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NAPLEX BABY > Renal & Liver Disease > Flashcards

Renal & Liver Disease Flashcards

Only Study Tip Gal & Key Drug Guy

1
Q

Select Drugs that Cause Kidney Disease

A

-Aminoglycosides
-Amphotericin B
-Cisplatin
-Cyclosporine
-Loop Diuretics
-NSAIDs
-Polymyxins
-Radiographic contrast dye
-Tacrolimus
-Vancomycin

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2
Q

CrCl: Cockcroft-Gault equation

A

-CrCl= [ (140-age)/(72 * SCr) ] * wt (kg) [* .85 if female]

–> use actual body weight if less than IBW
–> use IBW if normal weight (by BMI)
–> use adjusted body weight if overweight (by BMI)

-IBW:
–> males: 50 kg + 2.3 (inches over 5 ft)
–> females: 45.5kg + 2.3(inches oer 5 ft)

-Adjusted body weight:
–> IBW + 0.4(ABW - IBW)

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3
Q

GFR

A

-not commonly calculated by pharmacists, but may reported with BMP
-CKD-EPI and MRDR equations are used
-Used for staging kidney disease and for dosing select drugs (metformin, SGLT2)
–> CKD: GFR < 60
–> albuminuria: ACR >/ 30

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4
Q

ACE inhibitors and ARBs for albuminuria

A

Who: recommend in pts with HTN and albuminuria
Why: to prevent kidney disease progression
How: Inhibit renin-aldosterone system (RAAS), causing efferent arteriolar dilation
What: reduce pressure in the glomerulus, decrease albuminuria and provide cardiovascular protection

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5
Q

Key drugs that require dec dose or inc interval

A

Anti-infectives:
–> aminoglycosides (nephrotoxicity, extend interval)
–> beta-lactams (seizures)
–> fluconazole
–> quinolones (seizures) (except moxifloxacin)
–> Vancomycin (nephrotoxic)
Cardio Drugs:
–> LMWH (enoaparin)
–> Rivaroxaban (for Afib)
GI drugs:
–> H2RAs (CNS effects)
–> Metoclopramide (EPS)
Others:
–> Bisphosphonates
–> Lithium (toxic)

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6
Q

Drugs that are contraindicated in CKD

A

CrCl < 60
–> Nitrofurantoin
CrCl < 50
–> Tenofovir Disoproxil Fumarate containing products (stribild- cant start if < 70)
–> Voriconazole IV
CrCl < 30
–> Tenofovir Alafenamide containing (Genvoya, Bektarvy) products
–> NSAIDs
–> Dabigatran
–> Rovaroxaban
GFR < 30
–> SGLT2 inhibitors
–> Metformin
Other
–> Meperidine (seizures)

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7
Q

Tx pf hyperphosphatemia (P04): phosphate binders

A

–> restricy diet (chocolate, nuts, cola)
–> use phosphate binders: WITH FOOD/MEALS/SNACKS, binds to PO4, sends it to the bowels and does NOT get absorbed
DDI: levothyroxine, quinolones, tetracyclines, oral bisphosphonates

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8
Q

Tx pf hyperphosphatemia (P04) : Aluminimum hydroxide

A

–> aluminum - based (LAST LINE): potent, use short term
-toxic to the bone and CNS (mainly used in hospital setting
-can cause aluminmum intoxication (dialysis dementia)

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9
Q

Tx pf hyperphosphatemia (P04): Calcium acetate, calcium carbonate

A

-calcium based, FIRST LINE
-TID w/ meals
AEs: hypercalcemia, constipation

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10
Q

Tx pf hyperphosphatemia (P04): alumininum and calcium free

A

-not systemically absorbed
–> Lanthum Carbonate (Fosrenal): TID w/ meals must chew a lot can cause GI obstruction)
–> Sevelamer carbonate (Renvela): TID/meals, N/V/D, lowers LDL

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11
Q

TX of Vit D deficiency & secondary hyperparathyroidism (high PTH): Vitamin D analogs

A

-increase calcium absorption in the gut
–> Calcitriol (Rocaltrol): active form of Vit D3
SE: HYPERcalcemia

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12
Q

TX of Vit D deficiency & secondary hyperparathyroidism (high PTH): Calcimimetics

A

-act at the calcium-sensoring receptors on the parathyroid gland
–> Cinacalcet (Senipar): stop the PTH pathway of wanting to inc calcium
SE: HYPOcalcemia

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13
Q

TX: Anemia of CKD

A

-healthy kidneys produce EPO –> stimualtes bone marrow to make RBC
-disease kidney: dec EPO production
TX:
–> ESRAs ( Eopoetin alfa [Procrit], darbopoetin) only works if pt has WNL iron
AE: inc BP, thrombosis ( use when hemoglobin <10, stop > 11!!
–> IV iron

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14
Q

Key drugs that raise potassium levels

A

-ACEi
-ARBs
-Aliskerin
-Aldosterone receptor antagonists
-Canagliflozin (SGLT2
-Drospirenone continaing OCs (Yaz)
-Postassium-contianing IV fluids
- Sulfamethoxazole/Trimethoprim
-Transplant drugs (cyclosporine, everolimus, tacrolimis)

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15
Q

TX of hyperkalemia in CKD

A

Potassium: 3.5-5 mEq/L (> 5 = fatal arrhythmias)
–> causes of hyperkalemia: kidney failure, drugs or others (daibestes, hospitilizations)
1: STABILIZE THE HEART: calcium gluconate (prevent arrthymias)
2: MOVE K INTRACELLULARLY: regular insulin w/ dextrose, sodium bicarb, albuterol
3: REMOVE IT: furosemide (IV), binding agents (Patiromer, sodium zirconium cyclosilicate) hemodialysis

