Renal

Question 1

Chronic Kidney Disease (CKD) (Also known as Chronic Renal Failure)
Often un-recognized

Answer 1

until the most advanced stages

Question 2

CKD Dx determined by

Answer 2

by lab studies and/or a reduction in the glomerular filtration rate for more than 3 months duration

Question 3

Most common causes of CKD

Answer 3

diabetes and hypertension

Question 4

Less frequent causes of CKD

Answer 4

cystic disorders of the kidney, obstructive uropathy, glomerular nephrotic and nephrotic syndromes

Question 5

This is key in slowing the progression of CKD

Answer 5

Glycemic control for diabetic kidney disease and optimization of blood pressure

Question 6

CKD is a risk factor for

Answer 6

cardiovascular disease, independent of comorbidities such as diabetes, hypertension and dyslipidemia

Question 7

Classes of Diuretics

Answer 7

Loop Diuretics
Potassium Sparing Diuretics
Thiazide and Thiazide-like Diuretics
Miscellaneous Diuretics

Question 8

CMP includes

Answer 8

kidney function (GFR)

Question 9

GFR should be greater than

Answer 9

60

Question 10

With chronic disease what is important

Answer 10

lifestyle management. Diet exercise etc.

Question 11

Loop diuretics: potential for

Answer 11

cross-sensitivity with sulfa

Question 12

Loop examples

Answer 12

Furosemide, bumetanide, torsemide

Question 13

Potassium sparing often used

Answer 13

in combination with thiazide to reverse low potassium effect

Question 14

Potassium sparing examples

Answer 14

Triamterene
Spironolactone
Eplerenone (Inspra)

Question 15

Diuretics are used

Answer 15

because they reduce ECF

Question 16

Loop MOA

Answer 16

Inhibits sodium reabsorption at the ascending loop of Henley.

Cause a large amount of sodium loss through the urine. Water follows salt.

Question 17

Potassium sparing MOA

Answer 17

Inhibit potassium excretion distally. A little weaker. Keep K present by their function. Goal is to reduce potassium loss. This is why they are usually used in conjunction with thiazide.

weakest of all diuretics

Question 18

Thiazide MOA

Answer 18

Act on the distal renal tubule to prevent sodium reabsorption. Generally longer lasting. Used in less severe cases. Outpatient setting.

Question 19

Thiazide examples

Answer 19

HCTZ, chlorthalidone, indapamide, metolozone

Question 20

High-dose therapy (HCTZ greater than 50) has increased

Answer 20

risk of hypokalemia, increase in uric acid levels, and serious CV outcomes; use in combination vs pushing high doses

Question 21

Thiazide watch with

Answer 21

patients with hyperlipidemia

Question 22

Diuretics ADR

Answer 22

hypotension, decreased GFR, hypokalemia/hyperkalemia, electrolyte abnormalities, metabolic alkalosis, hyponatremia

Question 23

Eplerenone (Inspra)

Answer 23

next-generation aldosterone agent

Potassium sparing, selective aldosterone blocker

Question 24

Note on diuretics from text

Answer 24

Initially diruetics promote loss of sodium through the urine and reduce cardiac output. Overtime peripheral vascular resistance is reduced. This is believed to be the result of sodium in the vessel walls themselves.. Sodium could cause vessel walls to constrict. The loss of sodium decreases vascular resistance, reducing afterload, and reducing blood pressure.

Question 25

Diuretics Decreased effect with

Answer 25

NSAID

Question 26

Diuretics drug effects increased wtih

Answer 26

with grapefruit juice, azoles, CCBs

Question 27

Diuretics increased effects OF

Answer 27

ACEI, ARB, BB, potassium replacement

Question 28

Diuretics cost

Answer 28

approximately $110 to $125/month without superior outcomes

Question 29

Diuretics Monitoring

Answer 29

BP, HR, edema, weight gain, dyspnea, cough, urine output

Question 30

Diuretics Prior to Initiating therapy

Answer 30

BUN, creatinine, electrolytes (sodium, potassium, calcium, and magnesium), uric acid, and glucose levels

Question 31

Diuretics Ongoing monitoring

Answer 31

of electrolytes

Question 32

Diuretics take as

Answer 32

directed early in the day if there are urination issues

Question 33

Diuretics do not take

Answer 33

double dose

Question 34

Diuretics monitor

Answer 34

weight

Question 35

Diuretics Must

Answer 35

drink fluid

Question 36

Maintaining a balance of electrolytes is essential to

Answer 36

the body’s homeostasis. When an electrolyte imbalance occurs, the cause must be promptly identified and treated.

Question 37

Electrolytes affect multiple functions of the body. What are they.

Answer 37

``` functions in the body, including: Muscle function Neurologic activity Water balance regulation Bone formation ```

Question 38

When do you run lab like the CMP for an otherwise healthy individual on a diuretic?

Answer 38

every 3 to 6 months

Question 39

When electrolytes are lost, they can normally be replaced by

Answer 39

drinking fluids; this is the preferred treatment approach. However, if fluid loss is substantial, then fluids must be replaced by the intravenous route.

Question 40

Common electrolytes

Answer 40

``` Sodium Potassium Calcium Chloride Magnesium Phosphate ```

Question 41

This is how you rehydrate

Answer 41

70 to 80 ounces of water a day or one or two servings of electrolyte replacement. An example would be 8 to 16 oz of Gatorade