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

Exam 4 (AKI/Dialysis) Flashcards

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?

A

decreased renal elimination

25
Q

How is PD affected?

A

increase BBB permeability, decreased platelet aggregation

26
Q

What are six drugs that can accumulate metabolites?

A

allopurinol, cefotaxime, meperidine, morphine, primidone, sodium nitroprusside

27
Q

Which opioids are not toxic?

A

fentanyl and methadone

28
Q

Which opioids are somewhat toxic?

A

hydromorphone, oxycodone, and hydrocodone

29
Q

Which opioids are toxic?

A

morphine, codeine, and meperidine

30
Q

What affects the loading dose of a drug the most?

A

volume of distribution

31
Q

What drugs have loading dose exceptions?

A

digoxin, and hydrophilic antibiotics

32
Q

What are the antimicrobial agents that do not require dose adjustment?

A

metronidazole, azithromycin, nafcillin, tigecycline, oxacillin, linezolid, doxycycline, moxifloxacin, erythromycin, quinupristin/dalfopristin, ceftriaxone, clindamycin

33
Q

What are the target total and free phenytoin concentrations?

A

total = 10-20 mcg/mL, free = 1-2 mcg/mL

34
Q

Corrected phenytoin formula for patient with CrCL less than 20?

A

(measured phenytoin concentration)/[(0.2 x albumin) + 0.1]

35
Q

Corrected phenytoin formula for patient with CrCL greater than 20?

A

(measured phenytoin concentration)/[(0.275 x albumin) + 0.1]

36
Q

Which DOAC has the least and most renal clearance?

A

apixaban = least, dabigatran = most

37
Q

Which parenteral anticoagulant has the least and most renal clearance?

A

fondaparinux = least, bivalirudin = least

38
Q

What is the formula for calculating CrCL?

A

(140 - Age)/(72 x SCr) x IBW, where IBW = 45.5 or 50 + 2.3 x number of inches over five feet

39
Q

What are the metformin adjustments needed with renal dysfunction?

A

eGFR < 30 = contraindicated/stop, 30-45 half dose, > 45 no adjustment

40
Q

What is the sulfonylurea recommendation with renal dysfunction?

A

glyburide = bad, glipizide = better

41
Q

Which DPP4i does not require a dose adjustment with renal dysfunction?

A

linagliptin

42
Q

Thiazides are not effective if the creatinine clearance is what?

A

< 30 mL/min

43
Q

What are the dose adjustments needed for loop diuretics with renal dysfunction?

A

25-50 = 2x dose, <25 = 4x the dose

44
Q

What are the methods of drug removal during dialysis?

A

diffusion and convection

45
Q

What are three types of hemodialysis access in order of infection and thrombosis?

A

arteriovenous fistula, arteriovenous graft, and central venous catheter

46
Q

Hemodialysis uses _____ as a clearance mechanism, hemofiltration uses?

A

diffusion, convection

47
Q

What are drug factors that can influence drug removal by dialysis?

A

molecular weight, protein binding, Vd (lipophilicity)

48
Q

What are patient factors that can influence drug removal by dialysis?

A

albumin, fluid status, blood pressure

49
Q

When should drug concentration monitoring occur for hemodialysis, peritoneal, and CRRT?

A

hemodialysis = prior, peritoneal = random, CRRT = random

50
Q

What are six complications of hemodialysis?

A

hypotension, cramping, fatigue, infection, thrombosis, and bleeding

51
Q

What are three treatments for hypotension from hemodialysis?

A

NaCl 0.9% bolus, decrease fluid removal, midodrine

52
Q

midodrine dosing? Midodrine adverse effects?

A

2.5-10 mg po prior to HD; bradycardia, HTN, peripheral ischemia

53
Q

What are four treatments for cramping from hemodialysis?

A

NaCl 0.9% bolus, decrease fluid removal, Vitamin E, quinine

54
Q

What is a treatment for thrombosis from hemodialysis?

A

alteplase

55
Q

What are three complications of peritoneal dialysis?

A

peritonitis, fluid overload, hyperglycemia

56
Q

What is the loading dose for vancomycin?

A

25-35 mg/kg (maximum of 3g)

57
Q

What is the target range for vancomycin?

A

15-20 mg/L

58
Q

What is the target AUC for vancomycin?

A

400-600 mcg/mL

59
Q

What is the normal Vd for vancomycin?

A

0.7 L/kg

PHM 601 (2 decks)

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