Renal Drugs Quiz Flashcards
It is next year and you are in one of your clinical year primary care experiences. It is time to start treatment of hypertension for one of your patients in clinic. Your supervising clinician wants you to try out this new method called evidence based medicine. You can hardly wait to show off your stuff!! You determine your patient is a perfect candidate for management with a thiazide diuretic. However when you review his medical record you see the words sulfa allergy plastered all over his record. When you try to enter hydrochlorothiazide in his chart an allergy warning pops up. Before deciding which antihypertensive to prescribe you should do all of the following EXCEPT:
A) Inquire as to the type of allergic reaction
B) Ask if the medication related to the allergy was an antibacterial
C) Ask if the patient has ever received a diuretic or water pill
D) Prescribe the newest and most expensive antihypertensive medication available
D
Please match the correct statements:
Contrast induced renal failure
NSAIDs and ACE inhibitors
Loop diuretics
Thiazide diuretics
Can help to promote a diuresis as long as the GFR is greater than 5-15 mL/min
Can be added to loop diuretics to increase desired and undesired effects
The most common ADR seen in academic medical centers
Can act to reduce renal blood flow
Contrast induced renal failure - the most common ADR seen in academic medical centers
NSAIDs and ACE inhibitors - can act to reduce renal blood flow
Loop diuretics - can help to promote a diuresis as long as the GFR is greater than 5-15 mL/min
Thiazide - can be added to loop diuretics to increase desired and undesired effects
Match the correct statements:
Mannitol
Dopamine
Kayexalate
Calcium gluconate
Mannitol - When this medication is used osmotic pressure of the glomerular filtrate increases inhibiting reabsorption of water
Dopamine - a neurotransmitter having intrinsic activity. This medication is converted into norepinephrine in peripheral sites
Kayexalate - Removes potassium from the body. In many patients harm > benefit, takes days to reach peak effect
Calcium gluconate - Antagonizes the effects of hyperkalemia
Match the correct statements:
Calcium carbonate
Sevelamer
Desmopressin
Aminoglycoside antibiotics, acyclovir, cyclosporine, cisplatin and amphotericin B
Binds phosphates
All of these medications can cause renal failure
Non calcium containing phosphate binder
An antidiuretic hormone which promotes platelet aggregation through release of clotting factors such as factor VII and vWF
Calcium carbonate - binds phospates
Sevelamer - Non calcium containing phosphate binder
Desmopressin - ant antidiuretic hormone which promotes platelet aggregation through release of clotting factors such as factor VII and vWF
Aminoglycoside antibiotics, acyclovir, cyclosporine, cisplatin, and amphotericin B - all of these medications can cause renal failure
Match the correct statements:
Renal failure
Erythropoetin
Calcium gluconate injection vs. calcium chloride injection
A trough level of medication
Narrows the therapeutic window for water soluble medications
There is 3 times as much calcium in a gram of calcium chloride as in a gram of calcium gluconate
Is usually measured right before the next scheduled dose
Requires an adequate supply of iron to work properly
Renal failure - narrows the therapeutic window for water soluble medications
Erythropoetin - requires an adequate supply of iron to work properly
Calcium gluconate injection vs. calcium chloride injection - there is 3 times as much calcium in a gram of calcium chloride as in a gram of calcium gluconate
A trough level of medication - is usually measured right before the next scheduled dose
Your patient in clinic today is a 58 year old white F. She weighs 140 pounds, and is 5 Feet 5 inches tall. Last year she was hospitalized for ARF which resolved. At the time she was taking the following oral medications: ibuprofen 600 mg - 4 times a day for pain and fever. Ranitidine 150 mg twice a day for dyspepsia. Acyclovir 400 mg - 5 times a day for the past week. She had two contrast studies, and her serum creatinine rose from 1.1 to 2.8 following the second contrast study. Identify the medications/procedures likely implicated in her ARF. (3 points).
Today she presents with influenza and dyspepsia. Her serum creatinine at today’s visit is 1.5 mg/dl, BUN is 20 and her serum Albumin is 4. Her weight and all other objective values are the same as previously reported. Select and dose an analgesic/antipyretic for her to use. You plan to also continue ranitidine. Select the dose of ranitidine. (2 points)
Ibuprofen (inhibition of prostaglandins can impair renal blood flow, acyclovir (crystallization of acyclovir in the nephron, and contrast studies (renal vasoconstriction or direct toxicity) are the most likely implicated meds. 3 points
Acetaminophen 650 mg every 4-6 hours
Ranitidine: Her Creatinine Clearance is estimated to be around 40 ml/min- however you choose to estimate the value- it is less than 50 ml/min - so reduce the daily dose of ranitidine from 150 mg twice a day to 150 mg once a day.
