Renal Disease Flashcards
(133 cards)
1
Q
Most common causes of CKD
A
diabetes and HTN
2
Q
what measures are used to determine the severity of kidney disease
A
proteinuria and GFR
3
Q
MOA of loop diuretics
A
inhibit the Na-K pump in the ascending loop of Henle -> less water reabsorbed
4
Q
Long term use of loop diuretics effect on calcium
A
depletion of calcium (harmful to bone)
5
Q
MOA of thiazide diuretics
A
inhibit the Na-Cl pump in the distal tubule
6
Q
long term use of thiazide diuretics on calcium
A
increases calcium reabsorption - protective effect on bone
7
Q
Aldosterone MOA
A
increase Na and water retention and decrease K in the distal tubule
8
Q
Risk factors for DIKD
A
multiple nephrotoxic medications, baseline reduction in renal blood flow, large doses or frequent use of nephrotoxic medications, and increased age
9
Q
common medications associated with DIKD
A
aminioglycosides, amphotericin B, cisplatin, colistimethate, cyclosporine, loop diuretics, NSAIDs, radiographic contrast dye, tacrolimus, and vancomycin
10
Q
When is CrCl based estimations of kidney function limited
A
low or high muscle mass, obese, liver disease, pregnancy
11
Q
GFR considered normal or high in CKD
A
90+ and kidney damage
12
Q
GFR considered mild decrease in CKD
A
60-89 with kidney damage
13
Q
GFR considered mild-moderate disease in CKD
A
45-59
14
Q
GFR considered moderate-severe disease in CKD
A
30-44
15
Q
GFR considered severe disease in CKD
A
15-29
16
Q
GFR considered kidney failure in CKD
A
17
Q
GFR category G1
A
90+ and kidney damage
18
Q
GFR category G2
A
60-89 and kidney damage
19
Q
GFR category G3a
A
45-49
20
Q
GFR category G3b
A
30-44
21
Q
GFR category G4
A
15-29
22
Q
GFR category G5
A
23
Q
CKD stage 1 GFR
A
90+ and kidney damage
24
Q
CKD stage 2 GFR
A
60-89 and kidney damage
25
CKD stage 3 GFR
30-59
26
CKD stage 4 GFR
15-29
27
CKD stage 5 GFR
28
Normal to mild increase in measured urine albumin
29
measured urine albumin termed a moderate increase
30-300
30
a severe increase in measured urine albumin
>300
31
ALbumiuria category 1
32
Albuminuria category 2
30-300
33
Albuminuria category 3
> 300
34
Goal BP in CKD (KDIGO)
35
When should ACE/ARB be stopped due to SCr increase?
>30%
36
Dose reductions effect on peaks and troughs of medications
reduce peaks but maintain trough concentrations
37
Extending dosing intervals effect on peaks and troughs of medications
maintain peaks but reduce trough concentrations
38
Antimicrobials/antivirals/antifungals requiring dosage adjustments for impaired kidney function
acyclovir, valacyclovir, amantadine, amphotericin, aminoglycosides, azole antifungals, anti-tuberculosis medications ethambutol, pyrazinamide, aztreonam, beta lactams, ganciclovir, valganciclovir, maraviroc, NRTIs, polymyxins, quinolones (except moxifloxacin), SMZ/TMP, vancomycin
39
Cardiovascular medications that require dosage adjustments for impaired kidney function
antiarrhythmics (digoxin, disopyramide, procainamide, sotalol), dabigatran, LMWHs, Rivaroxaban, statins
40
Pain/gout medications that require dosage adjustments for impaired kidney function
allopurinol, colchicine, gabapentin, pregabalin, morphine, codeine, tramadol IR
41
GI medications that require dosage adjustments for impaired kidney function
Famotidine, ranitidine, metoclopramide
42
Drugs contraindicated in CrCl
chlorpropamide, cidofovir, ribavirin, voriconazole IV
43
Drugs contraindicated in CrCl
Avanafil, bisphosphonates, dabigatran, duloxetine, fondaparinux, NSAIDs, potassium sparing diuretics, ribavirin, rivaroxaban, tadalafil, tramadol ER, SGLT2 inhibitors
44
CKD patients should be screened for what abnormalities associated with CKD-MBD
PTH, phosphorus, calcium, vitamin D
