Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Board Review > Renal disease and Dosing consideration > Flashcards

Renal disease and Dosing consideration Flashcards

1
Q

what five factors determine the dialyzability of a drug?

A 
molecular size  (MW)
protein binding 
volume of distribution (VD) 
plasma clearance 
Dialysis membrane
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what does the level of albumin in the urine tell you?

A

it can be used to gage the severity of kidney damage in patients w/ kidney disease or nephropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is creatinine?

A

a waste product of muscle metabolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is BUN?

A

the ammount of nitrogen that comes from the waste product UREA. Higher BUN: more renal impairment (can also be affeccted by level of hydration)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what mainly happens in the proximal tubule?

A

water, Na+, cl- reabsorption. Some exchange of H+ and HCO3- ions here

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is the MOA of the LOOP diuretics?

A

the inhibit the Sodium potassium pump of the ascending loop of Henle . Sodium reabsorpiton is interrupted, meaning less water is absorbed. Also less calcium is absorbed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is the MOA of thiazide diuretics?

A

they inhibit the Na-Cl pump in the distal tubule.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what explains a positive benefit for thiazides at the distal tubule?

A

They also increase calcium absorption here (leading to protective bone effect)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

where is the MOA of potassium sparing diuretics?

A

thye were in the collecting duct by blocking the abosorption of Na and water by aldosterone. They also lead to potassium retention there.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

renal function stage 1

A

clcr > 90

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

renal function stage 2

A

clcr 60-89

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

renal function stage 3

A

clcr: 30-59

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

renal function stage 4

A

clcr 15-29

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

renal function stage 5

A

clcr < 15

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are the side effects of gabapentin?

A

Dizziness and somnolence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is metoclopramide used for?

A

nausea and poor GI motility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

which patients should receive ACE/ARBS for kidney protection?

A

those patients w/ proteinuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is the goal blood pressure in patients w/ kidney disease?

A

<130/80

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

how do ACE/ARBs provide a kidney protective benefit?

A

they cause efferent artiolar dilation (less pressure in the kidney and blood the Renin Angiotension alsdosterone system): decrease blood pressure: less kidney damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what lab marker is expected to increase w/ ACE arbs and how much? should you stop the medicine?

A

expect to have a 30% increase in Serum Createnine. Dont stop uless it goes higher than 30%increase
also expect increase in potassium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

after starting ACE/ARB, when should you check a Scr and K

A

1-2 weeks after starting or changing the dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is the function of erythropoeitin?

A

production of reticulocytes in the bone marrow (blood production)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

if a patient has a CKD stage 3 or more, what recommnded CA x pO4 number

A

<55 or you get precipitation in the blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what are the three main types of phosphate binders?

A

aluminum based agents (not currently used)
calcium based agents : calcium acentatie and carbonate)
non-calcium/non-aluminum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what is the firt line agents for hyperphosphatemia?

A

calcium acetate or calcium carbonate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

which are the most expesnive phosphate binders?

A

the ones that do not contain calcium or aluminum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

how do phophate binders work?

A

they bind meal-time phosphate. So must be taken with food

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what are the aluminum phophate binders?

A

aluminum hydroxide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

max time to use aluminum phosphate binders? why?

A

4 weeks because of risk of accumulation and toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

dose of aluminum hydroxide

A

300mg po TID w/ meals

600mg po tid w/ meals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

side effects of Alumin hydroxide

A

constipation
poor taste
nausea
osteomalacia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

brand calcium acetate?

A

phoslo, phoslyra

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

brand calcium carb?

A

tums

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

calcium carbonate dose for phosphate binding

A

500mg po tid w/ meals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

calcium acetate dose for phospate binding ?

A

667-1334 mg po tid w/ meals

36
Q

side effect of calcium phophate binders?

A

constipation
hypercalcemia
nausea

37
Q

which calcium phospahte binder binds more phosphate?

A

calcium acetate

38
Q

name two non-calcium/non aluminum phosphate binders?

A

lantahmum carbonate

sevelamer (carbonate vs hydrochloride)

39
Q

brand lanthanum?

A

fosrenol

40
Q

counseling point on administration of lanthanum?

A

musht chew tablets thoroughly

41
Q

side effects of lanthanum?

A

N,V
abd pain
constipation / diarrhea

42
Q

contrainidations for lanthanum?

A

bowel obstruction
fecal impaction
ileus

43
Q

whats an additional benefit of sevelamer?

