Pharmacology Ckd & Nephropathies

Front 1

Spironolactone is effective in the treatment of hypertension because it blocks
beta-adrenergic receptors.
B.Ca2+ channels.
C.aldosterone effects on the kidney.
D.cortisol effects on the kidney.
E.alpha-adrenergc receptors.

Back 1

Aldosterone effects on the kidney

Front 2

Angiotensin receptor-1 (AR1) antagonists are primarily used for
A. acute coronary thrombosis with pulmonary edema.
B. combination with ACE inhibitors.
C. hepatic cirrhosis with ascites.
D. hypertension.
E. patients with increased aldosterone secretion

Back 2

Hypertension

Front 3

Angiotensin receptor-1 (AR1) antagonists differ from angiotensin converting enzyme inhibitors in that AR1 antagonists cause
A. cough and angioedema in some patients.
B. greater decreases in tissue levels of angiotensin II.
C. more secretion of renin.
D. more stimulation of aldosterone secretion.
E. superior antihypertensive responses in some patients

Back 3

Superior antihypertensive responses in some patients

Front 4

Nearly two-thirds of filtered sodium is reabsorbed in which segment of the nephron?
A. Collecting ducts
B. Distal convoluted tubules
C. Proximal renal tubules
D. Thick ascending limb of the loop of Henle
E. Thin descending limb of the loop of Henle

Back 4

Proximal Renal tubules

Front 5

Which portion of the nephron utilizes the greatest amounts of ATP?
A. Collecting ducts
B. Distal convoluted tubules
C. Proximal renal tubules
D. Thick ascending limb of the loop of Henle
E. Thin descending limb of the loop of Henle

Back 5

Thick Ascending limb of the loop of Henle

Front 6

Which of the following drugs is LEAST effective when used alone for prolonged treatment of patients with edema?
A. Amiloride
B. Ethacrynic acid
C. Furosemide
D. Hydrochlorothiazide
E. Mannitol

Back 6

Amiloride

Front 7

Which of the following drugs is used to treat hypocalcemic states?
A. Acetazolamide
B. Amiloride
C. Captopril
D. Furosemide
E. Hydrochlorothiazide

Back 7

Hydrochlorothiazide

Front 8

Which of the following drugs has an antihypertensive effect at low doses and an antidiuretic effect at high doses?
A. Bumetanide
B. Hydrochlorothiazide
C. Lisinopril
D. Losartan
E. Spironolactone

Back 8

Hydrochlorothiazide

Front 9

Furosemide can produce all of the following effects EXCEPT
A. acute renal failure.
B. enhanced renin secretion.
C. hypokalemia.
D. metabolic alkalosis.
E. toxicity similar to that of sulfonamides.

Back 9

Enhanced renin secretion

Front 10

All of the following diuretics act at the lumenal side of renal tubules EXCEPT
A. bumetanide.
B. ethacrynic acid.
C. hydrochlorothiazide.
D. spironolactone.
E. triamterene.

Back 10

Spironolactone

Front 11

Spironolactone is effective in the treatment of hypertension because it
a) behaves as a beta-adrenergic antagonist (beta blocker)
b) blocks Ca++ channels
c) blocks aldosterone effects on the kidney
d) blocks acetylcholine binding

Back 11

blocks aldosterone effects on the kidney

Front 12

Which of the following combinations of diuretic drugs is LEAST effective?
a) Bumetanide and hydrochlorothiazide
b) Furosemide and triamterene
c) Hydrochlorothiazide and amiloride
d) Spironolactone and triamterene
e) Spironolactone and furosemide

Back 12

Spironolactone and Triamferene

Front 13

Furosemide can produce all of the following effects EXCEPT
a) hypokalemia
b) acute renal failure
c) toxicity similar to that of sulfonamides
d) enhanced renin secretion
e) metabolic alkalosis

Back 13

Enhanced renin secretion

Front 14

All of the following diuretics act at the lumenal side of renal tubules EXCEPT
a) hydrochlorothiazide
b) triamterene
c) ethacrynic acid
d) bumetanide
e) spironolactone

Back 14

Spironolactone

Front 15

Which of the following drugs has an antihypertensive effect at low doses and an antidiuretic effect at high doses?
a) Bumetanide
b) Lisinopril
c) Spironolactone
d) Hydrochlorothiazide
e) Losartan

Back 15

Hydrochlorothiazide

Front 16

Angiotensin converting enzyme inhibitors are used clinically for all of the following indications EXCEPT
a) treatment of cardiac systolic dysfunction
b) therapy of normal-renin associated hypertension
c) management of hypokalemia
d) treatment of acute coronary thrombosis and pylmonary edema
e) prevention of cardiac remodeling in hypertensive states

Back 16

Management of hypokalemia

Front 17

What does angiotensin do to blood vessels?

Back 17

Vasoconstriction

Front 18

ACE inhibitors such as Captopril are effective in the treatment of congestive heart failure because they are
a) afterload reducing agents
b) preload reducing agents
c) direct vasoconstrictors
d) direct vasodilators
e) effective in increasing sodium and water retention

Back 18

Afterload reducing agents

Front 19

What does kidney dysfunction have a major impact on?

Back 19

Drug clearance
Drug T 1/2
Adverse effects - the longer you have the drug or metabolite around, the higher the chance there is for an adverse effect, either from the drug or the metabolite.

Front 20

What are the risk factors for CKD?

Back 20

1. Diabetes mellitus
2. Hypertension
3. Cardivascular disease
4. Family Hx of ESRD
5. In US prevalence of CKD in people >65 w/o hypertension and diabetes is 11% (apparently, just through surviving)

Front 21

What is the strongest independent predictor of progression of CKD?

Back 21

Albumin to Creatinine ratio

Front 22

Does GFR stabilize after declining below 50% of normal?

Back 22

It doesn't stabilize at some lower level. It just keeps going down. This is the problem

Front 23

What are the risk factors for progression of CKD?

Back 23

1. Proteinuria
2. Diabetes Mellitus
3. Smoking
4. High dietary protein consumption
5. Obesity
6. Blacks have Increased risk
7. Women have increased risk
8. Cardiovascular Disease

Front 24

What are the complications of CKD?

Back 24

1. Anemia
2. Osteodystophy
3. Cardiovascular problems
4. Operations - even minor

Front 25

What are people most likely to die from if they have CKD?

Back 25

Cardiovascular Disease

Front 26

What clears ACE inhibitors?

Back 26

Kidney

Front 27

What are the adverse effects of ACE inhibitors?

Back 27

1. Teratogenic
2. Hypotension
3. Cough
4. Hyperkalemia
5. Abnormal taste

Front 28

What are the drug interactions associated with ACE inhibitors?

Back 28

1. Lithium increases (easy to get lithium toxicity)
2. NSAIDs (reduce ACE inhibitor levels)
3. K+ Supplements (Increased hyperkalemia)

Front 29

How is Lithium associated with ACE inhibitors?

Back 29

Lithium, is used to treat mania or depression and is increased by ACE inhibitors. Lithium toxicity is a risk.

Front 30

What is the interaction between ACE inhibitors and NSAIDs?

Back 30

If NSAIDs are taken chronically, it may reduce ACE inhibitor levels

Front 31

What is the interaction between K+ and ACE inhibitors?

Back 31

ACE inhibitors can create hyperkalemia, so don't take K+ supplements

Front 32

How do you know if something is an Angiotensin Receptor Antagonist?

Back 32

Angiotensin Receptor Antagonist is you see SARTAN

Front 33

What eliminates Angiotensin Receptor Antagonists?

Back 33

Liver, so decreased renal function does not affect clearance

Front 34

What are the adverse effects caused by Angiotensin Receptor Antagonists?

Back 34

1. Teratogenic -including breast feeding
2. Impotence
3. Muscle pain
4. Hypotension, dizziness, blurred vision
5. HYPERKALEMIA

Front 35

What are the drug interactions associated with Angiotensin Receptor Inhibitors?

Back 35

1. Lithium
2. NSAIDs
3. K+ sparing diuretics
4. K+ supplements
5. Fluconazole
6. Rifampin

Front 36

What problem occurs in patients taking Fluconazole and Angiotensin Receptor Inhibitors?

Back 36

Decreases fluconazole's metabolism to an active metabolite

Front 37

What drug interactions occur between Angiotensin Receptor Inhibitors and Rifampin and Erythromycin?

Back 37

Increases the metabolism

Front 38

What are the Contraindications in CKD?

Back 38

1. General Anesthetics
2. Midazolam
3. NSAIDs
4. Diphenhydramine (Benadryl)
5. Analgesics

Front 39

Why don't we use General Anesthetics in CKD?

Back 39

May increase K+ levels resulting in increased risk of cardiovascular incident

Front 40

Why do we want to avoid Midazolam in patients with CKD?

Back 40

Causes Prolonged Sedation

Front 41

Which analgesics are okay to use in CKD?

Back 41

Morphine
Tramadol

Front 42

In patients who have CKD what is the best choice of analgesia for perioperative?

Back 42

Morphine or Fentanyl

Front 43

In patients who have CKD what is the best choice of analgesia for postoperative?

Back 43

Tramadol or Codeine