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Apex Review > Kidney 6 > Flashcards

Kidney 6 Flashcards

1
Q

Drugs to avoid in the patient on dialysis include: (select 2):
a. vecuronium
b. meperidine
c. succinylcholine
d. dexmedetomidine

A

a. vecuronium
b. meperidine

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2
Q

________- do not directly cause kidney dysfunction

A

The modern halogenated anesthetics

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3
Q

Although there’s no human data that links AKI and compound A, the FDA recommends that sevoflurane be administered at a rate of

A

1 L/min for no more than 2 MAC hours

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4
Q

The rate of compound A production is increased by

A

low FGF
high sevo vol%
warm soda lime
increased CO2 production

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5
Q

Succinylcholine can increase serum potassium by _________ for up to ________

A

0.5-1.0 mEq/L for up to 10-15 minutes

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6
Q

Due to their organ-independent elimination ____________ are the best nondepolarizing NMBs for renal failure.

A

Cisatracurium and atracurium

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7
Q

The following do not require dosage adjustments in patients with kidney disease

A

Both anticholinesterases and anticholinergics

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8
Q

____________ is not recommended in patients with severe renal impairment

A

Sugammadex

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9
Q

____________ may need an upward dosage adjustment due to a hyperdynamic circulation and disruption of the blood-brain barrier secondary to uremia

A

Propofol

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10
Q

Morphine is metabolized to

A

morphine-6-glucuronide which relies on renal excretion

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11
Q

Meperidine is metabolized to

A

nonmeperidine

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12
Q

Accumulation of normeperidine can cause

A

convulsions

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13
Q

Altered responses to anesthetic drugs in the setting of kidney disease are usually due to one or more of the following:

A

active metabolites
acidosis increases the nonionized fraction
decreased protein binding increases the free fraction
impaired elimination of active metabolites
uremia-induced disruption in the blood-brain barrier

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14
Q

Patients with renal failure may experience exaggerated hemodynamic effects due to:

A

antihypertensive medications- specifically ACEI & ARBs
attenuation of SNS tone
positive pressure ventilation

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15
Q

_____________ metabolism liberates a significant amount of free fluoride ions and was related to high output renal failure

A

methoxyflurane

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16
Q

All of the following reduce the incidence of contrast-induce nephropathy EXCEPT:
a. sodium bicarbonate
b. fluid bolus with 0.9% NaCl
c. low-osmolar contrast dye
d. furosemide

A

d. furosemide

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17
Q

The risk of AKI related to nephrotoxic agents is increased in patients with

A

pre-existing kidney disease
hypovolemia
sepsis
CHF

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18
Q

_________ can also cause anaphylaxis

A

Radiographic contrast media

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19
Q

Prevention of contrast-induced nephropathy includse

A

use nonionic, iso or low-osmolar contrast instead of hyperosmolar contrast
use the lowest volume allowed
withhold other drugs with known nephrotoxic effects
hydrate with IV 0.9% NaCl before administration of contrast dye
sodium bicarb injection or infusion

20
Q

__________ is nephrotoxic and can lead to tubular obstruction and acute tubular necrosis

A

Myoglobin

21
Q

Myoglobin is best treated with

A

aggressive IV hydration and an agent to alkalize the urine (e.g. sodium bicarb or acetazolamide)

22
Q

Nephrotoxic antibiotics include

A

gentamycin
tobramycin
amikacin
vancomycin
amphotericin B
sulfonamide
tetracyclines
cephalosporins

23
Q

The two ways that sevoflurane can theoretically impair renal function include

A

compound A (produced in the breathing circuit)
production of free fluoride ions (produced by the liver)

24
Q

______________ are immunosuppressant agents that prevent the rejection of transplanted organs

A

Calcineurin inhibitors (cyclosporine & tacrolimus)

25
Q

___________ is a non-calcineurin inhibitor that carries a much lower risk of nephrotoxicity

A

Sirolimus

26
Q

The extent of nephrotoxic effects is determined by the

A

concentration of the toxin & duration of exposure

27
Q

How does radiographic contrast media cause nephrotoxicity?

A

ischemic injury d/t vasoconstriction in the renal medulla
direct cytotoxic effects

28
Q

Signs of AKI begin at

A

24-36 hours & peak at 3-5 days

29
Q

Myoglobin is released into the circulation during

A

a hemolytic reaction or rhabdomyolysis

30
Q

Rhabdomyolysis and myoglobinemia are sequelae of

A

direct muscle trauma
muscle ischemia
prolonged immobilization
MH
succinylcholine in a patient with Duchenne muscular dystrophy

31
Q

A level of creatine phosphokinase above _______ is associated with an increased risk of kidney injury

A

10,000 units/L

32
Q

Prevention strategies with myoglobin include

A

maintenance of renal blood flow and tubular flow with IV hydration
osmotic diuresis with mannitol
keep UOP >100-150 mL/hr
administer sodium bicarb and/or acetazolamide to alkalize the urine

33
Q

The risk of AKI with aminoglycosides is reduced with

A

IV fluids
correction of correctable risk factors
close monitoring of serum trough levels

34
Q

For the patient undergoing TURP, match each irrigation fluid with its unique anesthetic consideration
sorbitol
glycine
distilled water
normal saline
hemolysis
transient blindness
hyperglycemia
risk of electrocution

A

distilled water- hemolysis
sorbitol- hyperglycemia
normal saline- risk of electrocution
glycine-transient blindness

35
Q

The most common approach to TURP is

A

neuraxial anesthesia

36
Q

A level of ___ is required for TURP

A

T10

37
Q

Neuraxial anesthesia is preferred b/c it allows for

A

earlier detection of complications since the patient’s neurologic status can be assessed

38
Q

Risk of TURP related to continuous fluid administration include

A

circulatory overload & toxicity from irrigation solutes

39
Q

Resection time of TURP should be limited to

A

1 hour

40
Q

The absorbed volume can be estimated as

A

10-30 mL/min of resection time

41
Q

Absorption of a large volume of ___________ can produce TURP syndrome

A

hypo-osmolar irrigation solution

42
Q

The classic triad of TURP syndrome includes

A

hypertension
bradycardia
change in mental status

43
Q

Glycine absorption can lead to

A

transient blindness

44
Q

Treatment for transient blindness includes

A

no treatment is required

45
Q

Treatment for TURP syndrome includes

A

cardiopulmonary support
correcting serum sodium levels
administering midazolam for seizures

46
Q

Other complications of TURP include

A

bladder perforation (abdominal and shoulder pain)
bleeding
hypothermia

Apex Review (224 decks)

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