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p2 year > Renal Therapeutics > Flashcards

Renal Therapeutics Flashcards

1
Q

how long does an AKI last?

A

7 days or less

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2
Q

when does AKD occur?

A

7 to 90 days after AKI

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3
Q

AKI Dx

A

1) SCr 1.5-1.9 x baseline over 7 days
or
2) SCr increase greater than or equal to 0.3 mg/dL over 48 hours

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4
Q

monitoring for AKI loop use?

A

dec intravascular volume
dec BP
inc HR
alkalosis

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5
Q

nephrotoxins

A

aminoglycosides (gentamicin, …)
amphotericin
iodinated contrast
vancomycin

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6
Q

drugs to avoid in AKI prevention

A

sodium bicarbonate
vitamin C
dopamine
fenoldapam

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7
Q

pre-renal AKI Dx

A

FeNa < 1%
or
if on loop, FeUrea < 35%

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8
Q

what kidney assessment measure do you avoid in AKI?

A

SCr –> lags 1-2 days behind GFR

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9
Q

drugs to temporarily hold in hemodynamic AKI?

A
  • ACEi
  • ARB
  • SGLT2i
  • calcineurin inhibitors
  • NSAIDs
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10
Q

drugs to temporality hold in pre-renal AKI?

A
  • loop diuretic
  • thiazide diuretic (HCTZ, chlorthalidone)
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11
Q

dialysis modalities

A

hemodialysis
peritoneal dialysis
continuous kidney replacement therapy

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12
Q

HD access points

A

1) arteriovenous fistula
2) arteriovenous graft
3) central venous catheter

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13
Q

which HD access is highest risk of infection, thrombosis, inadequate dialysis?

A

central venous catheter

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14
Q

HD fistula characteristics

A

preferred long-term access, takes 6-12 weeks to mature after surgical creation, lowest infection/thrombosis risk

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15
Q

HD graft characteristics

A

plastic tube outside of body

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16
Q

HD catheter characteristics

A

last-line option, used short-term (while bridging to fistula), highest infection/thrombosis risk

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17
Q

what are the risk factors associated with HD access?

A
  • thrombosis
  • infection
  • inadequate dialysis (slower blood flow)
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18
Q

peritoneal dialysis complications

A

infection of peritoneal membrane
- can occur from site of entry and tip of catheter infection
- ensure aseptic technique

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19
Q

when to do HD TDM?

A

prior to HD
- bc after HD there is 4-6 hours of redistribution and fluid shifts, therefore fluctuating drug concentrations

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20
Q

when to do PD TDM?

A

random

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21
Q

when to do CRRT TDM?

A

random

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22
Q

HD complications

A

hypotension
cramping
fatigue
infection
thrombosis
bleeding

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23
Q

PD complications

A

peritonitis
fluid overload
hyperglycemia

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24
Q

midodrine indication

A

HD hypotension complication

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25
Q

midodrine MoA

A

alpha-1 agonist –> stimulates peripheral vasoconstriction (pro-drug) -> inc BP

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26
Q

midodrine dosing

A

2.5-10mg po 30 min before HD

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27
Q

midodrine AE

A

bradycardia, hypertension, peripheral ischemia, urinary retention

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28
Q

midodrine CI

A

severe PVD

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29
Q

midodrine DDI

A

MAOIs, sympathomimetics

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30
Q

vitamin E indication

A

HD cramping symptom improvement

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31
Q

vitamin E dose

A

400 IU po qhs

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32
Q

what to avoid to treat HD cramping

A

quinine

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33
Q

HD thrombosis treatment and dose

A

alteplase (cathflo) 2mg/2mL instilled for 30-120 min

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34
Q

HD hypotension and cramping treatment

A

100-250mL 0.9% NaCl

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35
Q

vancomycin efficacy failure vs toxicity for dialysis

A

toxicity: ototoxicity, nephrotoxicity, red man’s syndrome (puritis, …)
efficacy failure: infection mortality and morbidity

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36
Q

what drug characteristics allow for no renal dosing?

A

large therapeutic index
and
fraction excreted unchanged in urine 30% or less
and
inactive or no metabolites

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37
Q

which kidney assessment do you use for CKD staging?

A

eGFR (CKD-EPI)

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38
Q

which kidney assessment do you use for drug dosing?

A

eCrCl (cockcroft-gault)

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39
Q

opioids safe in kidney disease

A

fentanyl
methadone

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40
Q

opioids caution in kidney disease

A

hydromorphone
oxycodone
hydrocodone

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41
Q

opioids avoid in kidney disease

A

morphine
codeine (pro-drug of morphine)
meperidine

42
Q

loading dose most impacted by

A

Vd

43
Q

digoxin LD consideration

A

lower Vd –> cut LD by 50%

44
Q

hydrophilic antibiotics LD considerations

A

higher Vd –> inc dose

45
Q

hydrophilic antibiotics

A

aminoglycosides (gentamicin)
beta lactams
carbapenems
linezolid
colistin
glycopeptides (vancomycin)

46
Q

maintenance dose most impacted by

A

CL

47
Q

antimicrobials that do not require kidney dosing

A

metronidazole
azithromycin
nafcillin
tigecycline
oxacillin
linezolid
doxycycline
moxifloxacin
erythromycin
quinupristin/dalfopristin
clindamycin
ceftriaxone

48
Q

normal SCr

A

around 1.2 mg/dL

49
Q

normal BUN

A

24 mg/dL ish

50
Q

DOAC with lowest percent kidney CL

A

apixaban

51
Q

LMWH with lowest percent kidney CL

A

tinzaparin

52
Q

metformin CI

A

eGFR < 30

53
Q

SU bad for kidneys

A

glyburide

54
Q

SU preferred for kidney

A

glipizide (no beers too)

55
Q

DPP4i without renal adjustment

A

linagliptin

56
Q

thiazide renal impact

A

not effective for HTN when CrCl < 30

57
Q

K sparing and aldosterone antag CI

A

CrCl <30 bc hyperkalemia

58
Q

loop dietetic starting dose

A

40 mg furosemide po ???

