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1. NAPLEX Prep > Renal disease > Flashcards

Renal disease Flashcards

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1
Q

Most common causes of renal disease

A

Diabetes and HTN

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2
Q

Primary function of the nephron

A

Control the concentration of Na and water.
This regulates blood volume and BP

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3
Q

Protein bound drugs

A

Not filtered through the glomerulus, exit through the efferent arteriole. Albumin only passes through the urine if the kidney is damaged.

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4
Q

Medications that work in the proximal tubule

A

SGLT2 inhibitors

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5
Q

Medications that work in the DCT

A

Thiazides

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6
Q

Medications that work in the ascending loop of henle

A

Loop diuretics

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7
Q

Medications that work in the collecting duct

A

Potassium sparing diuretics- aldosterone antagonists (spironolactone, eplerenone

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8
Q

Select drugs that cause kidney disease

A

All Needy Cats Like Vinci Cry And Create Pee Tubs
Aminoglycosides
NSAIDs
Cisplatin
Loop diuretics
Vancomycin
Cyclosporine
Amphotericin B
Contrast
Polymyxins
Tacrolimus

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9
Q

The cockcroft gault eqn is not preferable in

A

the very young, kidney failure, unstable renal function

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10
Q

CKD=

A

GFR <60 and/OR albuminuria

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11
Q

Why are ACEi and ARBs recommended for albuminuria?

A

Prevents disease progression by causing efferent vasodialtion

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12
Q

When starting an ACE or an ARB

A

SCr can increase by up to 30%. This is expected and treatment should not be stopped.

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13
Q

Recommendations for patients with CKD, DM, and eGFR >30

A

SGLT2 inhibitor- shown to reduce CV and CKD progression
Metformin

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14
Q

Drugs CI when CrCl<60

A

Nitrofurantoin

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15
Q

Drugs CI when CrCl <50

A

TDF containing products
Voriconazole IV (d/t vehicle)

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16
Q

Drugs CI when CrCl <30

A

TAF products
NSAIDs
Dabigatran
Rivaroxaban

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17
Q

Drugs CI when GFR <30

A

SGLT2 inhibitors
Metformin

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18
Q

Key drugs that require renal dose adjustments

A

Aminoglycosides
Beta lactams
Fluconazole
Quinolones (except moxi)
Vancomycin
LWMH
Rivaroxaban, Apixaban, Dabigatran
H2RAs, Metoclopramide
Bisphosphonates
Lithium

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19
Q

Complications of CKD

A

Mineral and bone disorder- hyperphosphatemia, vitamin D deficiency and secondary hyperparathyroidism
Anemia
Hyperkalemia

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20
Q

Patients with advanced CKD require monitoring of

A

PTH, phos, Ca, vitamin D

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21
Q

Hyperphosphatemia treatment

A

Restrict dietary phos
Phosphate binders prior to each meal- Calcium acetate and calcium carbonate are first line

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22
Q

Types of phosphate binders

A

Aluminum based- aluminum hydroxide
Calcium based- Calcium acetate, calcium carbonate
Al free, ca free-sucroferric oxyhydroxide, ferric citrate, lanthanum carbonate
Sevelamer- non aluminum, non calcium, not systemically abs

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23
Q

Aluminum hydroxide

A

Aluminum based phosphate binder
Caution for dialysis dementia and aluminum toxicity

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24
Q

Calcium based phosphate binders can cause

A

Hypercalcemia, especially problematic with concomitant use of vitamin D (d/t increased ca abs)

