Renal Flashcards
(39 cards)
Abd pain, N/V, dizziness, and confusion
Digitalis toxicity
Digoxin + furosemide
- Loops can cause hypokalemia
HypoK increases the risk of Dig toxicity
Digoxin + metoprolol
- both drugs cause bradycardia
- Increase risk AV block
Furosemide + metropolol + lisinopril
All lower BP, increase risk hypotension
- Lower BP can reduce renal blood flow and contribute to prerenal azotemia –> increase Dig blood level
Most common cause of prerenal azotemia?
Hypoperfusion of the kidney (due to hypotension)
20 - 30% of Dig
bound to serum albumin
80% of Dig
unchanged by kidneys
Dig metabolized
by liver
Serum levels of Dig risk to peak at ____ then slowly decline until plateau reached in _____
- 30 - 90 min
- 6 - 8 hrs
Therapeutic range for Digitalis
0.5 - 2.0 ng/ml
How do you decide if you have administered enough Dig?
“Treat the pt, not the Dig level”
Drugs that potentiate the effects of Dig
- Diuretics (except spironolactone)
- Propranolol
- Amiodarone
- Erythromycine, tetracycline
- IV Calcium
- Nifedipine, Verapamil (CCB)
- Quinidine
- Thyroid hormone
Digitalis toxicity
- 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
Elevated BUN to Cr level indicates
- Prerenal
What can lead to renal failure
- NSAIDs
- Volume depletion
What will UA show in dehydrated pt
High specific gravity
What meds would you stop in the dehydrated pt in ARF?
Ibuprofen (NSAIDs) and ACE-I
ARF findings in UA, Renal US
UA - WBC/RBC casts, LE, SG
Renal U/S - urinary obstruction (post renal issues such as stones, obstruction, hydronephrosis)
What 2 drugs can you administer in case of hyperK
- Insulin (drive K into cell)
- Kayexalate ( K binding resin)
Normal DM value for A1C
6.5 - 7
BUN > 20:1
Prerenal
BUN
intrinsic or post renal
DM can lead to what type of renal failure
intrinsic (DM nephropathy)
Why do you need to d/c ACE-I in the case of renal dz?
Causing hyperK, reduced K excretion due to drug and poor renal fxn