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25 Cards in this Set
- Front
- Back
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How do NSAIDS contribute to ARF?
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NSAIDs inhibit prostaglandins, thereby negating compensatory vasodilation.
(i.e. NSAIDs cause vasoconstriction) |
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NSAIDs can induce abrupt decreases in GFR especially in what groups of patients?
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Patients who have: CHF, Liver Disease, Elderly, Dehydrated
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Which NSAID has the lowest risk of renal disruption?
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Aspirin
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Which NSAID has the highest risk of renal disruption?
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Indomethacin
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Is a COX - 2 better for the kidneys than COX - 1?
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No, COX 2s have not been shown to preserve renal function
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One NSAID has some renal sparing properties. Which one?
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Suldinac
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NSAID induced nephropathy results in proteinurea of >3.5. After you stop an NSAID will kidney function resolve quickly?
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No, NSAID induced nephropathy resolves slowly over several months after discontinuation of the drug.
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How might an
ACE cause ARF? |
ACE inhibitor is designed to disrupt the RAA system thereby ans ACE disrupts the compensatory renal arterial vasoconstriction which further reduces GFR
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What conditions are ACE inhibitors contraindicated in?
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Bilateral renal artery stenosis, dehydrated patients, patients with extensive atherosclerosis,
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ACE inhibitors can precipitate ARF in patients who are taking concomitant drugs, most notably which two?
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Cyclosporine (immunosupressent) and
NSAIDs |
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Which two lab test must be ordered periodically for patients on an ACE?
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SrCr and Potassium
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True or False
An ARBs are more "renally sparing" than ACEs. |
False
There is no eveidence that an ARB will be better tolerated |
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Acute Tubular Necrosis is the same as Intrinsic ARF. True or False
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True and False!
Acute Tubular Necrosis is often used to describe Intrinsic ARF but there are other subdivisions of Intrinsic ARF |
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Name two general causes of ATN.
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Ishemia
Drug Induced |
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Name four causes of ATN due to ischemia
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prolonged renal condition
burns hypotension surgery |
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Name two drugs that could cause ATN
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Aminoglycosides
Amphotercerin B |
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What is the treatment for ATN (nonoliguric)?
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Loop diuretics
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Name four groups of patients at high risk for ATN when given radio-contrast media.
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Patients with:
Diabetic nephropathy Chronic renal failure Sever CHF Dehydrated |
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Name some preventative measures taken that could prevent radio-contrast media induced ATN
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Hypotonic 0.45 Saline
N-acetylcytine (antioxident) Alternative imaging studies |
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If you have time, you can discontinue renally damaging drugs for 24 hours before administering radio contrast to prevent ATN. Name five renally harsh drugs
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Metformin
Diuretics NSAIDS including COX 2 ACE inhibitors ARBS |
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If a patient experiences radio contrast induced ATN, what is the treatment?
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Supportive - fluid and electrolye management
Severe needs dialysis |
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What drug comes to mind with aminoglycoside induced ATN?
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Gentamycin
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Name groups at risk for developing Aminoglycoside induced ATN.
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Elderly
Underlying renal disease Dehydrated Hypotension/Shock Therapy > 3 days Multiple daily dosing Trough > 2 Concomitant drug use |
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Name five drugs that when used in conjuction with gentamycin may cause ATN
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Lasix
Amphotericin B Cyclosporine Vancomycin Radio Contrast Media |
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After beginning Gentamycin, when could you see evidence of ATN? What are some signs that will tell you that ATN may be started?
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5-7 days
Urine will be hypo-osmolar, nonoliguric renal failure. Slow rise in SrCr. UA will show casts, epithelial cells, WBCs, protein, brush border cells |
