Acute And Chonic Renal Failure

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a cation-exchange resin used to lower K in exchange for Sodium in stage 4 of CKD. Contains sorbitol, alcohol sugar that has osmotic laxative action and K is excreted through bowel.

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Sodium Plystyrene sulfonate (Kayexalate)

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Diuretic used for CKD to tx HTN.

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furosemide (Lasix)

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B adrenergic blocker used in CKD to tx HTN.

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metoprolol (Lopressor)

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Calcium Channel Blocker used in CKD to tx HTN.

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nifidipine (Procardia)

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ACE inhibitors used in CKD to tx HTN.

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captopril (Capoten)
enalapril (Vasotec)

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Initial Drug Therapy recommended for non diabetic CKD pts to tx HTN.

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Diuretics and B adrenergic blockers

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Drug Therapy used in CKD pt with diabetic and non diabetic proteinuria because they decrease proteinuria and delay progression of CKD.

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ACE inhibitor captopril (Capoten)
enalapril (Vasotec) and Angiotensin Receptor blocker losartan (Cozaar)

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calcium based phosphate binders used to bind phosphate in the bowel and excreted in stool.

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calcium carbonate (Tums) and calcium acetate (PhosLo)

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phosphate binder that does not contain calcium or aluminum and can lower cholesterol and LDL and also may decrease formation of systemic calcium-phosphate deposits.

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sevelamer hydrochloride (Renagel)

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giving a calcium based phosphate binder when serum phosphate levels are still high (6 or >6) may cause a formation of

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Systemic calcium-phosphate deposits.

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phosphate binders is absorbed within 1 hr so it should be taken____

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with meals.

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a side effect of phosphate binder is?

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Constipation and may need stool softner.

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these magnesium containing antacids should be avoided with CKD

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Maalox and Mylanta

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Vit D given to CKD pts

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calcitrol (Rocaltrol) and IV prep (Calcijex)

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serum phosphate level should be lowered before administering calcium and Vit D to avoid

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soft tissue calcification if both calcium and phosphates are high.

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medication used to help parathyroid glands detect calcium at lower serum levels and decrease PTH secretion

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cinacalcet (Sensipar)

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erythropoietins used to treat anemia in CKD pt

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epoetin alfa (Epogen, Procrit).
IV and subQ form darbepoetin alfa (Aranesp), this one requires less injections.

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erythropoetin adverse effect due to increase of blood viscosity

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development or acceleration of HTN

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this med is prescribed if serum ferritin falls belog 100ng/ml in CKD pts

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Iron

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Iron supplement should not be taken with ______ ________because the calcium can bind to it and prevent absorption of this supplement

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calcium phosphate bindenders

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this supplement is given for RBC maturation and because it is removed in Dialysis

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Folic Acid

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drug given to lower LDL cholesterol in CK pt

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statins (HMG-CoA reductase inhibitors) a goal of below 100d is recommended LDL level

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drug effective for lowering tryglicerides and increasing HDLs in CKD pt

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fibrates (fibric acid derivatives) . triglycerides goal is below 200mg/dl

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theses preparations may not need to be changed for loading dose but for the maintenance dose. Hypokalemia can also potentiate the action of this preparation especially after Dialysis when K is removed.

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Digitalis preparation like digoxin (Lanoxin)

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how much digoxin (Lanoxin) will pt require every other day?

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0.125mg in CKD pts

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aminoglycosides, penicillin in high doses and tetracyclines are potentially nephortoxic and require dose and frequency adjusted. name two

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vancomycin (Vancocin) and gentamicin (Geramycin)

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this drug should not be given to CKD pt because it can cause seizures when it accumulates

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meperidine (Demerol)

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CKD pt should avoid this NSAID OTC meds because they can cause vasodilation and worsen renal hypoperfusion. Acetaminophen may be used instead.

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ibuprofen (Advil)

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dietary protein is restricted because the end products of protein metabolism are

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Urea nitrogen and creatinine

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pt how are not under going dialysis and createnine level is less than 25ml/min should only intake ____g of protein per Kg

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0.6 to 0.75g per kg

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some tx centers use a routine ___g of protein per day to treat CKD

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40g of protein per day

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these three dietary restrictions can slow progression of renal failure

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low protein (0.6-0.8g/kg per day), low phosphorus diet supplemented with Amino acids and their ketoanalogues.

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once pt starts dialysis protein intake can increase to

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1.2 to 1.3g/kg per day

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why are pt with PD not as protein restricted as HD patiens?

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excessive amount of proteins are lost in dialysate in Peritoneal Dialysis
at least 1.2g/kg per day is recommended

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what are sodium restrictions for Pre end stage renal disease?

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1-3g/day

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what are sodium restrictions for HD patients?

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2-3g/day

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what are sodium restrictions for PD patients?

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2-4g/day

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1 gram of Sodium equals to how many grams of salt?

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400g of salt (sodium chloride)

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phosphate for pre endstage renal disease is limited to ?

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8-12mg per kg

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phosphate for HD pt in renal disease is limited to ?

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17 or less than 17mg/kg
or 800-1200mg/day

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phosphate for PD pt in renal disease is limited to ?

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17 or less than 17mg/kg

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name 5 foods high in phosphate

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milk, ice cream, cheese, yogurt, foods containing dairy (pudding)

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Potassium restrictions are individualized for pre ESRD and PD (2-4g/day) depending on labs. But for HD it is

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40mg/kg or 2-3g per day

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39mg of potassium equals to how many mEq?

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1 mEq

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name 10 foods high in potassium

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oranges, banabas, melons, tomatoes, prunes, raisins, deep green veggies, yellow veggies, beans and legumes.

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Salt substitutes should be avoided because they contain

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potassium chloride.

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Calcium restrictions for CKD pt range from

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1000-1500mg/day

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Iron is supplemented for CKD pts receiving

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Erythorpoietin