Pk 2-1

Front 1

factors that decrease bioavailability (4)

Back 1

1. gastric emptying time
2. gastric pH
3. gut edema
4. NVD

Front 2

factors that affect gastric emptying time (3)

Back 2

1. diabetic gastroparesis
2. aluminum containing antacids
3. peritonitis

Front 3

factors that affect gastric pH (2)

Back 3

1. antacids (phosphate binders)
2. urea ammonia

Front 4

factor that increase bioavailability & 2 example drugs

Back 4

decreased first -pass metabolism

1. dihydrocodone
2. dextropropoxyphene

Front 5

altered distribution changes (2)

Back 5

1. water retention
2. altered plasma protein and tissue binding

Front 6

altered protein binding affected levels of... (2)

Back 6

1. phenytoin
2. calcium

Front 7

phenytoin in altered protein binding (3)

Back 7

1. measure free fraction due to narrow therapeutic window
2. free fraction in ESRD ~25% total
3. two equations that estimate only!

Front 8

phenytoin low album equation

Back 8

adjusted concentration = [measured conc] / [(0.2 * Alb) + 0.1]

Front 9

phenytoin CrCl <15 ml/min equation

Back 9

adjusted concentration = [measured conc] / [(0.1 * Alb) + 0.1]

Front 10

calcium w/ low albumin equation

Back 10

corrected calcium = (normal albumin – measured albumin) x 0.8 + measured calcium

Front 11

metabolites of concern in kidney disease (7 pairs)

Back 11

1. procainamide and NAPA
2. morphine and M6G
3. meperidine and normeperidine
4. oral sulfonylureas (chlorpropamide and glyburide)
5. propoxyphene and norpropoxyphene
6. allopurinol and oxypurinol
7. nitroprusside and thiocyanate

Front 12

Vit D activation

Back 12

1- a hydroxylation in kidney to become 1, 25 -dihydroxycholecalciferol (VitD3)

Front 13

difficulty measuring secretion & reabsorption?

Back 13

difficult to quantify – base dose on fraction eliminated by kidney & GFR

Front 14

morphine and M6G toxicity

Back 14

2x potency & CNS permeability

Front 15

meperidine and normeperidine toxicity

Back 15

seizures

Front 16

oral sulfonylureas (chlorpropamide and glyburide) toxicity

Back 16

↑ HL & ↑ risk of hypoglycemia

Front 17

propoxyphene and norpropoxyphene toxicity

Back 17

seizures

Front 18

allopurinol and oxypurinol toxicity

Back 18

crystal formation

Front 19

nitroprusside and thiocyanate toxicity

Back 19

cyanide toxicity

Front 20

special populations & limitations in CrCl calculations (6)

Back 20

1. children
2. liver disease (overestimate actual clearance)
3. pregnant women
4. transplant patients
5. critically ill patients
6. unstable renal function (∆SCr > 20%)

Front 21

CrCl in hemo- or peritoneal dialysis

Back 21

GFR/CrCL <10 – 15 ml/min

Front 22

CrCl in CRRT

Back 22

CrCl ~ 30 ml/min

Front 23

HLs to reach SS in renal impairment

Back 23

normally 4-5 HLs, thus 5+ HL in renal impairment

Front 24

bolus doses in renal impairment

Back 24

normal, unless altered Vd

Front 25

general things to keep in mind for dose adjustment in dialysis (2)

Back 25

adjustment of drug dosing may be necessary in patients receiving dialysis because of...

↓ elimination due to renal failure or ↑ drug removal during dialysis

Front 26

conventional HD CrCl

Back 26

300-400 ml/min

Front 27

slow dialysis CrCl

Back 27

15-30 ml/min (used if patient becomes hypotensive)

Front 28

standard cuprophane dialyzer MW cutoff

Back 28

500 daltons

Front 29

high flux dialyzer MW cutoff

Back 29

5000 daltons

Front 30

determining dialysis removal of a drug from blood (3)

Back 30

1. extraction from blood
2. rate of recovery in dialysate
3. amount recovered in dialysate

Front 31

log-linear relationship

Back 31

assumes...

C = Co * e ^(-kt)

Front 32

ke on HD equation

Back 32

ke(HD) = [ln(CpreHD/CpostHD)] / tHD

Front 33

fL equation

Back 33

fraction of drug loss during hemodialysis

fL = 1-e-(k*t)

Front 34

fD equation

Back 34

fraction of total elimination occurring during HD

fD = 1-[(HL on HD)/(HL off HD)]

Front 35

fel equation

Back 35

drug initially in the body that is eliminated by HD

fel = fD* fL

Front 36

significant fel

Back 36

30%+

Front 37

redistribution post HD

Back 37

increase in plasma concentrations of a drug after the completion of HD due to...

drug from plasma to HD >> drug from peripheral compartments (i.e. tissue) into the central compartment

Front 38

toxicological emergencies and PK (3)

Back 38

1. unpredictable PK
2. protein binding may be saturable (“non-dialyzable” drug becomes dialyzable)
3. dramatic Vd expansion

Front 39

two types of peritoneal dialysis

Back 39

1. continuous ambulatory peritoneal dialysis (CAPD)
2. continuous cycling peritoneal dialysis (CCPD)

Front 40

PD movement of drug

Back 40

movement of drug from the plasma to PD fluid << movement of drug from PD fluid into plasma

Front 41

factors affecting PD dialyzability (3)

Back 41

1. drug characteristics
2. peritoneal cavity characteristics
3. procedure characteristics

Front 42

drug characteristics (4)

Back 42

1. molecular size
2. protein binding effects
3. volume of distribution
4. water solubility

Front 43

peritoneal cavity characteristics (2)

Back 43

1. inflammation
2. blood flow rate

Front 44

procedure characteristics (2)

Back 44

1. dwell time
2. glucose concentration

Front 45

CRRT use

Back 45

patients unable to tolerate standard intermittent hemodialysis due to hypotension & hemodynamic instability