phosphate binder drug interactions

A

Separate administration of levothyroxine and antibiotics that chelate (quinolones, tetracyclines)

20
Q

CKD first treat hyperphosphatemia then treat _____ with?

Which one is synthesized in the skin?

Which is produced by plants?

What is reserved for later stages?

What is the main calcimimetic? Only used for?

A

elevations in PTH are treated with Vitamin D

  • Vit D def occurs when the kidney is unable to hydroxylate Vit D into the active form 1,5-dihydroxy Vit D
  • Vit D3 cholecalciferol which is synthesized in the skin after exposure to ultraviolet light
  • Vit D2: ergocalciferol produced from plant sterols PRIMARY DIETARY Source
  • Active form of vitamin D3 Calcitriol (used in later stages CKD or ESRD)
  • Cincacalcet (Sensipar): Calcimimetic mimics the action of calcium on the parathyroid gland which further reduces PTH (ONLY USED FOR PATIENTS ON Dialysis
21
Q

Vitamin D analogs: 4

Key side effect?

What should be monitored?

A
  1. Calcitriol (Rocaltrol) active form of Vit D3
  2. Calcifediol (rayaldee) ER
  3. Doxercalciferol (Hectorol)
  4. Paricalcitol (Zemplar)

SIDE effects hypercalemia

Monitor Ca

Vitamine D3: Cholecalciferol

Vitamin D2: Ergocalciferol

Elevations in PTH are treatment primarily with Vit D

22
Q

Calcimimetics

Brand Name

Contraindications and SEs

A

Cincacalcet (Sensipar)

Contraindications: Hypocalemia

Etelcalcetide (Parsabiv): warning for hypocalemia, muscle spasms, paresthesia (burning sensation on skin)

23
Q

How is anemia caused in CKD?

A

lack of erythropoeitin which is produced by the kidneys, which causes the stimulation of the production of RBCs

24
Q

What can limit the need for blood transfusions in CKD anemia

A

ESA

Erythropoeisis Stimulating Agents

  • Epoetin Alfa (procrit,epogen) and longer lasting darbepoetin (Aranesp)
  • Risks: elevated blood pressure, should only be used inf Hgb <10g/dL
  • Then should be held if hgb exceeds 11
  • Only works if there is enough Iron so look at iron levels
25
Q

Sodium polystyrene

A

SPS, kayexalate

Bind to other drugs watch DIs

26
Q

Patiromer (Veltassa)

A

Hypomagnesia

Binds to many drugs separate by 3 hours

Not for emergency use neither is sodium zirconium

27
Q

How should all phosphate binders be given?

A

With meals

Lanthanum should be chewed thoroughly to reduce risk of severe GI adverse effects

28
Q

What medications are not for emergency use in CKD patients with severe hyperkalemia? 3

A

Oral Sodium polystyrene sulfonate

Patiromer

Sodium zirconium cyclosilicate

29
Q

WHat is used when a patient has metobolic acidosis asscociated with their CKD?

A

Sodium bicarbonate

NAPLEX (64 decks)

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