Lecture 4: Kidney Disease Flashcards Preview

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Flashcards in Lecture 4: Kidney Disease Deck (54)
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1
Q

Uremic syndrome: cardiovascular symptoms (4)

A

HTN
Arrhythmia
CHF
Pericarditis

2
Q

Uremic syndrome: neurological symptoms (8)

A
Fatigue
Impaired cognition
Irritability/behavioral changes
Drowsiness
Vision changes
Peripheral neuropathy
Encephalopathy
Coma
3
Q

Uremic syndrome: GI symptoms (5)

A
Stomatitis
Anorexia
Nausea
Vomiting
GI bleeding
4
Q

Uremic syndrome: pulmonary symptoms (2)

A

Cough

Hemoptysis

5
Q

Uremic syndrome: hematologic/ immunologic/ dermatologic symptoms (6)

A
Anemia
Immunodeficiency
Bruising
Pallor
Hyperpigmentation
Uremic frost
6
Q

Uremic syndrome: musculoskeletal symptoms (2)

A

Arthralgia

Muscle wasting

7
Q

3 risks to consider when initiating dental management

A

Anemia/excessive bleeding
RIsk of infection
Medication intolerance

8
Q

6 lab tests to order prior to dental treatment if it will be carried out on an outpatient basis

A
CBC (Hb,Hct)
BUN
Cr
platelet count 
Routine hep B surf Ag
LFT (PT; PTT)
9
Q

4 points of treatment during dental procedure if it will be carried out on an outpatient basis

A

Continuous blood pressure monitoring

Ascertain anesthesia (decrease stress)

Meticulous attention to good surgical technique to decrease risk of excessive bleeding or infection

Let patient to stand and walk if long procedure

10
Q

5 medical considerations for a patient on dialysis

A

Blood tests

Treat on nondialysis day

Endarteritis – source of bacteremia; nephrologist consult to be considered for Ab prophy (for hemoaccess site)

Avoid blood pressure cuff on the side of arteriovenous fistula (infection and clotting)

Hemolysis secondary to hemodialysis and lack of erythropoetin production

11
Q

6 drugs that are mainly excreted by the kidney

A
Tetracycline
Aminoglycosides
Peniclline
Cephalosporins
Acyclovir
Ketoconazole
12
Q

Pharmacological considerations for pain control

A

Acetaminophen may be safer than ASA, NSAIDs

NSAIDs –> Nephrotoxicity (avoid in renal insufficiency NOT in ESRD; May cause bleeding or fluid retention)

13
Q

Pharmacological considerations for anaesthesia

A

Vasoconstriction should be used with caution ~ underlying HTN

14
Q

Pharmacological considerations for narcotics

A

Primarily metabolized in liver
With caution due to prolong effect – avoided with uremia
Avoid meperidine – active metabolites can accumulate leading to seizure

15
Q

When is clindamycin used?

A

Abscesses

16
Q

When is metronidazole used?

A

Periodontal disease

17
Q

Antibiotics to avoid (2)

A

Aminoglycoside (streptomycin) and polymyxin B

18
Q

Antibiotics to be careful with (3)

A

Tetracyclin
Cephalosporine
Penicillin (in case of potassium content in setting of hyperkalemia – need dialysis)

19
Q

Analgesics considerations (2 points)

A
Avoid long term NSAIDs in CKD
Avoid narcotics (can cause prolonged sedation and resp. depression)
20
Q

At what GFR is drug dosage adjustment likely?

A

<60

21
Q

Antibiotics considerations (30

A

Aggressively manage orofacial infections with culture and sensitivity testing and antibiotics

Consider hospitalization for severe infections and major procedures

Loading dose may be required for concurrent infection and CKD

22
Q

Drugs not requiring dosage adjustment

A

Local anaesthesia

Single-dose benzodiazepine (anti-anxiety)

23
Q

How to reduce risk of emergencies

A

Avoid invasive procedures and long appointments if CKD stage 3 or higher or not well-controlled

24
Q

6 oral manifestations

A

Increased attention for orofacial infections
Dry mouth; parotitis; pallor
Bad odor; metallic taste
Uremic stomatitis
Uremic frost
Renal osteodystrophy (Compensatory hyperparathyroidism)

25
Q

Define petechiae

A

Disrupted blood vessels in the setting of anemia (looks like red dots)

