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NAPLEX > Renal disease and dosing considerations > Flashcards

Renal disease and dosing considerations Flashcards

1
Q

What type of drugs are hard to filter through the kidneys

A

Large protein compounds and drugs that are bound to albumin

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2
Q

What type of drugs are hard to filter through the kidneys

A

Large protein compounds and drugs that are bound to albumin

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3
Q

Where do thiazide diuretics work

A

distal convoluted tubule

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4
Q

Where do ARA/K sparing diuretics work

A

distal convoluted tuble

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5
Q

Where do loop diuretics work

A

ascending loop of henle

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6
Q

How do loop diuretics work

A

Inhibit the Na/K pump in the ascending loop of Henle – this causes a significant increase in tubular concentration of sodium and less water reabsorption, also alters the electrical gradient causing a decrease in calcium reabsorption

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7
Q

Loop diuretics can have harmful effects on

A

the bone because of a decrease in calcium reabsorption

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8
Q

How do thiazide diuretics work

A

Inhibit the Na/Cl pump in the distal tubule, Weaker than loop diuretics because only 5% of the Na is resorbed in this portion of the nephron

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9
Q

Which diuretic has protective effects on the bones

A

Thiazide diuretics – they increase calcium absorption by affecting the calcium pump in the distal convoluted tubule

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10
Q

What is the primary function of aldosterone in the kidney

A

Increase Na and water retention and lowers K

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11
Q

Spironolactone and eplerenone work by

A

Blocking aldosterone in the collecting duct and the distal convoluted tubule and increase serum potassium

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12
Q

What does BUN stand for and what does it measure

A

BUN – blood urea nitrogen, Amount of nitrogen that comes from urea, a waste product

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13
Q

What other factors can affect the levels of BUN

A

Renal function and hydration

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14
Q

As renal function decreases, creat concentration

A

increases

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15
Q

When is eGFR accuracy limited

A

People with very high or very low muscle mass, obese, liver disease, pregnant or other conditions that cause abnormal muscle turnover

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16
Q

When is Cockcroft-gault not preferable for estimating renal function in order to adjust drug dose

A

Young children
End-stage renal disease
Rapidly fluctuating renal function

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17
Q

Beta-lactams are dosed based on

A

Time above the minimum inhibitory concentration, time-dependent killing properties

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18
Q

Aminoglycosides are dosed based on

A

Extended interval dosing, concentration depending bacterial killing, rely on achieving specific peak concentrations

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19
Q

Quinolones are dosed based on

A

Extended interval dosing, concentration dependent bacterial killing, rely on achieving a specific peak concentration

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20
Q

What are two types of patients who need renal protection using ACE/ARBs

A

Diabetic patients

Patients with proteinuria

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21
Q

Goal blood pressure in kidney disease with no proteinuria

A
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22
Q

Goal blood pressure in kidney disease with proteinuria

A
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23
Q

What are 3 benefits of ace/arbs

A

Preserve renal function
Reduce proteinuria
Provide cardiovascular protection

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24
Q

How do ace/arbs work

A

Inhibit renin-angeotensin-aldosterone system (RAAS) causing efferent arteriolar dialation

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25
Q

ACE/ARBs may cause what during initiation of treatment

A

30% rise in serum creatinine
Do not stop therapy unless the rise is greater than 30%
hyperkalemia

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26
Q

Monitoring parameters for a patient on ace/arbs

A

Serum creatinine
Potassium
Monitor 1-2 wks after initiating ace/arbs if patient has ckd

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27
Q

List the drugs that start with A/B/C that should not be used in renal impairment

A

Avanafil
Bisphosphonates
Chlorpropamide
Cidofovir

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28
Q

List the drugs that start with D that should not be used in renal impairment

A

Dabigatran
Dofetilide
Duloxetine

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29
Q

List the drugs that start with F that should not be used in renal impairment

A

Fondaparinux

Foscarnet

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30
Q

List the drugs that start with G/L/M that should not be used in renal impairment

A

Glyburide
Lithium
Meperidine
Metformin

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31
Q

List the drugs that start with N/P/R that should not be used in renal impairment

A

a. Nitrofurantoin
b. NSAIDs
c. Potassium-sparing diuretics
d. Ribavirin
e. Rivaroxaban

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32
Q

List the drugs that start with S/T/V that should not be used in renal impairment

A

a. Sotalol
b. Tadalafil
c. Tenofovir
d. Tramadol ER
e. Voriconazole IV

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33
Q

Where is erythropoietin produced

A

kidneys

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34
Q

what does erythropoietin do?

