Flashcards in Renal Smith Deck (26):
whats the 1st sign of of nephrotoxicity
increase in serum creatinine
which adverse effect is irreversible
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
how long should aminoglycosides should always infused for
over 30 mins
most feared, but usually reversible
what is the route for aminoglycosides? Loading dose vs Maintenance dose?
load dose required regardless of renal function
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
increased risk when used with vancomycin
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
why is gentamycin usually combined with vancomycin
because gentamicin covers majority of gram - and vancomycin covers majority of gram +
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
if peak is low, trough is normal, what do you need to do?
if peak is normal, and trough is high?
what effects can radiographic contrast agents cause?
increase plasma volume--due to injecting dye
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
definite risk factor of contrast induced ARF
pre-exisitng renal insufficiency
probable risk factors of contrast induced ARF
prior contrast induced ARF
possible risk factors `of contrast induced ARF
large contrast load
tx for contrast induced ARF
Dialysis ( best to identify patients that are AT RISK to avoid ARF), once developed tx usually unsuccessful
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
what is the common cause of post op fever? when does it usually occur?
urinary tract infection
usually occur 2nd day after surgery
How do you check for UTIs?
urinalysis for leukocytes-->if present, take urine culture
Check CBC and check wound
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
pneumonia-1st day after surgery
drug rxn? may need to consider switching drugs (5th day)
post op infection-3rd day