26
Q

4 early signs and symptoms of hypertension

A

Elevated BP readings
Headache
Dizziness
Tinnitus

27
Q

6 avanced signs and symptoms of HTN

A
Angina pectoris
CHF
Rupture and hemorrhage of retinal arterioles
Dementia
Renal failure
Encephalopathy
28
Q

4 organs involved in the late signs and symptoms of HTN

A

Eyes
Heart
Kidneys
Brain

29
Q

5 classes of drugs for treatment of HTN

A
Thiazide diuretics
ACE inhibitors
ARBs
Beta blockers
Calcium channel blockers
30
Q

2 oral manifestations that can arise with the use of thiazide diuretics

A

Dry mouth

Lichenoid reactions

31
Q

2 medical considerations with the use of thiazide diuretics

A

Orthostatic hypotension

Avoid prolonged NSAIDs (may reduce anti-HTN effects)

32
Q

Vasoconstrictor interactions with the use of non-selective beta blockers

A

Potential BP increase (max 0.036 mg epinephrine)

Avoid levonordefrine

33
Q

2 oral manifestations of non-selective beta blockers

A

Taste changes

Lichenoid reactions

34
Q

Medical consideration with the use of non-selective beta blockers

A

Avoid prolonged NSAIDs (may reduce anti-HTN effects)

35
Q

Vasoconstrictor interactions with the use of combined alpha and beta blockers

A

Both B1 and B2 adrenergic receptor site blocked = potential adverse effects, but alpha receptor blockade compensates –> unlikely

36
Q

Oral manifestations of combined alpha and beta blockers

A

Taste changes

37
Q

2 medical considerations with the use of combined alpha and beta blockers

A

Orthostatic hypotension

Avoid prolonged NSAIDs (may reduce anti-HTN effects)

38
Q

3 oral manifestations of ACE inhibitors

A

Angioedema of face, lips, tongue
Taste changes
Oral burning

39
Q

2 medical considerations with the use of ACE inhibitors

A

Orthostatic hypotension

Avoid prolonged NSAIDs (may reduce anti-HTN effects)

40
Q

Oral manifestations of ARBs

A

Angioedema of face, lips, tongue

41
Q

Medical considerations with the use of ARBs

A

Orthostatic hypotension

42
Q

Oral manifestations of calcium channel blockers

A

Gingival hyperplasia

43
Q

2 oral manifestations of alpha1-adrenergic blockers

A

Dry mouth

Taste changes

44
Q

Other medical considerations with the use of alpha1-adrenergic blockers

A

Orthostatic hypotension

Avoid prolonged NSAIDs (may reduce anti-HTN effects)

45
Q

2 oral manifestations of central a2-adrenergic blockers and other centrally acting drugs

A

Dry mouth

Taste changes

46
Q

Other medical considerations with the use of central a2-adrenergic blockers and other centrally acting drugs

A

Orthostatic hypotension

47
Q

2 oral manifestations of direct vasodilators

A

Lupus-like oral skin lesions

Lymphadenopathy

48
Q

2 other medical considerations with the use of direct vasodilators

A

Orthostatic hypotension

Avoid prolonged NSAIDs (may reduce anti-HTN effects)

49
Q

At what BP do we defer elective treatment and refer to a physician ASAP? Give one reason?

A

> or = to 180/100

Vasoconstrictors, i.e. epinephrine, not advised in patients with uncontrolled HTN

50
Q

4 points of epinephrine usage in the event of necessary urgent treatment and uncontrolled HTN

A

Will be dictated by the situation
Modest doses (e.g., one or two carpules)
Care is taken to avoid inadvertent intravascular injection
Consultation with the patient’s physician is advisable

51
Q

2 methods of vasoconstrictor application that should not e used in a patient with HTN

A

Topical vasoconstrictors generally should not be used for local hemostasis

Avoid using gingival retraction cord containing epinephrine

52
Q

3 alternatives to epinephrine for anesthesia in a patient with HTN

A

Tetrahydrozoline
Oxymetazoline
Phenylephrine

53
Q

3 types of drugs that lead to the development of orthostatic hypotension and potentiate the actions of anxiolytic and sedative drugs

A

Alpha blockers, alpha-beta blockers, and diuretics

54
Q

2 drugs that exacerbate the hypotensive effect of calcium channel blockers

A

Erythromycin and clarithromycin