renal & hepatic

Question 1

which drugs work at the proximal tubule

Answer 1

SGLT2 inhibitors

Question 2

loop diuretics MOA

Answer 2

inhibit NaK pump in the ascending loop of henle (LOW K, Mg, Na, Ca)

Question 3

which drugs work at the distal convoluted tubule

Answer 3

thiazides (NaCl pump - HIGH Ca)

Question 4

which drugs work at the collecting duct

Answer 4

potassium sparing diuretics

Question 5

which drugs cause kidney disease

Answer 5

vancomycin
aminoglycosides
cisplatin
ampB
CNI
loops
NSAIDs
polymyxin
contrast dye

Question 6

what is HTN treatment in CKD

Answer 6

ACE or ARB (with albuminuria)
can increase SCr initially by 30% - do not stop tx

Question 7

what is DM treatment in CKD

Answer 7

metformin + SGLT2 inhibitor (reduces CV events and CKD progression)

Question 8

which drugs require a decrease in dose or increase in interval in CKD

Answer 8

aminoglycosides, beta lactams, azoles, quinolones, vancomycin
LMWH, xarelto, eliquis, pradexa
H2RA, metoclopramide
bisphosphonates
lithium

Question 9

which drugs are contraindicated in CKD

Answer 9

macrobid <60
TDF, voriconazole <50
TAF, NSAIDs, pradexa, xarelto <30
SGLT2, metformin eGFR <30

Question 10

hyperphosphatemia treatment

Answer 10

dietary phosphate restriction (dairy, cola, chocolate, nuts) THEN
phosphate binders prior to each meal (Ca based is first line)

Question 11

Ca based phosphate binders

Answer 11

Phoslyra, PhosLo (calcium acetate)
Tums (calcium carbonate)

causes hypercalcemia

Question 12

aluminum & calcium free phosphate binders

Answer 12

sucroferric oxyhydroxide, ferric citrate, lanthanum carbonate

Question 13

sevelamer info

Answer 13

Renvela, Renagel
non calcium, non aluminum phosphate binder that is not systemically absorbed

can lower TC and LDL

Question 14

phosphate binder interactions

Answer 14

iron containing ones should be separated from doxycycline and ciprofloxacinn

Question 15

vitamin D deficiency & secondary hyperparathyroidism treatment

Answer 15

D2 (ergo) and D3 (chole)
calcitriol - D3
cinacalcet (sensipar) - calcimimetic (HYPOCALCEMIA)

Question 16

anemia of CKD treatment

Answer 16

ESA only when Hgb <10 and discontinue when >11

Question 17

drugs that cause hyperkalemia

Answer 17

potassium sparing diuretics
RAAS inhibitors
canagliflozin
drosperinone
SMX/TMP
CNI

Question 18

hyperkalemia treatment

Answer 18

1. stabilize heart - calcium gluconate
2. shift intracellular - albuterol, insulin/dextrose, sodium bicarb
3. remove - furosemide, SPS, patiromer, SZC, HD

Question 19

which potassium binder is preferred due to the fastest onset of action

Answer 19

sodium zirconium cyclosilicate

Question 20

what factors cause removal during HD

Answer 20

small particle size
small Vd
not protein-bound
high-flux HD filter
higher dialysis blood flow rate

Question 21

which Hep viruses are acute vs chronic

Answer 21

A - acute
B - both
C - both

Question 22

how are the Hep viruses transmitted

Answer 22

A - fecal/oral route
B & C - blood, bodily fluid

Question 23

which Hep virus does not have a vaccine

Answer 23

C

Question 24

what is the first line treatment for the Hep viruses

Answer 24

A - supportive care
B - PEG-INF or NRTI
C - DAA combination (2-3), DAA + RBV +/- PEG-INF

Question 25

HCV treatment regimen

Answer 25

2-3 DAA x 8-12 weeks PI (P for -previr) NS5A replication complex (A for -asvir) NS5B polymerase (B for -busvir)

Question 26

which DAA needs to be taken with food

Answer 26

PIG Protease Inhibitors & Grub

Question 27

info for all DAAs

Answer 27

BW - reactivation of HBV W - sofosbuvir CANNOT be used with amiodarone due to bradycardia

Question 28

mavyret generic

Answer 28

glecaprevir/pibrentasvir (GP)

Question 29

epclusa generic

Answer 29

sofosbuvir/velpatasvir (SV) NO AMIODARONE

Question 30

viekira pak generic

Answer 30

pariteprevir/ritonavir/ombitasvir + dasabuvir HEPATIC FAILURE

Question 31

DAA drug interactions

Answer 31

they are CYP inhibitors epclusa - no PPI

Question 32

ribavirin info

Answer 32

teratogenic - need 2 forms of contraception and no pregnancy 6 months after hemolytic anemia

Question 33

interferon alpha info

Answer 33

neuropsychiatric, autoimmune, ischemic, infection risk CNS effects, GI upset, increased LFTs, flu like syndrome (pre treat)

Question 34

HBV treatment regimen

Answer 34

interferon alpha monotherapy OR NRTI - test for HIV prior

Question 35

HBV NRTI info

Answer 35

BW - lactic acidosis and hepatomegaly, HBV exacerbation

Question 36

NRTIs brand and generic

Answer 36

TDF (Viread) TAF (Vemlidy) entecavir (Baraclude) - take OES lamivudine (Epivir HBV) tenofovir - renal toxicity, Fanconi syndrome, osteomalacia, decreased bone density

Question 37

which drugs can cause liver damage

Answer 37

acetaminophen amiodarone isoniazid ketoconazole methotrexate nefazodone nevirapine NRTIs PTU valproic acid

Question 38

alcoholic liver treatment

Answer 38

cessation BZD for withdrawal in inpatients naltrexone, acamprosate, disulfiram to prevent relapses thiamine

Question 39

varices treatment

Answer 39

band ligation or sclerotherapy octreotide (Sandostatin) or vasopressin octreotide causes cholelithiasis, biliary sludge

Question 40

portal HTN treatment

Answer 40

non selective BB - nadolol (Corgard), propranolol (Inderal)

Question 41

hepatic encephalopathy symptoms and presentation

Answer 41

musty odor, changes in thinking, confusion, asterixis (hand tremor), ammonia

Question 42

hepatic encephalopathy treatment

Answer 42

lactulose rifaximin (Xifaxan)

Question 43

ascites treatment

Answer 43

consider transplantation if cirrhosis restrict Na spironolactone monotherapy or + furosemide (40 F : 100 S)

Question 44

SBP treamtent

Answer 44

ceftriaxone