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Flashcards in Renal Smith Deck (26):
1

whats the 1st sign of of nephrotoxicity

increase in serum creatinine

2

which adverse effect is irreversible

otoxicity

3

what causes the adverse effect of Nm blockade? what happens?

due to rapid administration via IV bolus

Excessive levels of antibiotics accumulate at Nm junction which inhibits Ach release-->cause paralysis

4

how long should aminoglycosides should always infused for

over 30 mins

5

most feared, but usually reversible

nephrotoxicity

6

what is the route for aminoglycosides? Loading dose vs Maintenance dose?

all paraenteral

load dose required regardless of renal function
-Gentamycin/tobramycin: 2mg/kg
Amikacin 7.5 mg/kg

Maintenance dose is calculated based on renal function:
for normal renal function:
Gentamicin/tobramycin: 3-5 mg/kg every 8-12 hrs
Amikacin: 15 mg every 12 hrs

7

increased risk when used with vancomycin

nephrotoxicity

8

what does the cockcroft & gault calculate? whats the equation

Estimates creatinine clearance by collecting urine

[((140-age)x weightKg)/(serum creatininex72)] x0.85 if women

9

why is gentamycin usually combined with vancomycin

because gentamicin covers majority of gram - and vancomycin covers majority of gram +

10

what does peak and trough measure? what is each dependent on? when do you measure it

ways physicians can monitor amt of antibiotic in blood at certain periods of time.--measure before we give nxt dose and after the dose

Peak: dose dependent, drawn immediately after 3rd dose
Trough: TIME dependent--drawn 20-30 mins before 4th dose

11

if peak is low, trough is normal, what do you need to do?

increase dose

12

if peak is normal, and trough is high?

increase time

13

what effects can radiographic contrast agents cause?

increase plasma volume--due to injecting dye
osmotic diuresis
increase in uric acid and oxalate excretion
ARF can occur in 24-48 hrs after diuresis in some
Creatinine peaks 3-5 days and returns to normal in 10-14 days

14

definite risk factor of contrast induced ARF

pre-exisitng renal insufficiency

diabetes

15

probable risk factors of contrast induced ARF

dehydradtion

prior contrast induced ARF

16

possible risk factors `of contrast induced ARF

large contrast load
advanced age
CHF
vascular disease
proteinuria
hyperuricemia

17

tx for contrast induced ARF

Dialysis ( best to identify patients that are AT RISK to avoid ARF), once developed tx usually unsuccessful

18

Preventions for contrast induced ARF

**Hydration--not actually prevent but will minimize severity

Minimize contrast load--avoid repeated studies, sedate patient if need to avoid increase in contrast load

19

what is the common cause of post op fever? when does it usually occur?

urinary tract infection

usually occur 2nd day after surgery

20

How do you check for UTIs?

urinalysis for leukocytes-->if present, take urine culture

Check CBC and check wound

21

when does benign post op fever occur?

benign post-op fever--immediately after surgery, it is very common due to the general anesthetic agents throwing off thermoregulation center in the brain

22

Wind fever/time

pneumonia-1st day after surgery

23

wonder: fever/time

drug rxn? may need to consider switching drugs (5th day)

24

wound: fever/time

post op infection-3rd day

25

walk: fever/time

DVT-4th day

26

water fever/time

UTI-2nd day get urinalyais