Renal

Question 1

Abd pain, N/V, dizziness, and confusion

Answer 1

Digitalis toxicity

Question 2

Digoxin + furosemide

Answer 2

• Loops can cause hypokalemia

HypoK increases the risk of Dig toxicity

Question 3

Digoxin + metoprolol

Answer 3

• both drugs cause bradycardia

- Increase risk AV block

Question 4

Furosemide + metropolol + lisinopril

Answer 4

All lower BP, increase risk hypotension

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

Question 5

Most common cause of prerenal azotemia?

Answer 5

Hypoperfusion of the kidney (due to hypotension)

Question 6

20 - 30% of Dig

Answer 6

bound to serum albumin

Question 7

80% of Dig

Answer 7

unchanged by kidneys

Question 8

Dig metabolized

Answer 8

by liver

Question 9

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

Answer 9

• 30 - 90 min

- 6 - 8 hrs

Question 10

Therapeutic range for Digitalis

Answer 10

0.5 - 2.0 ng/ml

Question 11

How do you decide if you have administered enough Dig?

Answer 11

“Treat the pt, not the Dig level”

Question 12

Drugs that potentiate the effects of Dig

Answer 12

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

Question 13

Digitalis toxicity

Answer 13

• 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

Question 14

Elevated BUN to Cr level indicates

Answer 14

• Prerenal

Question 15

What can lead to renal failure

Answer 15

• NSAIDs

- Volume depletion

Question 16

What will UA show in dehydrated pt

Answer 16

High specific gravity

Question 17

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

Answer 17

Ibuprofen (NSAIDs) and ACE-I

Question 18

ARF findings in UA, Renal US

Answer 18

UA - WBC/RBC casts, LE, SG

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

Question 19

What 2 drugs can you administer in case of hyperK

Answer 19

• Insulin (drive K into cell)

- Kayexalate ( K binding resin)

Question 20

Normal DM value for A1C

Answer 20

6.5 - 7

Question 21

BUN > 20:1

Answer 21

Prerenal

Question 22

BUN

Answer 22

intrinsic or post renal

Question 23

DM can lead to what type of renal failure

Answer 23

intrinsic (DM nephropathy)

Question 24

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

Answer 24

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

Question 25

What should be addressed for a pt with kidney dz who needs abx?

Answer 25

- Dose dep adjustment - oral vs IV - Can pt be sent home or is hospitalization indicated?

Question 26

Options for Community Acquired PNA

Answer 26

- Ceftriaxone PLUS Azithromycin - Levaquin - Doxycycline

Question 27

Ceftriaxone/Azithromycin dose

Answer 27

1 gm IV q 24 hrs Ceftriaxon | 500mg IV q 24 hrs Azithromycin

Question 28

Ceftriaxone/Azithromycin Renal dosing

Answer 28

No initial adjustment, monitor serum levels | - If on dialyzed, give dose after dialysis

Question 29

Levaquin dose

Answer 29

750 mg initially, then renal dose

Question 30

Levaquin renal dose

Answer 30

- Cr 20 - 49: 750 mg q 48 hrs - Cr 10 - 19: 500 mg q 48 hrs - Cr

Question 31

Doxycycline dose

Answer 31

100 mg PO BID

Question 32

Doxycycline renal dose

Answer 32

No adjustment needed

Question 33

What is the best way to determine how to adjust med dosing in pt with renal failure?

Answer 33

Consult renal dosing chart

Question 34

What do you do with metformin if pt has renal failure?

Answer 34

D/C metformin --> Risk of Lactic Acidosis (esp if Cr

Question 35

What do you do with ACE-I if pt has renal failure?

Answer 35

D/C the pril --> Risk of HyperK | --100% excreted in urine, unchanged

Question 36

What do you do in the case of refractory hyperK that is unresponsive to meds (lasix)?

Answer 36

Dialysis

Question 37

Most acute renal failure is reversible or irreversible?

Answer 37

reversible

Question 38

Most causes of ARF

Answer 38

prerenal

Question 39

What studies should you avoid in a pt with ARF?

Answer 39

iodine contrast studies (IVP, CT)