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16
Q

Metabolic Acidosis in CKD

A

bicarbonate reabsorption decreases as CKD worsens
-TREAT WHEN SERUM HCO3 < 22 MEQ/L
–> Sodium bicarbonate
–> Sodium citrate/citric acid solution
-monitor sodium

17
Q

Dialysis

A

-hemodialysis (HD)
-peritoneal dialysis (PD)
–> factors affecting drug removal during dialysis:
-drug molecular weight, Vd, protein-binding
-dialysis membrane (low vs high flux) –> high flux membranes have the largest pore size
-blood flow rate

18
Q

Hepatitis A

A

-acute (self-limited infection)
-fecal-oral transmission
-has vaccine
-tx: supportive care

19
Q

Hepatitis B

A

-acute infection that leads into chronic
-blood, body fluids transmission
-has vaccine
-TX: PEG-INF or NRTI

20
Q

Hepatitis C

A

-acute infection that leads into chronic
-blood, body fluids transmission
-NO vaccine
-TX naive: DAA combo
-Others:
–> DAA combo + RBV
–> DAA combo + RBV + PG-INF

21
Q

Hep C drug tx: NS3/4A Protease Inhibitors

A

-previr
–> Grazoprevir
–> Paritaprevir
–> Simeprevir
–> Vaxilaprevir
*must take with food

22
Q

Hep C drug tx: NS5A Replication Complex inhibitor

A

-asvir
–> Daclatasvir
–> Ledipasvir
–> Ombitasvir
–> Pibrentasvir
–> Velpatasvir

23
Q

Hep C tx drugs: NS5B Poltmerase INhibitors

A

-buvir
–> Dasabivor
–> Sofosbuvir.

24
Q

Direct Acting Antivirals (DAAs) for hep c

A

**test all pts for HBV before starting a DAA
-for sofosbuvir-containing regimens: do not use with aminodarone = serious symptomatic bradycardia

25
Q

what HVC drugs are pan-genotype (approved fro all 6 HCV) for treatment naiive pts

A

-Epclusa
-Mavyret

–> salvage therapy: Vosevi and Mavyret

26
Q

DAA drug interactions

A

-Harvoni, Epclusa and Vosevi
–> antiacids, H2RAs and PPIs reduce concentrations of ledipasvir
**PPIs should not be used with Epclusa
**Ethinyl estradial-contianing products are specifically CI w/ Technivia and Viekira

27
Q

Ribaviran (RBV) for HCV TX

A

-oral drug
BBW: preg catergory X - avoid pregnancy (females and female partners of male pts) for 6 months after completion of therapy: use 2 forms of BC
–> MUST be used in combo with other agents
-Hemolytic anemia

**Big SEs to remember: RIBA

R: renal (CI when CrCl < 50)
I: n combination only
B: birth defects
A: anemia (hemolytic) = primary toxicity

28
Q

Interferon Alfa (INF-ALFA)

A

Alfa: HBV, HCV and some cancers
Beta: multiple sclerosis

-interferson do not provide a cure, and are hard to take. –> flu like syndrome 1-2 hrs after admin (fever, chills, arthalgias)
BBW: neuropsychiatric, autoimmune, ischemic and infectious
SE: CNS (depression, anxiety, fatigue), GI, inc LFT, myelosuppression,

29
Q

TX for Hep B: Nucleoside/tide reverse transcriptase inhibitors (NRTIs)

A

BBW: lactic acidosis and hepatomegaly with steatosis, exacerbation of Hep B once d/c
SE: GI upset, rash, inc LFTs
NRTIS approved:
–> Tenofovir disoproxil (Viread)
–> Tenofovir alafenamide (Vemildy)
–> Entecavir (Baraclude)
–> Adefovir (Hepsera)
–> Lamivudine (Epivir HBV)

TeNOFovir SEs:
N: nephrotoxic
O: osteoporosis
F: fanconi syndrome

30
Q

Lab tests for Liver disease

A

-Acute liver toxicity: inc AST/ALT
-Chronic liver disease: inc AST/ALT, alk phos, Tbili, LDH, PT/INR, dec albumin
-Alcoholic liver disease: inc AST > inc ALT, inc GGT
-Hepatic encephalopathy: inc ammonia
-Jaundice: inc bili

31
Q

Select drugs with BBW for liver damage

A

-acetaminophen (high doses, acute or chronic)
-Isoniazid
-Ketoconazole (oral)
-Methotrexate
-Nefazodone
-Nevirapine
-NRTIs
-Propylthiouracil
-Tipranavir
-Valproic acid

32
Q

Portal HTN and Variceal bleeding

A

-could have rectal bleeding or vomiting blood (this = emergency!)
-acute tx: octreotide or vasopressin
-prevention: non-selective beta blcoker - lifetime drug, target HR = 55-60 bpm
–> Nadolol (corgard)
–> Propranolol

33
Q

Hepatic Encephalopathy

A

-lactulose (reduces the ammonia in the body)- poop it out
-Rifaximin

34
Q

Ascites

A

-fluid build up in the abdomin
tx w/ spirnolactone + furosemide 100mg: 40 mg ratio –> potent at removing fluid and keeping K balanced

-can also do a parasynthesis - remove fluid

NAPLEX BABY (23 decks)

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