A

Stimulates production of reticulocytes (in mature red blood cells) in the bone marrow

35
Q

How does a patient get anemia of chronic kidney disease

A

As kidney function declines, the production of erythropoietin declines causing anemia

36
Q

Explain the treatment of anemia in CKD

A

Combination of erythropoiesis-stimulating agents and iron supplementation - IV iron is preferred over oral if patient is on hemodialysis and sometimes other pts with CKD d/t poor GI absorption in CKD

37
Q

Patients on erythropoietin-stimulating agents and correction of hemoglobin

A

Do not correct to normal for patients with CKD (generally lower with CKD) d/t increased risk of CVD, stroke and death

38
Q

What is the initial treatment of hyperphosphatemia

A

Restricting dietary phosphorus

Avoid dairy, cola, chocolate, and nuts

39
Q

What happens if a patient misses a dose of a phosphate binder

A

Once food is already absorbed, the dose should be skipped and the patient should resume normal dosing at the next meal or snack

40
Q

Aluminum based phosphate binders

A

Potent but can accumulate in ckd
Toxic to nervous system and bone
May lead to dialysis dementia
Should only be used, if at all

41
Q

Calcium based phosphate binders

A

Effective first line agents in ckd

Dose limiting effect is hypercalcemia, problematic for patients taking vit D which increase calcium absorption

42
Q

Iron based phosphate binders

A

Utilize iron as the cation to bind phosphorus in the gut

43
Q

Aluminum-free calcium-free agents

A

Effective at controlling phosphorus
Do not contain aluminum and calcium, don’t cause problems with excess albumin load and less problem with excess calcium load
Not expensive

44
Q

Where do thiazide diuretics work

A

distal convoluted tubule

45
Q

Where do ARA/K sparing diuretics work

A

distal convoluted tuble

46
Q

Where do loop diuretics work

A

ascending loop of henle

47
Q

How do loop diuretics work

A

Inhibit the Na/K pump in the ascending loop of Henle – this causes a significant increase in tubular concentration of sodium and less water reabsorption, also alters the electrical gradient causing a decrease in calcium reabsorption

48
Q

Loop diuretics can have harmful effects on

A

the bone because of a decrease in calcium reabsorption

49
Q

How do thiazide diuretics work

A

Inhibit the Na/Cl pump in the distal tubule, Weaker than loop diuretics because only 5% of the Na is resorbed in this portion of the nephron

50
Q

Which diuretic has protective effects on the bones

A

Thiazide diuretics – they increase calcium absorption by affecting the calcium pump in the distal convoluted tubule

51
Q

What is the primary function of aldosterone in the kidney

A

Increase Na and water retention and lowers K

52
Q

Spironolactone and eplerenone work by

A

Blocking aldosterone in the collecting duct and the distal convoluted tubule and increase serum potassium

53
Q

What does BUN stand for and what does it measure

A

BUN – blood urea nitrogen, Amount of nitrogen that comes from urea, a waste product

54
Q

What other factors can affect the levels of BUN

A

Renal function and hydration

55
Q

As renal function decreases, creat concentration

A

increases

56
Q

When is eGFR accuracy limited

A

People with very high or very low muscle mass, obese, liver disease, pregnant or other conditions that cause abnormal muscle turnover

57
Q

When is Cockcroft-gault not preferable for estimating renal function in order to adjust drug dose

A

Young children
End-stage renal disease
Rapidly fluctuating renal function

58
Q

Beta-lactams are dosed based on

A

Time above the minimum inhibitory concentration, time-dependent killing properties