A

can loswer TC and LDL by 15-30%

44
Q

advantage of sevelamer carbonate over sevelamer hydrochloride?

A

can mainatina bicarbonate concentrations

45
Q

brand sevelamer Carbonate

A

renvela

46
Q

brand sevelamer HCL

A

renagel

47
Q

contrindications for sevelamer

A

bowel obstruction

48
Q

SE sevelamer

A

N,V,
constipation/diarrhea
abd pain

49
Q

what is the active form of vitamin D3 called (brand and generic)

A

calcitriol (rocaltrol)

50
Q

what is the function of vitamin d3 (calcitrol)

A

increase calcium absorption in the gut
raise serum calcium concentration
inhibit PTH secretion

51
Q

where does vitamin D3 come from?

A

conversion in skin from the sun

52
Q

where does vitamin D2 come from

A

from eating palnts

53
Q

what is the dose for calicitriol CKD dose?

A

0.25mcg po TIW to daily

54
Q

brand calcitriol

A

rocaltrol

calcijex

55
Q

brand doxercalciferol

A

hectorol

56
Q

doxercaliciferol ckd dose

A

1mc po tiW to qd

57
Q

paricalcitol brand

A

zemplar

58
Q

paricalcitol dose ckd

A

1mct po tiw to qd

59
Q

Vitamin D3 and analogs Side effects

A

hypercalcemia
hyperphohatemia
NVD

60
Q

contraindications to VIT d therapy

A

hypercacemia

vitamin D toxicity

61
Q

how can you prevent N/V/D w/ vitamin D

A

take w/ food

62
Q

what is the MOA of cinacalcet?

A

mimetic of calcium activeting the PTH receptor

63
Q

what are the two treatment for hyperparathyroidism (secondary)?

A 
Vitamin D (calcitrioll, doxercalciferol, paricalcitol)
Cinacalcet
64
Q

what are the side effects of cinacalcet?

A

hypocalcemia

NVD

65
Q

duration of treatement for vitamin D deficiency in CKD?

A

6 months

66
Q

vitamin D3 dose for vitamin d deff in ckd

A

2000 IU po qd

67
Q

vitamin D2 dose for vit def in CKD?

A

level < 5: 50,000 u po q week x 12 weeks, then every month
5-15: 50,000 U po q w x 4 weeks, then every month
16-30 : 50, 000 U po Q month

68
Q

normal potassium level

A

3.5-5.o mEQ/L

69
Q

which type sof medications mostly leed to hypokalemia?

A

diuretics (excetp potassium sparing)

aldosterone

70
Q

what is the effect of insulin to potassium?

A

it causes potassium to shift into the cells

71
Q

whats the most common cause of hyperkalemia?

A

renal failure leading to less excrtion or due to medcaitons

72
Q

which meds increas potassium?

A 
ACEI /ARBs 
NSAIDS 
K+ sparing diuretics 
OC w/ drospirenone
cyclosporine/tacrolimus
SMX/TMP
K supplements
Potassium if IV fluids like TPN
73
Q

what are the consequences of hyperkalemia?

A

muscle weakness
bradycardia
fatal arrhythmias

74
Q

when should you administer IV calcium in hyperkaelmia?

A

if the ECG shows cardiac instability

75
Q

what are the quick active agents can give to treat hyperkalemia?

A 
insulin and glucose (drive k into cells)
Albuterol
if metbolic acidoses HCO3
rectal SPS (works in 2 hours)
76
Q

how much can kayexaelate lower Potassium by?

A

2mEQ/L in 2 hours

77
Q

generic kayexelate?

A

sodium polystyrene sulfonate

78
Q

longer term tx for hyperkalemia?

A

SPS
furosemide (diuretics)
fludrocortisone (florinef)

79
Q

treatment of metabolic acidosis

A

soidum bicarb

soitium citrate/citric acid

80
Q

when do you start tx for metabolic acidosis in an ambulatory care setting?

A

when bicarb is < 22mEq/L

81
Q

what dose to use for sodium vicar in metabolic acidosis cod?

A

1-2 tabs po 1-3 times per day

82
Q

SE of NaHCO3?

A

NVD

increased sodium

83
Q

contraindications of nahco3

A 
hypernatremia
hypocalcemia
pulmonary edema
alkalosis
Caution w/ HTN, CVD and fluid problems
84
Q

moa of sodium citrate?

A

nnetds to be metabolized by the liver to bicarrbonated to work

85
Q

when to take sodium citarted and whhy?

A

take after meals to avoid laxiative effect

Board Review (65 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions