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70 Cards in this Set

  • Front
  • Back
What are the three phases of ARF?
oliguric, diuretic, recovery
What are the causes of ARF?
prerenal azotemia, functional, intrinsic, postrenal
What are some drugs that cause afferent arteriole vasoconstriction?
afferent - NSAIDS, COX-2 inhibitors, cyclosporine, Amphotericin B, Radiocontrast media, vasopressors
What are some drugs that cause efferent arteriole vasodilation?
ACEi's, ARB's, dihydropyridine CCB's, Diltiazem, Verapamil
What can either afferent arteriole vasoconstriction or efferent arteriole vasodilation lead to?
functional ARF
What is the MC cause of intrinsic renal failure?
ATN
If a patient has evidence of dehydration or decreased effective circulating volume, what should you suspect could be happening in their kidneys?
prerenal azotemia
If a pt has edema with normal cardiac function, what could be going on?
early signs of nephrotic syndrome
A pt presents with rash + ARF + recent antibiotic exposure, what do you suspect?
drug induced allergic interstitial nephritis
A UA reveals increased osmolality and increased specific gravity, what do you suspect?
prerenal azotemia
Any time a pt has proteinuria/hematuria, what do you suspect?
glomerular damage
What lab value defines nephrotic syndrome?
urinary protein loss >3.5g/day
In which pts are ACEi's contraindicated?
BRAS, conditions of Na and water depletion, pre-existing renal disease, concurrent use of afferent arteriole vasoconstrictors esp. NSAIDS, cyclosporine
T or F? ARB's are preferred over ACEi's for their renal sparing activity.
false - there is NO DATA to suggest ARB's are better than ACEi's regarding renal dysfunction
When is the onset of post streptococcal glomerulonephritis usually?
7 - 21 days after start of infection
What are PE findings of PSGN?
edema, tea colored urine, HTN, decreased urine output
Tx for PSGN?
symptomatic, prophylaxis for close contacts, protein restriction, Na and water restriction,
loop diuretics--->monitor electrolytes
T or F? rapidly progressive glomerulonephritis is a medical emergency?
true
What is a common cause of RPGN?
multisystemic vasculitic disorders (often autoimmune)
SSx of RPGN?
gross hematuria, proteinuria, >50% glomerular crescents on Bx, rapid decline in renal function (days to weeks)
What is the most common cause of ATN?
ischemia or drugs
How do you differentiate ATN from prerenal azotemia?
tubular cell death and unresponsiveness to immediate volume resucitation
Do diuretics improve the outcome of established ATN?
no, use of diuretics only facilitates fluid, electrolyte and nutritional support by increasing urinary output.
Can dopamine be used to treat or prevent ARF?
no
What are risk factors for radiocontrast media induced ATN?
diabetic nephropathy, chronic renal failure, severe CHF, volume depletion/hypotension, dosage & frequency of contrast administration
What is one way to prevent aminoglycoside induced ATN?
use extended interval once daily dosing
How do you prevent Amphotericin B induced ATN?
choose a lipid based formula
What are some drugs associated with DIAIN?
antibiotics - PCN, ceph, quinolones, sulfonamides, rifampin
NSAIDS
What are the hallmark Sx of DIAIN?
malaise, fever, macular rash
(6-10 days post exposure)
What is involved in the supportive management of ARF?
close pt monitoring (vitals q shift, daily med review, serum chemistries if TPN), strict fluid and electrolyte mgmt., Tx of life threatening conditions, avoidance of nephrotoxic drugs, initiation of dialysis or CRRT's, diuretics will help with edema & prevention of ATN although no role in decreasing duration of ARF
Who is renal replacement therapy reserved for?
pts with severe acid-base d/o, fluid overload, hyperkalemia, symptomatic uremia, or drug intoxications
What are the two types of renal replacement therapy?
intermittent hemodialysis and continuous renal replacement therapy
What should you consider when modifying the dose of any drug in pts with renal failure?
1. What is it's route of elimination?
2. Does the drug produce pharmacologically active and/or more water soluble metabolites that could accumulate?
3. What is the therapeutic window?
What should trough levels be for aminoglycosides?
