Wk 3 Flashcards by Genevieve Stubbs

Cockroft - Gault. equation for Males

CrCl (M): (140-age) x (IBW)kg /

72 (kg) x SCr (mg/dl)

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Cockfort-Gault equation for women

CrCl (F): (CrCl Male) x 0.85

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Cockroft Gault assumes:

assumes “stable” renal function and “normal” muscle mass

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In high risk patients, avoid and minimize the following nephrotoxic agents:

Aminoglycosides
Amphotericin B 
Radiocontrast agents
Cylosporin &amp; Tacrilimus
ACE Inhibitors &amp; ARBs
NSAIDs

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Kidney functions

Excretory (fluid, electrolytes, solutes)
Metabolic (vitamin D, some drugs: insulin B-lactams)
Endocrine (erythropoietin)

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Diuretics

Thiazides 
Carbonic Anhydrase Inhibitors
Potassium-sparing
Osmotic
Loop

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Thiazide diuretics increase secretion of :

Na, Cl, K, Mg

decreased serum levels

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Thiazide diuretics decrease secretion of

Ca and uric acid (increased serum levels)

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Thiazides are ____ efficacious

moderately (not potent)

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Thiazides are not effective for CrCl ____

<30

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administration of chlorothiazide

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relative potency of chlorothiazide

0.1;500 mg

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relative potency of hydrochlorothiazide

1;50 mg

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relative potency of indapamide

20; 2.5mg

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The two diuretics that may be used if CrCl is under 30

indapamide

metolazone

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relative potency of metolazone

10; 5 mg

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relative potency of chlorthalidone

1;50 mg

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limited usefulness as diuretics

carbonic anhydrase inhibitors

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what are carbonic anhydrase inhibitors used for?

mainly for open-angle glaucoma

occasionally use for edema or HF

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example of carbonic anhydrase inhibitor

acetazolamide (diamo)

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potassium-sparing diuretics are usually administered with ___

K+ losing thiazides (helps minimize potassium loss)

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Na channel blockers may cause ___

hyperkalemia

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aldosterone antagonists may cause ___

hyperkalemia

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two types of potassium sparing duiretics

na channel blockers

aldosterone antagnoists

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Na channel blockers

amiloride | triamterene

CrCl for amiloride in which you would give 50% of usual dose

CrCl 10-50 mL/min: give 50% of usual dose

when should you avoid use of triamterene

CrCl <10mL / min

aldosterone antagonists

spironolactone (aldactone)

If CrCl is ___, administer spironolactone q24

CrCl 10-50 mL/min

when should you avoid use of spironolactone

CrCl <10

diuretic of choice in patients with hepatic cirrhosis

spironolactone

side effects of spironolactone

gynecomastia, impotence

Osmotic diuretics

Mannitol | glycerine, isosorbide, era (little use clinically)

use of Mannitol

cerebral edema

what will happen if mannitol is stored at low temperatures

may crystalize out

Loop Diuretics

Furosemide | Ethacrynic Acid

Most potent classic diuretics (individualize therapy)

loop

__ major agents available both PO and IV of loop diuretics

adverse effects of loop diuretics

ototoxicity (tinnitus, deafness, vertigo, usually reversible) hyperurcemia (rarely gout) hyperglycemia

when is ethacrynic acid useful

useful in patients with sulfa allergy (contains no sulfur atoms)

greatest propensity for ototoxicity for all loops

ethacrynic acid

best absorption for furosemide

excellent bioavailability -- good PO absorption

ototoxicity of furosemide is increased if:

given IV @ <4mg/min (high dose)

Dose of furosemide if a patient is in acute pulmonary edema

usual dose: 40 mg IVP over 1-2 min, increase to 80mg IVP for inadequate response

may be added to patients refractory to furosemide (synergistic effect)

metolazone (zaroxolyn) (thiazide) -- double dose q24 to desired response

inability f a drug to produce additional effects above a certain maximum effective dose

ceiling effect

___ is preferred in patients with persistent fluid retention despite high doses of other loops

torsemide

overactive bladder medication

oxybutynin

urine acidifying agent

ammonium chloride

increases elimination of asprin

urinary alkalinizing agents

na bicarbonate | k citrate

Po4 is retained

phosphate binders

ESRD

end stage renal disease

Phosphate binders

``` Calcium acetate (first gen) sevelamer (renagel) lanthanum carbonate (fosrenol) ```

target serum PO4 for calcium acetate

Po4 < 6 mg/dl

adverse effects of calcium acetate

``` mild hypercalcemia (>10.5 mg -->, constipation, anorexia, N/V) severe hypercalcemia (>12 --> delirium, stupor, coma) ```

when is calcium acetate contraindicated

hypercalcemia (NML 8.4-10.2)

when is sevelamer useful

in patients with hypercalcemia

sevelamer may reduce absorption of :

vit d, e, k and foltate

anion-exchange resin

sevelamer

sevelamer may induce ___ in patients on HD

metabolic acidosis

sevelamer is being replaced by ___

renvela

target Po4 level for sevelamer

<6mg/dl

potassium binding agents

sodium polystyrene sulfonate (kayexalate)

adverse effects of sodium polystyrene sulfonate

``` hypocalcemia hypokalemia hypomagnesemia constipation fecal impaction nausea vomiting ```

what should you monitor for a patient on sodium polystyrene sulfonate

electrolytes: Na, K, Ca, Mg | EKG

___ can be given for CKD anemia

elemental Fe

Titrate dose of elemental FE to minimize __

GI upset

Serious AE of IV iron

iron accumulation/overload

High IV iron doses are assoc with increased ___

mortalityq

IV iron formulations

Ferric gluconate | Iron sucrose

ferric pyrophosphate citrate (FPC) is __ soluble complex iron salt

water

ferric pyrophosphate citrate is added to the ____ solution

hemodialysate

advantages of ferric pyrophosphate citrate

progressive iron accumulation does not occur reduces cost of costly ESAs Inexpensive

ESA's

``` Epoetin Alfa (epogen, procrit) Darbepoetin alfa ```

Non-dialysis CRF doses of Epoetin Alfa

75-150 units/kg/week

hemodialysis CRF dose of epoetin Alfa

75 units / ig 3x / week

round doses of epoetin alfa to the nearest ___ units

1,000

half life of darbepoetin alfa is ___ that of epoetin alfa

darbepoetin allows for:

once weekly SQor IV administration

darbepoetin is dosed in ___

mcg, not units (expensiveO

to convert epoetin to darbepoetin, ___

add weekly units

Benign prostatic hyperplasia medications

a1-antagonists | 5a reductase inhibitors

a1 antagonists

tamsulosin (flomax) alfuzosin (uroxatral) silodosin (rapaflo)

adverse effects of tamsulosin

orthostatic hypotension (16% @ .4; 19% @ 0.8)

MOA of 5a reducatase inhibitors

5a reductase catalyzes conversion of testosterone to dihydrotestosterone (DHT)

type II 5AR is mainly in___

prostate and hair follicles

5a reductase inhibitors

finasteride (proscar, propecia) | dutasteride (avodart)

finasteride is selective for ___

type 2 5ar

finasteride is pregnancy category:

x | pregnant females should not ingest or handle tablets

dutasteride binds to ___

type I and II 5ar (nonselective)

dutasteride is pregnancy category:

x (avoid ingestion or handling)

Wk 3 Flashcards

(92 cards)