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Pharm Final > Renal > Flashcards

Renal Flashcards

1
Q

Abd pain, N/V, dizziness, and confusion

A

Digitalis toxicity

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2
Q

Digoxin + furosemide

A
  • Loops can cause hypokalemia

HypoK increases the risk of Dig toxicity

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3
Q

Digoxin + metoprolol

A
  • both drugs cause bradycardia

- Increase risk AV block

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4
Q

Furosemide + metropolol + lisinopril

A

All lower BP, increase risk hypotension

- Lower BP can reduce renal blood flow and contribute to prerenal azotemia –> increase Dig blood level

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5
Q

Most common cause of prerenal azotemia?

A

Hypoperfusion of the kidney (due to hypotension)

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6
Q

20 - 30% of Dig

A

bound to serum albumin

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7
Q

80% of Dig

A

unchanged by kidneys

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8
Q

Dig metabolized

A

by liver

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9
Q

Serum levels of Dig risk to peak at ____ then slowly decline until plateau reached in _____

A
  • 30 - 90 min

- 6 - 8 hrs

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10
Q

Therapeutic range for Digitalis

A

0.5 - 2.0 ng/ml

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11
Q

How do you decide if you have administered enough Dig?

A

“Treat the pt, not the Dig level”

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12
Q

Drugs that potentiate the effects of Dig

A
  • Diuretics (except spironolactone)
  • Propranolol
  • Amiodarone
  • Erythromycine, tetracycline
  • IV Calcium
  • Nifedipine, Verapamil (CCB)
  • Quinidine
  • Thyroid hormone
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13
Q

Digitalis toxicity

A
  • Aggressive tx depends on clinical features and blood level
  • D/C drug
  • Ensure adequate blood K level
  • Cardiac monitor
  • Avoid cardioversion, except as last resort
  • Dig specific Fab antibody for life-threatening Dig tox
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14
Q

Elevated BUN to Cr level indicates

A
  • Prerenal
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15
Q

What can lead to renal failure

A
  • NSAIDs

- Volume depletion

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16
Q

What will UA show in dehydrated pt

A

High specific gravity

17
Q

What meds would you stop in the dehydrated pt in ARF?

A

Ibuprofen (NSAIDs) and ACE-I

18
Q

ARF findings in UA, Renal US

A

UA - WBC/RBC casts, LE, SG

Renal U/S - urinary obstruction (post renal issues such as stones, obstruction, hydronephrosis)

19
Q

What 2 drugs can you administer in case of hyperK

A
  • Insulin (drive K into cell)

- Kayexalate ( K binding resin)

20
Q

Normal DM value for A1C

A

6.5 - 7

21
Q

BUN > 20:1

A

Prerenal

22
Q

BUN

A

intrinsic or post renal

23
Q

DM can lead to what type of renal failure

A

intrinsic (DM nephropathy)

24
Q

Why do you need to d/c ACE-I in the case of renal dz?

A

Causing hyperK, reduced K excretion due to drug and poor renal fxn

25
Q

What should be addressed for a pt with kidney dz who needs abx?

A
  • Dose dep adjustment
  • oral vs IV
  • Can pt be sent home or is hospitalization indicated?
26
Q

Options for Community Acquired PNA

A
  • Ceftriaxone PLUS Azithromycin
  • Levaquin
  • Doxycycline
27
Q

Ceftriaxone/Azithromycin dose

A

1 gm IV q 24 hrs Ceftriaxon

500mg IV q 24 hrs Azithromycin

28
Q

Ceftriaxone/Azithromycin Renal dosing

A

No initial adjustment, monitor serum levels

- If on dialyzed, give dose after dialysis

29
Q

Levaquin dose

A

750 mg initially, then renal dose

30
Q

Levaquin renal dose

A
  • Cr 20 - 49: 750 mg q 48 hrs
  • Cr 10 - 19: 500 mg q 48 hrs
  • Cr
31
Q

Doxycycline dose

A

100 mg PO BID

32
Q

Doxycycline renal dose

A

No adjustment needed

33
Q

What is the best way to determine how to adjust med dosing in pt with renal failure?

A

Consult renal dosing chart

34
Q

What do you do with metformin if pt has renal failure?

A

D/C metformin –> Risk of Lactic Acidosis (esp if Cr

35
Q

What do you do with ACE-I if pt has renal failure?

A

D/C the pril –> Risk of HyperK

–100% excreted in urine, unchanged

36
Q

What do you do in the case of refractory hyperK that is unresponsive to meds (lasix)?

A

Dialysis

37
Q

Most acute renal failure is reversible or irreversible?

A

reversible

38
Q

Most causes of ARF

A

prerenal

39
Q

What studies should you avoid in a pt with ARF?

A

iodine contrast studies (IVP, CT)

Pharm Final (5 decks)

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