59
Q

Aminoglycosides are dosed based on

A

Extended interval dosing, concentration depending bacterial killing, rely on achieving specific peak concentrations

60
Q

Quinolones are dosed based on

A

Extended interval dosing, concentration dependent bacterial killing, rely on achieving a specific peak concentration

61
Q

What are two types of patients who need renal protection using ACE/ARBs

A

Diabetic patients

Patients with proteinuria

62
Q

Goal blood pressure in kidney disease with no proteinuria

A

less than 140/90

63
Q

Goal blood pressure in kidney disease with proteinuria

A

less than 130/90

64
Q

What are 3 benefits of ace/arbs

A

Preserve renal function
Reduce proteinuria
Provide cardiovascular protection

65
Q

How do ace/arbs work

A

Inhibit renin-angeotensin-aldosterone system (RAAS) causing efferent arteriolar dialation

66
Q

ACE/ARBs may cause what during initiation of treatment

A

30% rise in serum creatinine
Do not stop therapy unless the rise is greater than 30%
hyperkalemia

67
Q

Monitoring parameters for a patient on ace/arbs

A

Serum creatinine
Potassium
Monitor 1-2 wks after initiating ace/arbs if patient has ckd

68
Q

List the drugs that start with A/B/C that should not be used in renal impairment

A

Avanafil
Bisphosphonates
Chlorpropamide
Cidofovir

69
Q

List the drugs that start with D that should not be used in renal impairment

A

Dabigatran
Dofetilide
Duloxetine

70
Q

List the drugs that start with F that should not be used in renal impairment

A

Fondaparinux

Foscarnet

71
Q

List the drugs that start with G/L/M that should not be used in renal impairment

A

Glyburide
Lithium
Meperidine
Metformin

72
Q

List the drugs that start with N/P/R that should not be used in renal impairment

A

a. Nitrofurantoin
b. NSAIDs
c. Potassium-sparing diuretics
d. Ribavirin
e. Rivaroxaban

73
Q

List the drugs that start with S/T/V that should not be used in renal impairment

A

a. Sotalol
b. Tadalafil
c. Tenofovir
d. Tramadol ER
e. Voriconazole IV

74
Q

Where is erythropoietin produced

A

kidneys

75
Q

what does erythropoietin do?

A

Stimulates production of reticulocytes (in mature red blood cells) in the bone marrow

76
Q

How does a patient get anemia of chronic kidney disease

A

As kidney function declines, the production of erythropoietin declines causing anemia

77
Q

Explain the treatment of anemia in CKD

A

Combination of erythropoiesis-stimulating agents and iron supplementation - IV iron is preferred over oral if patient is on hemodialysis and sometimes other pts with CKD d/t poor GI absorption in CKD

78
Q

Patients on erythropoietin-stimulating agents and correction of hemoglobin

A

Do not correct to normal for patients with CKD (generally lower with CKD) d/t increased risk of CVD, stroke and death

79
Q

What is the initial treatment of hyperphosphatemia

A

Restricting dietary phosphorus

Avoid dairy, cola, chocolate, and nuts

80
Q

What happens if a patient misses a dose of a phosphate binder

A

Once food is already absorbed, the dose should be skipped and the patient should resume normal dosing at the next meal or snack

81
Q

Aluminum based phosphate binders

A

Potent but can accumulate in ckd
Toxic to nervous system and bone
May lead to dialysis dementia
Should only be used, if at all

82
Q

Calcium based phosphate binders

A

Effective first line agents in ckd

Dose limiting effect is hypercalcemia, problematic for patients taking vit D which increase calcium absorption

83
Q

Iron based phosphate binders

A

Utilize iron as the cation to bind phosphorus in the gut

84
Q

Aluminum-free calcium-free agents

A

Effective at controlling phosphorus
Do not contain aluminum and calcium, don’t cause problems with excess albumin load and less problem with excess calcium load
Not expensive

NAPLEX (15 decks)

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