renal & hepatic Flashcards
which drugs work at the proximal tubule
SGLT2 inhibitors
loop diuretics MOA
inhibit NaK pump in the ascending loop of henle (LOW K, Mg, Na, Ca)
which drugs work at the distal convoluted tubule
thiazides (NaCl pump - HIGH Ca)
which drugs work at the collecting duct
potassium sparing diuretics
which drugs cause kidney disease
vancomycin
aminoglycosides
cisplatin
ampB
CNI
loops
NSAIDs
polymyxin
contrast dye
what is HTN treatment in CKD
ACE or ARB (with albuminuria)
can increase SCr initially by 30% - do not stop tx
what is DM treatment in CKD
metformin + SGLT2 inhibitor (reduces CV events and CKD progression)
which drugs require a decrease in dose or increase in interval in CKD
aminoglycosides, beta lactams, azoles, quinolones, vancomycin
LMWH, xarelto, eliquis, pradexa
H2RA, metoclopramide
bisphosphonates
lithium
which drugs are contraindicated in CKD
macrobid <60
TDF, voriconazole <50
TAF, NSAIDs, pradexa, xarelto <30
SGLT2, metformin eGFR <30
hyperphosphatemia treatment
dietary phosphate restriction (dairy, cola, chocolate, nuts) THEN
phosphate binders prior to each meal (Ca based is first line)
Ca based phosphate binders
Phoslyra, PhosLo (calcium acetate)
Tums (calcium carbonate)
causes hypercalcemia
aluminum & calcium free phosphate binders
sucroferric oxyhydroxide, ferric citrate, lanthanum carbonate
sevelamer info
Renvela, Renagel
non calcium, non aluminum phosphate binder that is not systemically absorbed
can lower TC and LDL
phosphate binder interactions
iron containing ones should be separated from doxycycline and ciprofloxacinn
vitamin D deficiency & secondary hyperparathyroidism treatment
D2 (ergo) and D3 (chole)
calcitriol - D3
cinacalcet (sensipar) - calcimimetic (HYPOCALCEMIA)
anemia of CKD treatment
ESA only when Hgb <10 and discontinue when >11
drugs that cause hyperkalemia
potassium sparing diuretics
RAAS inhibitors
canagliflozin
drosperinone
SMX/TMP
CNI
hyperkalemia treatment
- stabilize heart - calcium gluconate
- shift intracellular - albuterol, insulin/dextrose, sodium bicarb
- remove - furosemide, SPS, patiromer, SZC, HD
which potassium binder is preferred due to the fastest onset of action
sodium zirconium cyclosilicate
what factors cause removal during HD
small particle size
small Vd
not protein-bound
high-flux HD filter
higher dialysis blood flow rate
which Hep viruses are acute vs chronic
A - acute
B - both
C - both
how are the Hep viruses transmitted
A - fecal/oral route
B & C - blood, bodily fluid
which Hep virus does not have a vaccine
C
what is the first line treatment for the Hep viruses
A - supportive care
B - PEG-INF or NRTI
C - DAA combination (2-3), DAA + RBV +/- PEG-INF
HCV treatment regimen
2-3 DAA x 8-12 weeks
PI (P for -previr)
NS5A replication complex (A for -asvir)
NS5B polymerase (B for -busvir)
which DAA needs to be taken with food
PIG
Protease Inhibitors & Grub
info for all DAAs
BW - reactivation of HBV
W - sofosbuvir CANNOT be used with amiodarone due to bradycardia
mavyret generic
glecaprevir/pibrentasvir (GP)
epclusa generic
sofosbuvir/velpatasvir (SV) NO AMIODARONE
viekira pak generic
pariteprevir/ritonavir/ombitasvir + dasabuvir
HEPATIC FAILURE
DAA drug interactions
they are CYP inhibitors
epclusa - no PPI
ribavirin info
teratogenic - need 2 forms of contraception and no pregnancy 6 months after
hemolytic anemia
interferon alpha info
neuropsychiatric, autoimmune, ischemic, infection risk
CNS effects, GI upset, increased LFTs, flu like syndrome (pre treat)
HBV treatment regimen
interferon alpha monotherapy OR
NRTI - test for HIV prior
HBV NRTI info
BW - lactic acidosis and hepatomegaly, HBV exacerbation
NRTIs brand and generic
TDF (Viread)
TAF (Vemlidy)
entecavir (Baraclude) - take OES
lamivudine (Epivir HBV)
tenofovir - renal toxicity, Fanconi syndrome, osteomalacia, decreased bone density
which drugs can cause liver damage
acetaminophen
amiodarone
isoniazid
ketoconazole
methotrexate
nefazodone
nevirapine
NRTIs
PTU
valproic acid
alcoholic liver treatment
cessation
BZD for withdrawal in inpatients
naltrexone, acamprosate, disulfiram to prevent relapses
thiamine
varices treatment
band ligation or sclerotherapy
octreotide (Sandostatin) or vasopressin
octreotide causes cholelithiasis, biliary sludge
portal HTN treatment
non selective BB - nadolol (Corgard), propranolol (Inderal)
hepatic encephalopathy symptoms and presentation
musty odor, changes in thinking, confusion, asterixis (hand tremor), ammonia
hepatic encephalopathy treatment
lactulose
rifaximin (Xifaxan)
ascites treatment
consider transplantation if cirrhosis
restrict Na
spironolactone monotherapy or + furosemide (40 F : 100 S)
SBP treamtent
ceftriaxone