45
treatment of secondary hyperparathyroidism in CKD
phosphate restricted diet, phosphate binders
46
Duration of use for aluminum based phosphate binders
4 weeks - aluminum is toxic to the nervous system and bone
47
which phosphate binders are used first line for hyperphosphatemia of CKD
calcium based phosphate binders
48
Aluminum hydroxide brand name
AlternaGEL, Amphojel,
49
Aluminum hydroxide dosing in hyperphosphatemia of CKD
300-600 mg TID with meals
50
Aluminum hydroxide side effects
constipation, poor taste, nausea, aluminum intoxication, dialysis dementia, osteomalacia
51
Aluminum hydroxide monitoring
Ca, PO4, serum aluminum concentrations, PTH
52
Calcium acetate brand name
PhosLo, Phoslyra
53
Calcium acetate dosing in hyperphosphatemia of CKD
667-1334 mg TID with meals
54
Calcium carbonate brand name
Tums
55
Calcium carbonate dosing in hyperphosphatemia of CKD
500 mg TID with meals
56
calcium based phosphate binders side effects
constipation, nausea, hypercalcemia
57
calcium base phosphate binders monitoring
Ca, PO4, PTH
58
sucroferric oxyhydroxide brand name
velphoro
59
sucroferric oxyhydroxide dosing for hyperphosphatemia in CKD
500 mg TID with meals
60
ferric citrate brand name
auryxia
61
ferric citrate dosing in hyperphosphatemia of CKD
2000 mg TID with meals up to 12 grams per day
62
side effects of sucroferric oxyhydroxide and ferric citrate
diarrhea, discolored (black) feces
63
monitoring for sucroferric oxyhydroxide and ferric citrate
PO4, iron, ferritin, TSAT (ferric citrate only)
64
Lanthnum carbonate brand name
Fosrenol
65
Lanthanum carbonate dosing for hyperphosphatemia of CKD
500-1000 mg TID with meals - must chew thoroughly
66
Contraindications for Lanthanum carbonate
Bowel obstruction, fecal impaction, ileus
67
Side effects of lanthanum carbonate
N/V/d, constipation, abdominal pain
68
Monitoring for lanthanum carbonate
Ca, PO4, PTH
69
Sevelamer carbonate brand name
Renvela
70
Sevelamer hydrochloride brand name
Renagel
71
Sevelamer dosing for hyperphosphatemia in CKD
800-1600 mg TID with meals
72
Sevelamer contraindictions
bowel obstruction
73
Sevelamer side effects
N/V/d (>20%), constipation, abdominal pain
74
Sevelamer monitoring
Ca, PO4, HCO3, Cl, PTH
75
treatment of elevations in PTH in CKD
controlling hyperphosphatemia, vitamin D
76
vitamin D3 other name
cholecalciferol
77
vitamin D2 other name
ergocalciferol
78
active form of vitamin D
calcitriol
79
calcitriol brand name
Rocaltrol, calcijex
80
Advantage of newer vitamin D analogs
less hypercalcemia than calcitriol
81
calcitriol dosing in CKD
0.25 mcg PO 3x/week to daily. take with food to decrease stomache upset
82
calcitriol dosing in dialysis
0.5-1 mcg PO daily or 0.5-4 mcg IV 3x/week. take with food to decrease stomach upset
83
doxercalciferol brand name
hectorol
84
doxercalciferol dosing in CKD
1 mcg PO 3x/week to daily
85
doxercalciferol dosing in dialysis
2.5-10 mcg PO 3x/week, 1-4 mcg IV 3x/week
86
paricalcitol brand name
Zemplar
87
paricalcitol dosing in CKD
1 mcg PO 3x/week to daily
88
paricalcitol dosing in dialysis
2.8-7 mcg IV 3x/week, 2-4 mcg PO 3x/week
89
Vitamin d analogs contraindications
hypercalcemia, vitamin D toxicity
90
vitamin D analogs side effects
N/V/d, hypercalcemia, hyperphosphatemia
91
vitamin D analogs monitoring
Ca, PO4, PTH
92
cinacalcet brand name
sensipar
93
cinacalcet MOA
increase sensitivity of calcium receptor on the parathyroid. decrease PTH, decrease Ca, decrease Phosphorus
94
cinacalcet dosing for hyperparathyrodism
30-180 mg PO daily with food - Swallow whole
95
contraindications to cinacalcet
hypocalcemia
96
cinacalcet warning
caution in patients with a history of seizures
97
cinacalcet side effects
