Renal Disease - Quiz 4 Flashcards
Where do thiazides work?
DCT
Where do K sparing diuretics work?
DCT and collecting ducts
Where do loop diuretics work?
Ascending loop of henle
Where do SGLT2I work?
PCT
Drugs that cause nephrotoxicity?
- Aminoglycosides
- Amphotericin B
- Cisplatin
- Cyclosporine
- Loops
- NSAIDs
- Polymyxins
- Radiographic dyes
- Tacrolimus
- Vanc
What lab do we take to assess kidney function?
- BUN
- sCr
- eGFR
Normal sCr range?
0.6-1.3
What is the criteria for CKD?
eGFR <60
Albuminuria ≥30
Greater than 3 months
G1
> 90
G2
60-89
G3a
45-59
G3b
30-44
G4
15-29
G5
<15
A1
<30
A2
30-300
A3
300+
What is the tx for HTN with CKD?
ACEI and ARBs despite race
Tx for diabetes and CKD
SGLT2i, finerenone
Anti-infectives that requrire renal dosage adju?
- Aminoglycosides
- Beta-lactams (except antistaph (nafcillin, oxacillin), ceftriaxone
- FLuconazole
- Quinolones (not moxifloxacin)
- Vanc
CV drugs that require dosage adj?
- LMWH (enoxaparin)
- Rivaroxaban
- Apixaban
- Dabigatran
GI drugs that require renal dose adjustment?
- H2RAs
- Metoclopramide
Other drugs that require dosage adj?
- Bisphosphanates
- Lithium
Drugs that are CI with CKD?
- Nitrofurantoin
- TDF, TAF
- Voriconazole
- NSAIDs
- Dabigatran
- Metformin
- Meperidine
- Rivaroxaban
- SGLT2I
Tx for hyperphosphatemia?
- Reduced phosphate intake (avoiding dairy, cola, chocolate, nuts)
- Phosphate binders that block absoprtion of dietary phosphate
What to do if you miss dose of phosphate binder?
Skip til next dose
Aluminum based phosphate binders?
- AALuminum hydroxide
Alumnium hydroxide ADRs?
Aluminum intoxication
Calcium based phosphate binder?
- Calcium acetate
- Calcium carbonate
ADRs of calcium based phosphate binder?
- Hypercalcemia
- Constipation
- Concomitant ue of vit D can cause hypercalcimium
What are the aluminium and calcium free phosphate binders?
- Sucroferric oxyhydroxide (Velphoro)
- Ferric citrate
- Lanthanum carbonate (Fosrenol)
- Sevelamer carbonate (Renvela)
- Sevelamer HCl (Renagel)
ADR of Sucroferric and ferric citrate?
Constipation
ADRs of lanthanum carbonate?
- NV
- Diarrhea
- COnstipation
ADR of sevelamer?
- NVD
- Lower LDL
What drugs should be separated from phosphate binders?
- levothyroxine
- Quinolones
- Tetracyclines
MOA of calcimemetic
Mimics that action of calcium on the parathyroid gland and reduces PTH
Vitamin D2
Ergocalciferol
Vitamin D3
Cholecalciferol
What is the active form of Vitamin D?
Calcitriol
ADR of calcitriol
Hypercalcemia
* Take with food to decrease GI upset
Types of calcimimetics?
- Cinacalcet
- Etelcalcetide
Cinacalcet
Sensipar
Sevelamer carbonate
Renvela
Sevelamer HCl
Renagel
Tx for ESA
- epoetin alfa (Procrit, Epgen, Retacrit)
- Darbepoetin alfa (Aranesp)
Indicaion for ESA
Hgb <10, DC is >11 to prevent risk of TED
What should be given with ESA?
IV iron
Drugs that cause increase potassium?
- ACEI
- Aliskirin
- ARBs
- Canagliflozin
- Drospirenon COC
- Potassium
- Potassium sparing
- Bactrim
- Transplant drugs
How do you treat hyperkalemia?
- Stabilize heart
- Move potassium
- Remove potassium
Drugs used to stabilize heart?
- Calcium gluconate
- Calcium chloride
Drugs that move potassium
- Regular insulin with D5W (to prevent hypoglycemia)
- Sodium bicarb (metabolic acidosis)
- Albuterol
Drugs used to remove K?
- Loops
- SPS
- Patiromer
- SZC
- Hemodialysis
Types of potassium binder>
SPS, Patiromir, SZC
ADR for SPS
CI necrosis, binds to other meds
ADR for patiromer
- Hypomagnesia
- Constipation
- Binds to other drugs (separate by 3 hrs)
- Delayed onset
ADR of SZC
Separte from other drugs by 2 hr
Tx for metabolic acidosis?
- Sodium bicarb
- Sodium citrate
Factors to consider for dialysis med?
- Molecular weight/size
- Vd
- Protein-binding
- Memebrane
- Blood flow rate