Renal Flashcards

(39 cards)

1
Q

Abd pain, N/V, dizziness, and confusion

A

Digitalis toxicity

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2
Q

Digoxin + furosemide

A
  • Loops can cause hypokalemia

HypoK increases the risk of Dig toxicity

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3
Q

Digoxin + metoprolol

A
  • both drugs cause bradycardia

- Increase risk AV block

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4
Q

Furosemide + metropolol + lisinopril

A

All lower BP, increase risk hypotension

- Lower BP can reduce renal blood flow and contribute to prerenal azotemia –> increase Dig blood level

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5
Q

Most common cause of prerenal azotemia?

A

Hypoperfusion of the kidney (due to hypotension)

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6
Q

20 - 30% of Dig

A

bound to serum albumin

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7
Q

80% of Dig

A

unchanged by kidneys

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8
Q

Dig metabolized

A

by liver

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9
Q

Serum levels of Dig risk to peak at ____ then slowly decline until plateau reached in _____

A
  • 30 - 90 min

- 6 - 8 hrs

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10
Q

Therapeutic range for Digitalis

A

0.5 - 2.0 ng/ml

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11
Q

How do you decide if you have administered enough Dig?

A

“Treat the pt, not the Dig level”

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12
Q

Drugs that potentiate the effects of Dig

A
  • Diuretics (except spironolactone)
  • Propranolol
  • Amiodarone
  • Erythromycine, tetracycline
  • IV Calcium
  • Nifedipine, Verapamil (CCB)
  • Quinidine
  • Thyroid hormone
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13
Q

Digitalis toxicity

A
  • Aggressive tx depends on clinical features and blood level
  • D/C drug
  • Ensure adequate blood K level
  • Cardiac monitor
  • Avoid cardioversion, except as last resort
  • Dig specific Fab antibody for life-threatening Dig tox
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14
Q

Elevated BUN to Cr level indicates

A
  • Prerenal
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15
Q

What can lead to renal failure

A
  • NSAIDs

- Volume depletion

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16
Q

What will UA show in dehydrated pt

A

High specific gravity

17
Q

What meds would you stop in the dehydrated pt in ARF?

A

Ibuprofen (NSAIDs) and ACE-I

18
Q

ARF findings in UA, Renal US

A

UA - WBC/RBC casts, LE, SG

Renal U/S - urinary obstruction (post renal issues such as stones, obstruction, hydronephrosis)

19
Q

What 2 drugs can you administer in case of hyperK

A
  • Insulin (drive K into cell)

- Kayexalate ( K binding resin)

20
Q

Normal DM value for A1C

21
Q

BUN > 20:1

22
Q

BUN

A

intrinsic or post renal

23
Q

DM can lead to what type of renal failure

A

intrinsic (DM nephropathy)

24
Q

Why do you need to d/c ACE-I in the case of renal dz?

A

Causing hyperK, reduced K excretion due to drug and poor renal fxn

25
What should be addressed for a pt with kidney dz who needs abx?
- Dose dep adjustment - oral vs IV - Can pt be sent home or is hospitalization indicated?
26
Options for Community Acquired PNA
- Ceftriaxone PLUS Azithromycin - Levaquin - Doxycycline
27
Ceftriaxone/Azithromycin dose
1 gm IV q 24 hrs Ceftriaxon | 500mg IV q 24 hrs Azithromycin
28
Ceftriaxone/Azithromycin Renal dosing
No initial adjustment, monitor serum levels | - If on dialyzed, give dose after dialysis
29
Levaquin dose
750 mg initially, then renal dose
30
Levaquin renal dose
- Cr 20 - 49: 750 mg q 48 hrs - Cr 10 - 19: 500 mg q 48 hrs - Cr
31
Doxycycline dose
100 mg PO BID
32
Doxycycline renal dose
No adjustment needed
33
What is the best way to determine how to adjust med dosing in pt with renal failure?
Consult renal dosing chart
34
What do you do with metformin if pt has renal failure?
D/C metformin --> Risk of Lactic Acidosis (esp if Cr
35
What do you do with ACE-I if pt has renal failure?
D/C the pril --> Risk of HyperK | --100% excreted in urine, unchanged
36
What do you do in the case of refractory hyperK that is unresponsive to meds (lasix)?
Dialysis
37
Most acute renal failure is reversible or irreversible?
reversible
38
Most causes of ARF
prerenal
39
What studies should you avoid in a pt with ARF?
iodine contrast studies (IVP, CT)