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PHM 601 > Exam 4 (AKI/Dialysis) > Flashcards

Exam 4 (AKI/Dialysis) Flashcards

(59 cards)

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1
Q

AKI is defined as?

A

Decline in kidney function over 7 days or less

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2
Q

AKD is defined as?

A

7-90 days after AKI, before CKD

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3
Q

Stages of AKI based on serum creatinine?

A

1 = 1.5-1.9x, 2 = 2.0-2.9, 3 = 3.0 or greater

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4
Q

What are biomarkers of functional change in AKI?

A

serum creatinine, BUN, GFR

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5
Q

What are biomarkers of kidney damage in AKI?

A

NGAL, TIMP2 and IGFBP7, KIMI

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6
Q

What are the six risk factors for AKI?

A

age (>65), African American, CKD, DM, nephrotoxin, decreased effective circulatory volume

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7
Q

What is the number one way to prevent AKI?

A

maintain euvolemia and normal electrolytes, and organ perfusion

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8
Q

What is the mean arterial pressure recommended for organ perfusion?

A

MAP > 65 mmHg

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9
Q

What is the treatment recommendation for AKI?

A

isotonic, sodium-containing crystalloids

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10
Q

What drugs do not help with AKI?

A

loop diuretics, dopamine, fenoldapam

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11
Q

What is the goal urine output for intravascular volume repletion?

A

at least 0.5 mL/kg/hr

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12
Q

What medications should be temporarily held in hemodynamic AKI?

A

ACEi/ARBs, NSAIDs, SGLT2i, calcineurin inhibitors

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13
Q

What is required for the diagnosis of pre-renal AKI?

A

fractional excretion of sodium <1% or urea <35% IF on loop diuretic

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14
Q

How do you treat pre-renal AKI?

A

hold loop and thiazide diuretics

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15
Q

How do you treat intrinsic AKI (glomerulonephritis)?

A

immunosuppression

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16
Q

How do you treat intrinsic AKI (acute tubular necrosis)?

A

supportive care

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17
Q

How do you treat intrinsic AKI (tubulointerstitial nephritis)?

A

glucocorticoids (prednisone)

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18
Q

How do you treat intrinsic AKI (vasculitis)?

A

immunosuppression

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19
Q

How do you treat post-renal AKI?

A

relieve obstruction (Foley catheter)

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20
Q

Why can you not use serum creatinine for assessing kidney function?

A

serum creatinine lags behind change in GFR by 1-2 days

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21
Q

How is A affected (PK?)

A

unchanged

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22
Q

How is D affected?

A

can be increased, decreased, or unchanged

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23
Q

How is M affected?

A

decreased phase I enzyme capacity, NO change in phase II

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24
Q

How is E affected?

Study These Flashcards
A

decreased renal elimination

25
How is PD affected?
increase BBB permeability, decreased platelet aggregation
26
What are six drugs that can accumulate metabolites?
allopurinol, cefotaxime, meperidine, morphine, primidone, sodium nitroprusside
27
Which opioids are not toxic?
fentanyl and methadone
28
Which opioids are somewhat toxic?
hydromorphone, oxycodone, and hydrocodone
29
Which opioids are toxic?
morphine, codeine, and meperidine
30
What affects the loading dose of a drug the most?
volume of distribution
31
What drugs have loading dose exceptions?
digoxin, and hydrophilic antibiotics
32
What are the antimicrobial agents that do not require dose adjustment?
metronidazole, azithromycin, nafcillin, tigecycline, oxacillin, linezolid, doxycycline, moxifloxacin, erythromycin, quinupristin/dalfopristin, ceftriaxone, clindamycin
33
What are the target total and free phenytoin concentrations?
total = 10-20 mcg/mL, free = 1-2 mcg/mL
34
Corrected phenytoin formula for patient with CrCL less than 20?
(measured phenytoin concentration)/[(0.2 x albumin) + 0.1]
35
Corrected phenytoin formula for patient with CrCL greater than 20?
(measured phenytoin concentration)/[(0.275 x albumin) + 0.1]
36
Which DOAC has the least and most renal clearance?
apixaban = least, dabigatran = most
37
Which parenteral anticoagulant has the least and most renal clearance?
fondaparinux = least, bivalirudin = least
38
What is the formula for calculating CrCL?
(140 - Age)/(72 x SCr) x IBW, where IBW = 45.5 or 50 + 2.3 x number of inches over five feet
39
What are the metformin adjustments needed with renal dysfunction?
eGFR < 30 = contraindicated/stop, 30-45 half dose, > 45 no adjustment
40
What is the sulfonylurea recommendation with renal dysfunction?
glyburide = bad, glipizide = better
41
Which DPP4i does not require a dose adjustment with renal dysfunction?
linagliptin
42
Thiazides are not effective if the creatinine clearance is what?
< 30 mL/min
43
What are the dose adjustments needed for loop diuretics with renal dysfunction?
25-50 = 2x dose, <25 = 4x the dose
44
What are the methods of drug removal during dialysis?
diffusion and convection
45
What are three types of hemodialysis access in order of infection and thrombosis?
arteriovenous fistula, arteriovenous graft, and central venous catheter
46
Hemodialysis uses _____ as a clearance mechanism, hemofiltration uses?
diffusion, convection
47
What are drug factors that can influence drug removal by dialysis?
molecular weight, protein binding, Vd (lipophilicity)
48
What are patient factors that can influence drug removal by dialysis?
albumin, fluid status, blood pressure
49
When should drug concentration monitoring occur for hemodialysis, peritoneal, and CRRT?
hemodialysis = prior, peritoneal = random, CRRT = random
50
What are six complications of hemodialysis?
hypotension, cramping, fatigue, infection, thrombosis, and bleeding
51
What are three treatments for hypotension from hemodialysis?
NaCl 0.9% bolus, decrease fluid removal, midodrine
52
midodrine dosing? Midodrine adverse effects?
2.5-10 mg po prior to HD; bradycardia, HTN, peripheral ischemia
53
What are four treatments for cramping from hemodialysis?
NaCl 0.9% bolus, decrease fluid removal, Vitamin E, quinine
54
What is a treatment for thrombosis from hemodialysis?
alteplase
55
What are three complications of peritoneal dialysis?
peritonitis, fluid overload, hyperglycemia
56
What is the loading dose for vancomycin?
25-35 mg/kg (maximum of 3g)
57
What is the target range for vancomycin?
15-20 mg/L
58
What is the target AUC for vancomycin?
400-600 mcg/mL
59
What is the normal Vd for vancomycin?
0.7 L/kg

PHM 601 (2 decks)

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