Pharmacotherapy of AKI

Question 1

Define anuria

Answer 1

Less than 100 mL/d

Question 2

Define oliguria

Answer 2

100-400 mL/d

Question 3

Define non-oliguria

Answer 3

> 400 mL/d

Question 4

Goals of therapy are

Answer 4

Prevention of AKI
Avoid or minimize renal insults
Survive the acute insult
Provide supportive measures
Regain life-sustaining renal function

Question 5

High risk patients are:

Answer 5

preexisting renal prob
CHF
Cirrhosis
DM
Advancing age
Dehydration
Nephrotoxic drugs
IV contrast dye

Question 6

Nephrotoxic agents include

Answer 6

AG, amp B, cisplatin

IV contrast

Question 7

Agents that have impact on renal blood flow:

Answer 7

NSAIDs
ACE-i
cyclosporine
tacrolimus

Question 8

Benefits of volume expansion

Answer 8

Maintain renal perfusion
Flush out toxins
Decreased RAAS activation
Minimize the decreases in NO and prostacycline (dilators)

Question 9

Goal of therapy of volume expansion

Answer 9

> 150 mL/hr

Question 10

In a patient who is critically ill what volume expansion would you use:

Answer 10

isotonic crystalloids

Question 11

Volume expansion for contrast dye administration

Answer 11

NS (0.9% NaCl)

Sodium bicarbonate

Question 12

NS dose

Answer 12

1.0-1.5 mL/kg/hr for 3-12 hours before and 6-12 hours after

Question 13

Sodium bicarbonate

Answer 13

3 mL/kg/hr for 1 hour prior to dye administration, then 1 mL/kg/hr for 6 hours after

Question 14

Aminoglycosides

Answer 14

Use only when necessary
QD dosing in appropriate pts
Monitor levels and adjust accordingly

Question 15

Amp B

Answer 15

Use only when necessary

Lipid formulation preferred

Question 16

N-acetylcystein (Mucomyst) oral

Answer 16

Adjunct to isotonic crystalloids
Inexpensive, few side effects, well tolerated
MOA: scavengers free oxygen radicals

Question 17

N-acetylcystein (Mucomyst) oral dose

Answer 17

600-1200 mg BID before and after contrast

Question 18

Drugs that are not recommended

Answer 18

Theophylline
Ascorbic Acid
Statins
Fenoldopam

Question 19

Define oliguria

Answer 19

100-400 mL/d

Question 20

Define non-oliguria

Answer 20

> 400 mL/d

Question 21

Goals of therapy are

Answer 21

Prevention of AKI
Avoid or minimize renal insults
Survive the acute insult
Provide supportive measures
Regain life-sustaining renal function

Question 22

High risk patients are:

Answer 22

preexisting renal prob
CHF
Cirrhosis
DM
Advancing age
Dehydration
Nephrotoxic drugs
IV contrast dye

Question 23

Nephrotoxic agents include

Answer 23

AG, amp B, cisplatin

IV contrast

Question 24

Benefits of volume expansion

Answer 24

Maintain renal perfusion
Flush out toxins
Decreased RAAS activation
Minimize the decreases in NO and prostacycline (dilators)

Question 25

Goal of therapy of volume expansion

Answer 25

>150 mL/hr

Question 26

In a patient who is critically ill what volume expansion would you use:

Answer 26

isotonic crystalloids

Question 27

Volume expansion for contrast dye administration

Answer 27

NS (0.9% NaCl) | Sodium bicarbonate

Question 28

NS dose

Answer 28

1.0-1.5 mL/kg/hr for 3-12 hours before and 6-12 hours after

Question 29

Sodium bicarbonate

Answer 29

3 mL/kg/hr for 1 hour prior to dye administration, then 1 mL/kg/hr for 6 hours after

Question 30

Aminoglycosides

Answer 30

Use only when necessary QD dosing in appropriate pts Monitor levels and adjust accordingly

Question 31

Amp B

Answer 31

Use only when necessary | Lipid formulation preferred

Question 32

N-acetylcystein (Mucomyst) oral

Answer 32

Adjunct to isotonic crystalloids Inexpensive, few side effects, well tolerated MOA: scavengers free oxygen radicals

Question 33

N-acetylcystein (Mucomyst) oral dose

Answer 33

600-1200 mg BID before and after contrast

Question 34

Drugs that are not recommended:

Answer 34

``` Theophylline Ascorbic Acid Statins Fenoldopam Dopamine Diuretics ```

Question 35

Goals of therapy for AKI

Answer 35

Remove offending agent Treat underlying cause Limit exposure to subsequent nephrotoxic events Speed up recovery of renal function

Question 36

Treatment of Postrenal AKI

Answer 36

Removal of obstruction Electrolyte management Fluid management

Question 37

Treatment of Prerenal, intrinsic AKI

Answer 37

``` Electrolyte management (Na/K) Maintain blood pressure and CO Carefully anuric and oliguric ```

Question 38

Treatment of Prerenal, intrinsic AKI

Answer 38

``` Electrolyte management (Na/K) Maintain blood pressure and CO Carefully anuric and oliguric ```

Question 39

Hypovolemic Treatment

Answer 39

250-500 mL over 15-20 minutes, then reassess

Question 40

Hypervolemic treatment

Answer 40

Reduce IV fluids to keep vein open | Concentration of IV meds and tube feeds

Question 41

Diuretics

Answer 41

Reserved for hypervolemic patients who make adequate urine in response to diuretics

Question 42

What are the loop diuretics

Answer 42

Furosemide (lasix) Torsemide (demadex) Bumetanide (bumex) Ethacrynic acid (edecrin)

Question 43

Furosemide dose

Answer 43

40-80 mg IV/PO, increase 20-40 mg/dose Q6-8 hrs

Question 44

Torsemide dose

Answer 44

10-20 mg IV/PO, double dose Q2 hours if necessary

Question 45

Torsemide dose

Answer 45

10-20 mg IV/PO, double dose Q2 hours if necessary

Question 46

Loop diuretic resistance MOA

Answer 46

They increase delivery of sodium to distal tubule and collecting ducts and in time the kidney gets used to this and increases the reabsorption there

Question 47

Causes of diuretic resistance

Answer 47

``` Excessive sodium intake Inadequate dose or drug regimen Reduced bioavailability Nephrotic syndrome Reduced renal blood flow Increased Na reabsorption ```

Question 48

Thiazides work where?

Answer 48

Distal convoluted tubule

Question 49

Where do loops work?

Answer 49

Thick ascending limb

Question 50

Metolazone (zaroxoxlyn) is good when

Answer 50

CrCl is

Question 51

Renal Replacement Therapy

Answer 51

``` Acid-base abnormalities Electrolyte imbalance Intoxication Fluid overload Uremia ```

Question 52

Pre-renal cause

Answer 52

Decreased blood flow to the kidney or issue getting blood to the kidney

Question 53

Intrinsic cause

Answer 53

damage to the kidney itself

Question 54

Postrenal cause

Answer 54

obstruction that keeps blood from flowing from the kidney