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Gold Standards > Treatment - Renal & GU > Flashcards

Treatment - Renal & GU Flashcards

1
Q

minimal change disease (nephrotic syndrome)

A

prednisone/corticosteroids

+/- diuretics for edema and ACE/ARB to reduce pressure on kidneys

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2
Q

acute glomerulonephritis (nephritic syndrome)

A

corticosteroids +/- ACE

+ cyclophosphamide if rapidly progressing

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3
Q

acute tubular necrosis (ATN)

A

remove offending agents, IV fluids (restore BP), +/- furosemide if euvolemic and not urinating

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4
Q

adult polycystic kidney disease

A

-increased fluid intake (to decrease vasopressin/ADH)
-control HTN
+/- dialysis or transplant

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5
Q

chronic kidney disease

A

prevent progression; HTN, low protein diet, DM control

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6
Q

SIADH

A

tx underlying, H2O restriction (<800/d)

-demeclocycline in severe cases (inhibits ADH)

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7
Q

diabetes insipidus

A
  • central: desmopressin/DDAVP (synthetic ADH) +/- carbamazepine (inc ADH)
  • nephrogenic: Na/protein restrict, hydroclorothiazide (causes mild hypovolemia to promote retention), indomethacin (potentiates effect of ADH)
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8
Q

hyponatremia and hypernatremia fluid rate

A

correct <0.5 mEq/L/h to prevent demyelination (hypo) or cerebral edema (hyper)

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9
Q

hypovolemic hyponatremia

A

normal saline (correct volume)

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10
Q

critical hyponatremia

A

hypertonic saline + loop diuretic (furosemide)

-with neurologic symptoms require treatment with hypertonic (3%) saline.

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11
Q

euvolemic hyponatremia

A

water restriction (<1500mL/d)

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12
Q

hypervolemic hyponatremia

A

water and salt restriction

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13
Q

hypomagnesemia

A

oral magnesium oxide

severe - IV mag sulfate (also w/ TORSADES de POINTES)

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14
Q

hypokalemia

A

KCl oral (IV if severe) *use non-dextrose IV bc dextrose induced insulin release will shift K into cells)

  • replace Mg
  • hypoK associated w/ increased risk of digoxin toxicity
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15
Q

hyperkalemia

A

-repeat blood draw to verify not from venipuncture error

  • IV calcium gluconate - stabilizes cardiac membrane if significant lab (>6.5) and ECG findings
  • insulin w/ glucose to shift K intracellularly
  • kayexalate (sodium polystyrene sulfonate) to enhance GI excretion
  • beta-2 agonists (albuterol helps move K intracellular)
  • lasix to rid extra through kidneys
  • sodium bicarb
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16
Q

corrected serum sodium (high glucose) calculation

A

1.6 mEq/L to the sodium value for every 100 mg/dL of glucose above 100 mg/dL

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17
Q

corrected serum potassium in acidosis

A

subtracting 0.6 mEq/L from the initial potassium value for every 0.1 decrease in pH from 7.4.

18
Q

chlamydia

A

doxy 100mg x 10d

alt: azithro

19
Q

gonorrhea

A

ceftriaxone (250 mg IM)

20
Q

chronic epididymitis (enteric cause)

A

fluoroquinolones

children - cephalexin or amoxicillin

21
Q

testicular torsion

A

detorsion + orchiopexy (testicle fixation in scrotum)

-orchiectomy if testicle not salvageable

22
Q

cryptorchidism

A

orchiopexy (ideal btw 6 mo and 1 yr)

-observation if <6 mo - most descend by 3 mo

23
Q

testicular cancer

A

low-grade nonseminoma –> orchiectomy w/ retroperitoneal lymph node dissection
low-grade seminoma –> orchiectomy –> radiation
high-grade seminoma –> debulking chemo –> orchiectomy + radiation

24
Q

hydrocele

A

infants: no tx needed, most resolve by 1 yo
adults: sx if communicating (elective) or complications

25
Q

uncomplicated cystitis

A

nitrofurantoin (macrobid) - not if pyelo suspected
fluoroquinolones
bactrim double strength

26
Q

complicated cystitis or pyelo

A

fluoroquinolones, aminoglycosides

27
Q

pregnant + cystitis

A

AMOXICILLIN, augmentin, cephalexin

nitrofurantoin

28
Q

acute prostatitis

A

> 35 yo - fluoroquinolones or bactrim 4-6 weeks

<35 yo - ceftriaxone plus doxy (or azithro)

29
Q

chronic prostatitis

A

fluoroquinolones or bactrim 6-12 wks or TURP if refractory (transurethral resection)

30
Q

BPH

A

5-a-reductase inhibitors (suppress growth, reduce obstx)
a-1-blockers (sx relief but not course of BPH)
TURP

31
Q

prostate cancer

A

local - radical prostatectomy

advanced - external beam radiation, androgen deprivation (orchiectomy + GnRH agonists)

32
Q

bladder cancer

A

local/superficial: transurethral resection (elecrocautery)

invasive: radical cystecomty, +/- chemo, radiation
recurrent: Bacillus Calmette-Guerin vaccine intravesicular (immune rx stim cross-rx w/ tumor antigens) dont use if immunosuppressed

33
Q

renal cell carcinoma

A

stage 1-3 –> radical nephrectomy, immune therapy

usually resistant to chemo and radiation

34
Q

wilms tumor / nephroblastoma

A

nephrectomy followed by chemo (80-90% cure rate)

-radiation if extends beyond renal capsule or lung mets

35
Q

ischemic priapism

A

phenylephrine (intracavernous injection) alpha-agonist
C/I –> cardiac or cerebrovascular hx

(non ischemic - observation)

36
Q

renal artery stenosis

A

angioplasty w/ stent (if Cr >4 or >80% stenosis)

+ACE/ARB (unless bilateral or one kidney)

37
Q

enuresis

A

bedwetting

  • behavioral: motivational tx, education and reassurance, bladder training (most resolve spontaneously)
  • alarm: if fail bx tx, sensor
  • DESMOPRESSIN - better for short-term use (synthetic ADH)
  • TCAs (stim ADH secretion, detrusor muscle relax) i.e. imipramine
38
Q

stress incontinence

A

laugh, sneeze

  • pelvic floor exercises
  • alpha agonists: midodrine, pseudoephedrine (increase urethral sphincter tone)
  • surgery, anti-incontinent devices, estrogen
39
Q

urge incontinence

A

overactive bladder

  • bladder training (time void, dec fluid intake)
  • ANTICHOLINERGICS: oxybutynin/ditropan, tolterodine
  • TCAs
  • Mirabergon
  • avoid spicy foods, citrus fruit, chocolate, caffiene
40
Q

overflow incontinence

A

intermittent or indwelling catheter 1st line
-cholinergics (bethanacol)
BPH –> a-1-blockers tamsulosin

41
Q

Haemophilus ducreyi (painful ulcers + enlarged lymph nodes in groin)

A

ceftriaxone 250 mg or one gram of oral azithromycin

Gold Standards (7 decks)

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