<2mg/L
T or F? Once daily dosing is NOT recommended for aminoglycosides and pts with renal failure
TRUE
How should aminoglycosides be adjusted for pts with renal failure?
extend the dosing interval and/or decrease the dose
When obtaining peak and trough levels of a drug, when should each be drawn?
peak - 30 min. post infusion

trough - shortly before next dose is due
How do you minimize nephrotoxicity with acyclovir?
increase hydration, infuse dose over 1 hour
What are the leading causes of ESRD?
DM, HTN, chronic glomerulonephritis
What is the Tx of CKD?
reduction of risk factors for progression, mgmt of secondary complications, RRT and/or transplant for ESRD
Why are loop diuretics preferred in pts with CKD?
because thiazides require GFR >30 to work properly
Why might Darbopoietin Alpha be preferred over Epogen and Procrit?
less frequent dosing
T or Fa? K sparing diuretics are contraindicated in pts with CKD?
true
Tx for secondary hypoparathyroidism and renal osteodystrophy?
dietary restriction of phosphorous, phosphate binding agents, vit. D therapy, dialysis
How far apart should ferrous sulfate and phosphate binders be taken?
2 hours
What is the first line phosphate binder in stage 5 kidney disease?
Sevelamer HCl (Renagel) - binds phospate in GI tract, non absorbed, decreases LDL & TC, works best with Ca supplementation
What are available Vit. D preparations?
ergocalciferol, cholecalciferol, calcitriol
What must be done prior to starting a pt on calcitriol?
control serum phosphorous
What are the MC forms of chronic glomerulonephritis?
lupus nephritis, Goodpasture's disease, Wegener's
Tx of lupus nephritis?
immunosuppression, corticosteroids, cytotoxic agents (cycophosphamide, azathioprine)
How do you avoid toxicity in pts taking cyclophosphamide?
monthly IV pulse on well hydrated pt.
Tx of Goodpasture's?
do not withhold tx pending Bx results! - control alveolar hemorrhage, prevent irreversible damage to extrapulmonary organs esp. kidneys, plasmapheresis with 5% albumin, chemotherapy to prevent Ab synthesis --pulse methylprednisolone and may be combined with cyclophosphamide
Tx of Wegener's?
cyclophosphamide, and corticosteroids
If a pts GFR is between 30-59, what stage of kidney disease do they have?
3
GFR 60-89?
stage 2 kidney disease
When is medical intervention indicated for ED?
occurrance over 6 months and in >50% of attempts
When is testosterone indicated for ED?
only for pts with severely deficient serum testosterone due to primary hypogonadism
side effects of testosterone?
gynecomastia, increased hematocrit, fluid retention, risk of prostate cancer
what are risk factors for increased plasma levels of viagra?
age >65, hepatic impairment, creatinine clearance <30, concomitant use of cyp 3a4i drugs (if any of these risk factors exist, start at 25mg & cautiously titrate up
In which pts might cialis be advantageous over viagra?
pts with psychogenic or neurogenic ED and healthy cardiovascular systems - shorter onset and longer duration for multiple attempts, few to no visual side effects
What are drug therapy options for BPH?
alpha blockers, alpha reductase inhibitors
What must you be concerned about when initiating therapy with Hytrin (terazosin)?
first dose syncope - titrate up slowly
Of the alpha blockers, which has the least effect on BP, with no need to titrate up?
Tamsulosin
MOA of alpha reductase inhibitors?
decrease conversion of testosterone to DHT
What are available alpha reductase inhibitors?
Finasteride (proscar), Dutasteride (avodart)
What advantages might avodart have over proscar?
greater decrease in DHT (works on 1&2 receptors), sx relief as early as 3 months (vs 12 months with proscar)
What volume of urine is abnormal on a PVR?
>50 mL
First line Tx for urge incontinence?
oxybutinin (anticholinergic)
2nd line Tx for urge incontinence?
tolterodine (more expensive than ditropan, adjust dose for hepatic impairment, twice daily dosing
What drugs can be used to treat stress incontinence?
imipramine, estrogen therapy