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Fall Therapeutics > AKI > Flashcards

AKI Flashcards

1
Q

AKI

A

An abrupt (within 48 hours) reduction in kidney function currently defined as:
◦ Absolute increase in Scr of ≥ 0.3mg/dL OR
◦ Increase in Scr ≥ 50%(≥ 1.5 x baseline), within the prior 7 days OR
◦ A reduction in urine output (documented oliguria of< 0.5 ml/kg/hr for > 6 hours)

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2
Q

Drug Induced Hemodynamic AKI

A

-ACEI/ARB
-Cyclosporine/Tacrolimus
-Diuretics
-NSAIDS/COX II INH

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3
Q

Acute Tubular Necrosis - Nephrotoxins

A

-Aminoglycosides
-Amph B
-Cisplatin, carboplatin
-Cyclophosphamide
-Ifosfamide
-Pentamidine
-Radiocontrast media
-Vancomycin

PRIV CACA

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4
Q

Acute Interstitial Nephritis - Nephrotoxins

A

-NSAIDS
-Quinolones
-Penicillins
-Sulfonamides
-Rifampin, vanco

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5
Q

Obstructive Nephropathy

A
  • Acyclovir
  • Allopurinol
  • Indinavir
  • Nelfinavir
  • Methotrexate
  • Quinolones
  • Sulfonamides
  • Triamterene
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6
Q

Goals of Therapy

A
  • Prevent AKI if possible
  • Reduce morbidity (progression to ESRD) and mortality
  • Avoid or minimize further insults
  • Provide supportive treatment of AKI
  • Return of kidney function to baseline
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7
Q

Volume Status

A
  • Hydration
    -Sodium chloride or sodium bicarbonate preferred (help renal blood flow)
    -Sodium loading beneficial
    -Prevent overload

NaCl 0.9% 1L over 2 hr

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8
Q

Vasopressors

A

For hemodynamic AKI
-only if pt is resuscitated
-norepinephrine, dopamine, vasopressin
-low dose dopamine <= 2 mcg/kg/min

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9
Q

Loop Diuretics

A

Reserved for volume overload
-convert oliguric AKI to non-oliguric AKI
-patients who are volume overloaded and respond to initial dose of loop diuretic
-but increased mortality in ICU pts with AKI

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10
Q

Indications for Acute Dialysis

A

-Acidosis (ph<7.1)
-Electrolytes (K>6.5)
-Intoxication (overdose)
-Overload (edema, weight gain, pulmonary congestion)
-Uremia (pericarditis, mental status, neuropathy)

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11
Q

Intermittent Hemodialysis (IHD)

A
  • Patients with hemodynamic stability
  • Overdose cases
  • Hyperkalemia
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12
Q

Continuous Renal Replacement Therapies (CRRT)

A
  • Hemodynamic instability
  • ICU patients are catabolic, better control of uremia
  • Excessive volume overload
  • Sepsis, SIRS (?)
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13
Q

Dialysis Prescription: IHD

A
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14
Q

Dialysis Prescription: CRRT

A
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15
Q

Types of CRRT: CVVH

A
  • Continuous venovenous hemodiafiltration
  • Convective and diffusive clearance
  • Dialysate and replacement solutions (20 L)
  • Blood flow maintained by pump
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16
Q

Determinants of Drug Removal by Dialysis

A
  • Protein Binding
  • Volume of Distribution
  • Molecular Weight
  • Drug Charge?
  • Type of modality
  • Effluent flow rate
  • Blood flow rate
  • Fluid replacement (pre/post)
  • Hemofilter
17
Q

Protein Binding

A

Drugs with a high degree of protein binding (>90%) are less likely to be removed by dialysis
-most important determinant of drug removal by hemodialysis or CRRT

18
Q

Volume of Distribution

A

Drugs with small Vd
(< 0.3 L/kg)are located in the intravascular space and more
likely to be removed by dialysis

Drugs with large Vd (> 1 L/kg) are likely distributed at other tissue sites

19
Q

Molecular Weight

A
  • Most drugs have a MW < 1500 daltons (1 Da=1 g/mol)
  • MW is not a major determinant of removal since new hemofilters have large pore size
20
Q

____ Doses of Fluconazole are Needed in CRRT

A

HIGHER

21
Q

Dose Adjustments for Patients with AKI

A

-IV drugs to bypass absorption issues

Adjust the loading dose of hydrophilic drugs to account for increased Vd
-If Vd doubles, double loading dose
-but reduce once Vd decreases

22
Q

Etiology

A

HEMO
-Volume depletion, decreased circulating volume, hypotension, shock, renal vascular occlusion, AA constrictors, EA dilators

INTRINSIC
-Glomerular disorders, acute tubular necrosis, interstitial nephritis (GIT)

OBS
-Nephrolithiasis, BPH, pregnancy, cancer (PBNC)

Fall Therapeutics (34 decks)

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