hypocalcemia, N/V/d, paresthesia, fatigue, depression, anorexia, constipation, bone fractures, weakess, arthralagia, myalgia, limb pain, URTIs
98
cinacalcet monitoring
Ca, PO4, PTH
99
most common cause of hyperkalemia
decreased renal excretion due to kidney failure
100
drugs that raise potassium levels
ACE/ARB, aldosterone receptor antagonists, aliskiren, NSAIDs, cyclosporine, tacrolimus, everolimus, mycophenolate, glycopyrrolate, drospirenone, SMZ/TMP, chronic heparin use, canagliflozin, pentamidine
101
s/s of hyperkalemia
muscle weakness, bradycardia, fatal arrhythmias
102
3 steps for treating severe hyperkalemia
1. stabilize the heart 2. move it 3. remove it
103
how to stabilize the heart during severe hyperkalemia
calcium gluconate IV
104
how to move it during severe hyperkalemia
1. insulin with dextrose or glucose 2. sodium bicarbonate (if metabolic acidosis) 3. beta-agonists (albuterol)
105
hot to remove it during severe hyperkalemia
1. loop diuretics 2. SPS or Veltassa (takes hours to days) 3. Fludrocortisone (Florinef) (if hypoaldosteronism) 4. Dialysis
106
Sodium polsteyrene sulfate brand names
SPS, kayexalate, kalexate, kionex
107
SPS dosing
PO: 15 grams 1-4x/day (DO NOT MIX with fruit juices containing K) rectal: 30-50 grams Q6H
108
SPS warnings
electrolyte disturbances including hypokalemia, fecal impaction, do not mix oral products with sorbitol (increased risk of GI necrosis)
109
SPS side effects
Hypernatremia, hypocalcemia, hypokalemia, hypomagnesemia, N/V/d, constipation
110
SPS monitoring
K, Mg, Na, Ca
111
Patiromer brand name
Veltassa
112
Patiromer dosing
8.4 grams PO daily with food. max 25.2 grams/day
113
Patiromer administration
Add veltassa packet to 30 ml of water and stir well. Add 60 ml of water and stir (will be cloudy). drink immediately. add water and drink if powder remains in cup
114
Patiromer warnings
give 6 hours before or after other drugs (binds), Can worsen GI motility and cause hypomagnesemia
115
patiromer side effects
constipation, hypomagnesemia, hypokalemia, N/d
116
patiromer monitoring
K, Mg
117
When is treatment for metabolic acidosis initiated
serum bicarbonate
118
Sodium bicarbonate dosing for metabolic acidosis in CKD
1-2 tabs PO 1-3x/day
119
sodium bicarbonate contraindications
alkalosis, hypernatremia, hypocalcemia, pulmonary edema, unknown abdominal pain
120
sodium bicarbonate warnings
caution in HTN, cardiovascular disease, fluid retention (Na load)
121
sodium bicarbonate side effects
N/V/d, hypernatremia
122
sodium bicarbonate monitoring
Na, HCO3
123
Sodium citrate/citric acid brand names
Bicitra, Cytra-2, Oracit, Shohl's solution
124
Sodium citrate/citric acid dosing
10-30 ml PO with water after meals and at bedtime (chilled improves taste, timing to avoid laxative effect)
125
Sodium citrate/citric acid contraindications
Alkalosis, Na restricted diet, hypernatremia
126
Sodium citrate/citric acid side effects
N/V/d metabolic alkalosis, tetany
127
sodium citrate/citric acid monitoring
Na, HCO3, urinary pH
128
Sodium citrate/citric acid counseling note on drug interactions
avoid use with aluminum containing products
129
Effect of MW/size on drug removal during dialysis
smaller molecules are more readily removed
130
Effect of Vd on drug removal during dialysis
large Vd are less likely to be removed
131
Effect of Protein binding on drug removal during dialysis
highly protein bound are less likely to be removed
132
Effect of the membrane on drug removal during dialysis
high flux and high efficiency are more likely to remove drug
133
Effect of the blood flow rate on drug removal during dialysis
higher blood flow rates increase drug removal over a given time interval
