Renal Therapeutics

Question 1

what things can we treat that are associated with renal disease?

Answer 1

proteinuria
hypertension
hyperphosphatemia
anemia
electrolytes: usually potassium

Question 2

what can we use to block RAAS?

Answer 2

angiotensin converting enzyme inhibitors
angiotensin-receptor blockers

Question 3

when do we use drugs to block RAAS?

Answer 3

proteinuria
CHF
hypertension

Question 4

what do we do to monitor angiotensin converting enzyme inhibitors and angiotensin-receptor blockers?

Answer 4

monitor blood pressure and renal values

Question 5

why is benazepril preferred in kidney disease over enalapril?

Answer 5

benazepril also has hepatic elimination so less potential for accumulation

Question 6

how much of a drop in blood pressure can angiotensin converting enzyme inhibitors cause?

Answer 6

10-15% overall reduction

Question 7

what is amlodipine?

Answer 7

calcium channel blocker

Question 8

are angiotensin-receptor blockers useful for hypertension?

Answer 8

maybe
telmisartan approved for cats

Question 9

what should you start if the PCV in a kidney disease animal is less that 20%?

Answer 9

generally recombinant human erythropoietin

Question 10

what happens in 60% of cats on darbepoetin?

Answer 10

hypertension

Question 11

what are some ways to increase appetite?

Answer 11

capromorelin
ghrelin agonist
mirtazapine
cerenia for nausea

Question 12

how long do we need to treat leptospirosis with doxycycline?

Answer 12

2 weeks

Question 13

what are good first choices for treating pyelonephritis?

Answer 13

fluoroquinolone
cefpodoxime

Question 14

when should you reduce the dose of a drug for an animal with kidney disease?

Answer 14

drugs with >70% renal elimination
GFR is <66% of normal
drugs with narrow therapeutic range

Question 15

what things can we use to treat renal disease?

Answer 15

diet
fluids
antimicrobials
surgery
dialysis
uncommonly diuretics
rarely anti-inflammatory/immunosuppression

Question 16

what is an angiotensin-receptor blocker?

Answer 16

telmisartan

Question 17

what are some angiotensin converting enzyme inhibitors?

Answer 17

enalapril
benazepril

Question 18

what is the goal of ACE inhibitor and angiotensin receptor blocker therapy?

Answer 18

decrease UPC to <0.5 or 50% baseline

Question 19

do angiotensin receptor blockers or ACE inhibitors have a greater decrease in GFR?

Answer 19

angiotensin receptor blockers: more concerning for already azotemic

Question 20

what drugs can we use for hypertension?

Answer 20

ACE inhibitors
amlodipine
angiotensin receptor blockers

Question 21

which angiotensin receptor blocker is approved for feline hypertension?

Answer 21

telmisartan: semintra

Question 22

what is amlodipine?

Answer 22

calcium channel blocker

Question 23

which drug is the first choice for cats with hypertension?

Answer 23

amlodipine

Question 24

is darbopoeitin or epoetin alfa more immunogenic?

Answer 24

epoetin alfa more immuogenic

Question 25

when should you start recominant human erythropoietin?

Answer 25

if PCV<20%

Question 26

what should you give to a cat with chronic kidney disease and anemia (moderate)?

Answer 26

darbeepoietin
parenteral iron dextran

Question 27

what are the adverse effects of darbepoietin?

Answer 27

hypertension
seizures
+/- vomiting, fever
pure red cell aplasia

Question 28

what can you use to treat leptospirosis?

Answer 28

doxycycline for 2 weeks
ampicillin prior to if having gastrointestinal signs, then must follow with 2 weeks of doxycycline

Question 29

what are some nephrotoxic drugs?

Answer 29

NSAIDs
aminoglycosides

Question 30

how can we use creatinine to estimate GFR?

Answer 30

1/creatinine about proportional to GFR for creatinine<4mg/dL

Question 31

why would we want to estimate GFR?

Answer 31

adjust doses of drugs in animals with kidney disease

Question 32

what is the indication for aluminum hydroxide?

Answer 32

hyperphosphatemia insufficiently controlled by diet