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25
Lanthanum carbonate
Aluminum free, Ca free phosphate binder Must chew thoroughly to reduce severe GI AE
26
Renvela
Sevelamer carbonate Non Aluminum, Non calcium, not systemically abs phos binder Can lower total cholesterol and LDL.
27
Renagel
Sevelamer hydrochloride Non Aluminum, Non calcium, not systemically abs phos binder Can lower total cholesterol and LDL.
28
Calcium based phosphate binders interact with
quinolones, tetracyclines, oral bisphosphonates, thyroid products
29
After controlling hyperphosphatemia, elevations in PTH are treated with
Vitamin D
30
Why does vitamin D deficiency occur in kidney disease?
Kidney is unable to hydroxylate vitamin D to its active form, 1,25-dihydroxy vitamin D
31
Vitamin D3
Cholecalciferol- from the skin
32
Vitamin D2
Ergocalciferol- from plants
33
Why are vitamin D analogs used in CKD?
Increase Ca absorption Inhibit PTH
34
What is the active form of D3?
Calcitriol
35
Drugs for the treatment of secondary hyperparathyroidism
Vitamin D analogs Calcimimetic
36
Vitamin D analogs agents and AE
Calcitriol, calcifediol -Hypercalcemia
37
Calcimimetics MOA
Increase sensitivity of calcium receptor on parathyroid gland. Causes decreased PTH, decreased Ca, decreased phosphate
38
Sensipar
Cinacalcet Calcimimetic- causes HYPOcalcemia
39
Risks of ESAs
Elevated BP Thrombosis
40
When should ESAs be used?
When Hgb <10 D/C once Hgb exceed 11
41
Key drugs that raise K levels
ACEi ARAs Aliskiren ARBs Canagliflozin Drospirenone K containing fluids SMX/TMP Cyclosporine, tacrolimus
42
S/S of hyperkalemia
Muscle weakness, bradycardia, fatal arrhythmias
43
What is used to stabilize the heart in hyperkalemia?
Calcium gluconate
44
What pushes K intracellularly?
Dextrose + insulin Sodium bicarb Albuterol
45
What removes K from the body?
Furosemide Sodium polystyrene sulfonate Patiromer Sodium zirconium cyclosilicate Hemodialysis
46
Which potassium binder is the quickest?
Sodium zirconium cyclosilicilate 1 hr
47
Kayexalate
SPS Warning for GI necrosis
48
______molecules are more readily removed by dialysis
Smaller
49
Drugs with a _______Vd are less likely to be removed by dialysis
larger
50
_______protein bound drugs are less likely to be removed by dialysis
Highly
51
_______________HD filters remove more substances
High-flux (large pore size) and high-efficiency (large SA)
52
________dialysis blood flow rate increase drug removal
higher
53
Preferred HCV treatment regimens consist of
2-3 DAAs with different mechanisms for 8-12 weeks
54
NS3/4A Protease Inhibitors
-Previr P for PI Must be taken with food Examples- glecaprevir, grazoprevir
55
NS5A replication complex inhibitors
-Asvir A for NS5A Examples- Elbasvir, ledipasvir
56
NS5B polymerase inhibitors
-Buvir B for NS5B -Dasabuvir, sofosbuvir
57
BBW for all DAAs
Risk of reactivating HBV Must be tested for HBV before starting a DAA
58
Sofosbuvir containing DAAs
Do NOT USE Amiodarone Serious symptomatic bradycardia has been reported
59
Which DAAs are pan-genotypic
Epclusa and Mavyret
60
Mavyret
DAA for HCV Glecaprevir/Pibrentasvir for 8 weeks WF
61
Epclusa
DAA for HCV Sofosbuvir/velpatasvie for 12 weeks DO NOT use amiodarone Dispense in original container
62
DDI for all DAAs
Strong inducers of 3A4 PORCS PR Phenobarbital Oxcabazepine Rifampin Carbamazepine St. Johns Wort Phenytoin Rifabutin
63
Harvoni, Epclusa, and Vosevi interact with
antacids, H2RAs, and PPIs Decrease conc of ledipasvir and velpatasvir
64
Do not take _______with Epclusa
PPIs
65
Viekira Pak DDI
Ethinyl estradiol
66
When is ribavirin used in HCV?
in combo with other drugs. NOT MONO
67
Aerosolized ribavirin is used for
RSV
68
Ribavirin BBW
Teratogenic Hemolytic anemia
69
Interferon alfa BBW
Neuropsychiatric, autoimmune, ischemic, or infections disorders
70
Treatment of HBV
Interferon alfa preferred NRTIs- TDF, TAF, entecavir, and lamivudine can be used
71
BBW for NRTIs
hepatomegaly and lactic acidosis Exacerbations of HBV if d/c'd
72
Viread
TDF
73
Vemlidy
TAF
74
Baraclude
Entecavir
75
Natural products for cirrhosis
Milk thistle
76
Drugs with BBW for liver damage
APAP Amiodarone Isoniazid Ketoconazole oral MTX Nefazodone Nevirapine NRTIs PTU Valproic acid

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