59
Q

how does loop dose change with renal impairment

A

CrCl 25-50: 2x dose
CrCl < 25: 4x dose

60
Q

analgesic to avoid kidney dysfunction

A
  • NSAIDs (inc progression of CKD, can use ESRD bc no progression to prevent against – already happened)
  • gabapentin/pregabalin (falls, altered mentation)
61
Q

preferred analgesic in kidney dysfunction

A

APAP
1000mg po tid

62
Q

duloxetine CI

A

CrCl < 30

63
Q

anemia Dx

A

male: Hgb < 13 g/dL
female: Hgb < 12 g/dL

64
Q

anemia treatment labs

A

Hgb 10-11 g/dL –> o2 carrying capacity
serum ferritin > 500 ng/mL –> storage form iron
transferrin saturation (Tsat) > 30% –> functional form iron

65
Q

most common cause of erythropoeitin resistance?

A

iron deficiency

66
Q

when to hold IV iron

A

Tsat > 50%
ferritin > 1200 ng/dL

67
Q

oral iron characteristics

A

10-15% F (low)
slow replenishment of iron

68
Q

iv iron characteristics

A

high F
rapid replenishment of iron
risk of iron overload

69
Q

oral iron AE

A

**GI upset –> nausea, cramp, constipation
dark stool
DDI

70
Q

iv iron AE

A

infusion reactions (itching, hypotension, edema, chest pain)
anaphylactic
**infection

71
Q

IV iron CI

A

active systemic infections

72
Q

oral iron tid dosing AE

A

more iron –> inc hepcidin –> dec iron absorption –> need more iron

to dec risk of this: qd or every other day dose

73
Q

oral iron CI (ish)

A

PPI, H2RA –> need low gastric pH to absorb

74
Q

oral iron DDIs

A

drugs that are impacted by iron and therefore need 2 hr separation
- fluoroquinolones
- levothyroxine
- tetracyclines
- mycophenolate
- methyldopa
- levodopa

75
Q

ferric gluconate brand, dose

A

iv
ferrlecit
125 mg tiw 8 doses

76
Q

iron sucrose brand, dose

A

iv
venofer
100mg 1-3x weekly, total 1g

77
Q

what is the marker of good ESA response

A

2.5% inc in reticulocytes in 1-2 weeks

78
Q

longest acting ESA

A

methoxy polyethylene glycol epoetin beta (Mircera)

79
Q

cheapest ESA

A

epoetin alfa epbx (Retacrit)

80
Q

epoetin alfa

A

Epogen

81
Q

darbapoetin alfa

A

Aranesp

82
Q

dialysis ESA goals

A

initiate: Hg < 9-10
target: Hg < 10-11

83
Q

non-dialysis ESA goals

A

initiate: Hg < 10
target: Hg < 10

84
Q

how long does it take for ESA to improve Hg?

A

4-6 weeks

85
Q

goal ESA Hg change

A

1-2 g/dL/month

86
Q

when to lower ESA dose

A

by 25% if
- Hg approach 12
- Hg inc by > 1 g/dL in 2 weeks

for AE

87
Q

causes of ESA resistance

A

1: iron deficiency

ACEi
hyperparathyroidism
aluminum toxicity
folate or b12 deficiency
infection
malignancy
trauma
inflammation

88
Q

ESA AE

A

hypertension
hypercoagulability
HA
progression of malignancy

89
Q

ESA CI

A

active malignancy with anticipated cure
high risk CVA (stroke)
Hgb > 11 g/dL

90
Q

blood transfusion indication

A

Hgb < 7
- 1 unit PRBC = 200mg elemental iron, inc Hgb 1 g/dL

91
Q

consequences of CKD MBD

A

cv disease
bone disease
calciphylaxis

92
Q

MBD labs

A

calcium 8.5-10.2 mg/dL
phosphorus 3.5-5.5 mg/dL
iPTH 2-9X ULN (150-600 pg/mL)

93
Q

how to take phosphate binders

A

with food

94
Q

renvela

A

sevelamer carbonate

95
Q

ca based phosphate binders AE

A

stones, bones, abdominal groans
nephrolithiasis
calciphylaxis
bone pain
abdominal discomfort

96
Q

phoslo

A

calcium acetate (first line)

97
Q

which ca based phos binder has mire binding capacity

A

calcium acetate (renvela)

98
Q

which ca based phos binder has mire binding capacity

A

calcium acetate (renvela

99
Q

which non-ca phos binder do you have to chew

A

lanthanum carbonate (Fosrerol)

100
Q

cinacelcet dose

A

30mg/day start –> titrate q2-4 weeks up to MDD 180mg

101
Q

cinacalcet consideration

A

need to treat Ca if Ca < 8.4

102
Q

top ckd causes in us

A
  1. DM
  2. HTN
  3. glomerulonephritis
  4. polycystic kidney disease

p2 year (9 decks)

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