Kidney 6

Question 1

Drugs to avoid in the patient on dialysis include: (select 2):
a. vecuronium
b. meperidine
c. succinylcholine
d. dexmedetomidine

Answer 1

a. vecuronium
b. meperidine

Question 2

________- do not directly cause kidney dysfunction

Answer 2

The modern halogenated anesthetics

Question 3

Although there’s no human data that links AKI and compound A, the FDA recommends that sevoflurane be administered at a rate of

Answer 3

1 L/min for no more than 2 MAC hours

Question 4

The rate of compound A production is increased by

Answer 4

low FGF
high sevo vol%
warm soda lime
increased CO2 production

Question 5

Succinylcholine can increase serum potassium by _________ for up to ________

Answer 5

0.5-1.0 mEq/L for up to 10-15 minutes

Question 6

Due to their organ-independent elimination ____________ are the best nondepolarizing NMBs for renal failure.

Answer 6

Cisatracurium and atracurium

Question 7

The following do not require dosage adjustments in patients with kidney disease

Answer 7

Both anticholinesterases and anticholinergics

Question 8

____________ is not recommended in patients with severe renal impairment

Answer 8

Sugammadex

Question 9

____________ may need an upward dosage adjustment due to a hyperdynamic circulation and disruption of the blood-brain barrier secondary to uremia

Answer 9

Propofol

Question 10

Morphine is metabolized to

Answer 10

morphine-6-glucuronide which relies on renal excretion

Question 11

Meperidine is metabolized to

Answer 11

nonmeperidine

Question 12

Accumulation of normeperidine can cause

Answer 12

convulsions

Question 13

Altered responses to anesthetic drugs in the setting of kidney disease are usually due to one or more of the following:

Answer 13

active metabolites
acidosis increases the nonionized fraction
decreased protein binding increases the free fraction
impaired elimination of active metabolites
uremia-induced disruption in the blood-brain barrier

Question 14

Patients with renal failure may experience exaggerated hemodynamic effects due to:

Answer 14

antihypertensive medications- specifically ACEI & ARBs
attenuation of SNS tone
positive pressure ventilation

Question 15

_____________ metabolism liberates a significant amount of free fluoride ions and was related to high output renal failure

Answer 15

methoxyflurane

Question 16

All of the following reduce the incidence of contrast-induce nephropathy EXCEPT:
a. sodium bicarbonate
b. fluid bolus with 0.9% NaCl
c. low-osmolar contrast dye
d. furosemide

Answer 16

d. furosemide

Question 17

The risk of AKI related to nephrotoxic agents is increased in patients with

Answer 17

pre-existing kidney disease
hypovolemia
sepsis
CHF

Question 18

_________ can also cause anaphylaxis

Answer 18

Radiographic contrast media

Question 19

Prevention of contrast-induced nephropathy includse

Answer 19

use nonionic, iso or low-osmolar contrast instead of hyperosmolar contrast
use the lowest volume allowed
withhold other drugs with known nephrotoxic effects
hydrate with IV 0.9% NaCl before administration of contrast dye
sodium bicarb injection or infusion

Question 20

__________ is nephrotoxic and can lead to tubular obstruction and acute tubular necrosis

Answer 20

Myoglobin

Question 21

Myoglobin is best treated with

Answer 21

aggressive IV hydration and an agent to alkalize the urine (e.g. sodium bicarb or acetazolamide)

Question 22

Nephrotoxic antibiotics include

Answer 22

gentamycin
tobramycin
amikacin
vancomycin
amphotericin B
sulfonamide
tetracyclines
cephalosporins

Question 23

The two ways that sevoflurane can theoretically impair renal function include

Answer 23

compound A (produced in the breathing circuit)
production of free fluoride ions (produced by the liver)

Question 24

______________ are immunosuppressant agents that prevent the rejection of transplanted organs

Answer 24

Calcineurin inhibitors (cyclosporine & tacrolimus)

Question 25

___________ is a non-calcineurin inhibitor that carries a much lower risk of nephrotoxicity

Answer 25

Sirolimus

Question 26

The extent of nephrotoxic effects is determined by the

Answer 26

concentration of the toxin & duration of exposure

Question 27

How does radiographic contrast media cause nephrotoxicity?

Answer 27

ischemic injury d/t vasoconstriction in the renal medulla direct cytotoxic effects

Question 28

Signs of AKI begin at

Answer 28

24-36 hours & peak at 3-5 days

Question 29

Myoglobin is released into the circulation during

Answer 29

a hemolytic reaction or rhabdomyolysis

Question 30

Rhabdomyolysis and myoglobinemia are sequelae of

Answer 30

direct muscle trauma muscle ischemia prolonged immobilization MH succinylcholine in a patient with Duchenne muscular dystrophy

Question 31

A level of creatine phosphokinase above _______ is associated with an increased risk of kidney injury

Answer 31

10,000 units/L

Question 32

Prevention strategies with myoglobin include

Answer 32

maintenance of renal blood flow and tubular flow with IV hydration osmotic diuresis with mannitol keep UOP >100-150 mL/hr administer sodium bicarb and/or acetazolamide to alkalize the urine

Question 33

The risk of AKI with aminoglycosides is reduced with

Answer 33

IV fluids correction of correctable risk factors close monitoring of serum trough levels

Question 34

For the patient undergoing TURP, match each irrigation fluid with its unique anesthetic consideration sorbitol glycine distilled water normal saline hemolysis transient blindness hyperglycemia risk of electrocution

Answer 34

distilled water- hemolysis sorbitol- hyperglycemia normal saline- risk of electrocution glycine-transient blindness

Question 35

The most common approach to TURP is

Answer 35

neuraxial anesthesia

Question 36

A level of ___ is required for TURP

Answer 36

T10

Question 37

Neuraxial anesthesia is preferred b/c it allows for

Answer 37

earlier detection of complications since the patient's neurologic status can be assessed

Question 38

Risk of TURP related to continuous fluid administration include

Answer 38

circulatory overload & toxicity from irrigation solutes

Question 39

Resection time of TURP should be limited to

Answer 39

1 hour

Question 40

The absorbed volume can be estimated as

Answer 40

10-30 mL/min of resection time

Question 41

Absorption of a large volume of ___________ can produce TURP syndrome

Answer 41

hypo-osmolar irrigation solution

Question 42

The classic triad of TURP syndrome includes

Answer 42

hypertension bradycardia change in mental status

Question 43

Glycine absorption can lead to

Answer 43

transient blindness

Question 44

Treatment for transient blindness includes

Answer 44

no treatment is required

Question 45

Treatment for TURP syndrome includes

Answer 45

cardiopulmonary support correcting serum sodium levels administering midazolam for seizures

Question 46

Other complications of TURP include

Answer 46

bladder perforation (abdominal and shoulder pain) bleeding hypothermia