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NAPLEx > Renal Disease > Flashcards

Renal Disease Flashcards

1
Q

afferent arteriole

A

delivers the blood

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2
Q

efferent arteriole

A

blood exists

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3
Q

proximal tubule

A

SGLT2 inhibitors work here

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4
Q

Loop of Henle

A
  • Na CL ions are reabsorbed back into the blood, water is not. Unless antidiuretic hormone (ADH) is present, water passes through the wall and is reabsorbed. ADH is also known as vasopressin
  • loop diuretics inhibit the Na-K pump (less NA is reabsorbed), also cause less Ca reabsorption back into the blood (SE decrease bone density)
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5
Q

Distal convoluted tubules

A

thiazide diuretics inhibit the Na-Cl pump. increase in Ca reabsorption

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6
Q

collecting duct

A

potassium sparring diuretics- including aldosterone antagonists (spironolactone, eplerenone),
ultimately decrease Na and increase K

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7
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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8
Q

cockcroft-gault equation

A
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9
Q

ACE inhibitors and ARBs for albuminuria

A

prevent kidney disease progression,
RAAS causes efferent arteriolar dilation
by reducing pressure in the glomerulus, decreasing albuminuria, cardio protection

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10
Q

CKD

A

GFR <60 and/or albuminuria (ACR or AER >=30)

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11
Q

ACE/ARB increase

A

K, so monitor

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12
Q

metformin and SGLT2 inhibitors

A

for pt with CKD, type 2 diabetes, and GFR> 30
SGLT2- specifically canagliflozin, dapagliflozin, and empagliflozin- demonstrated reduction in cardo event and CKD progression

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13
Q

key drugs that require dose reduction or interval increase in CKD
anti-infectives

A

Aminoglycosides (increase dose interval primarily)
Beta-lactam (except antistaphylococcal and ceftriaxone)
Fluconazole
Quinolones (except moxifloacin)
Vancomycin

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14
Q

key drugs that require dose reduction or interval increase in CKD
cardio drugs

A

LMWHs (enoxaparin)
Rivaroxaban* (for AF)
Apixaban* (for AF)
Dabigatran* (for AF)

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15
Q

key drugs that require dose reduction or interval increase in CKD
GI

A

H2RAs (famotidine, ranitidine)
Metoclopramide

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16
Q

key drugs that require dose reduction or interval increase in CKD
others

A

bisphosphonates
lithium

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17
Q

Key drugs contra
CrCl <60

A

nitrofurantoin

18
Q

Key drugs contra
CrCl<50

A

Tenofovir disoproxil fumarate
Products include atripla, complera, delstrigo, stribild (don’t start if less the<70), symfi

vorconazole IV (due to vehicle)

19
Q

Key drugs contra
CrCl<30

A

tenofovir alafenamide
products include biktarvy, descovy, genvoya, odefsay, symtuza

20
Q

Key drugs contra
GFR<30

A

SGLT2 inhibitors
Metformin - dont start if GFR<45

21
Q

provide overview of Ca, PO4, vitamin D in CKD system EPO too

A
22
Q

Aluminum Hydroxide suspension

A

TID w/meals
SE: “Dialysis dementia”

Aluminum-based: potent phosphate binders, rarely used due to the risk of aluminum accumulation (which can cause nervous system and bone toxicity). tx max… 4 weeks

  • phosphate binder
23
Q

calcium acetate

A

phoslyra, PhosLo
TID w/meals
SE: Hypercalcemia- monitor Ca avoid with vitamin D..

  • calcium-based: first line phosphate binder
24
Q

calcium carbonate

A

tums, TID w/meals

SE: hypercalcemia- monitor Ca, avoid with vitamin D..

  • calcium-based: first line phosphate binder
25
Q

sucroferric oxyhydroxide

A

velphoro
TID w/meals
SE: black feces

  • aluminum-free, calcium-free
26
Q

Ferric citrate

A

auryxia
iron absorption with ferric citrate monitor TSAT
SE: black feces

  • aluminum-free, calcium-free phosphate binder
27
Q

Lanthanum carbonate

A

Fosrenol
TID w/meals
must chew thoroughly…
Avoid in GI obstruction fecal impaction ileus pts

SE. N/v, diarrhea, constipation….
- aluminum-free, calcium-free phosphate binder

28
Q

Sevelamer carbonate
sevelamer hydrochloride

A

Sevelamer carbonate- renvela
sevelamer hydrochloride- renagel

contra: bowel obstructions
can lower TC and LDL
- non-calcium, non-aluminum based phosphate binder that is not systemically absorbed

29
Q

phosphate binders DI:

A

separate admin from levo and antibiotics that chelate

30
Q

Calcitriol

A

Rocaltrol
- vitamin D analogs: increase absorption of Ca, which provides a negative feed back to the parathyroid gland

31
Q

Calcifediol

A

Rayaldee
- vitamin D analogs: increase absorption of Ca, which provides a negative feed back to the parathyroid gland

32
Q

Doxercalciferol

A

Hectorol
- vitamin D analogs: increase absorption of Ca, which provides a negative feed back to the parathyroid gland

33
Q

Paricalcitol

A

Zemplar
- vitamin D analogs: increase absorption of Ca, which provides a negative feed back to the parathyroid gland

34
Q

Cinacalcet

A

Sinsipar
SE: Hypocalcemia

-Calcimimetic: increases sensitivity of the calcium-sensing receptors on the parathyroid gland, which causes decrease PTH and decrease Ca and decrease PO4

35
Q

Etelcalcetide

A

Parsabiv
SE: hypocalcemia, muscle spasms, paresthesia
-Calcimimetic: increases sensitivity of the calcium-sensing receptors on the parathyroid gland, which causes decrease PTH and decrease Ca and decrease PO4

36
Q

EPO

A

kindy function declines, EPO production decreases, ESAs produce more RBCs

ESA include epoetin alfa (procrit, epogen, Retacrit)… long lasting formula, darbepoetin alfa (arnesp)

only used when hemoglobein <10g/dL

37
Q

select drugs that raise K levels

A

ACE inhibitors
Aldosterone receptor antagonists
Aliskiren
ARBs
Canagliflozin
Drospirenone-containing COCs
PN- IV fluids containing K
Potassium supplements
Sulfamethoxazole/Trimethoprim
Transplant drugs (cyclosporine, everolimus, tacrolimus)

38
Q

Sodium polystyrene sulfonate

A

SPS, kayexalate
warning: GI necrosis (increased risk with sorbitol)
can bind to other meds… check
monitor K, Na, Mg, Ca
oral and rectal
- tx of hyperkalemia

39
Q

Patiromer

A

Veltassa
Warning: worsen GI motality, hypoMg
binds to oral drugs, at least 3 hrs before and 3 hr after
monitor K, Mg
delayed onset of action…
- tx of hyperkalemia

40
Q

Sodium zirconium cyclosilicate

A

Lokelma
binds other drugs, separate by 2 hrs before and after
fast onset of action

NAPLEx (75 decks)

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