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27 Cards in this Set
- Front
- Back
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highest risk of developing CKD |
Native Americans, Asians, African Americans, Hispanics |
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loop diuretics |
inhibit Na-K pump in ascending loop of henle -can cause decreased Ca absorption |
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thiazide diuretics |
inhibit Na-Cl pump in distal tubule -increase Ca reabsorption |
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measuring severity of kidney damage |
amount of albumin in the urine eGFR |
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BUN |
increases as kidney function declines -measures amount of nitrogen that comes from urea |
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Creatinine |
normal range 0.6-1.3 mg/dL |
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GFR |
CKD-EPI or MDRD equation CrCl is close enough estimate for exam used for SGLT2 inhibitors and meftformin dosing |
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Drugs that cause kidney disease |
aminoglycosides amphoterin B cisplatin colisthimethate cyclosporine loop diuretics NSAIDs Radiographic contrast dye Tacrolimus Vancomycin |
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GFR categories |
>90+kidney damage: G1, stage 1 60-89+ kidney damage: G2, stage 2 45-59: G3a, stage 3 30-44: G3b, stage 3 15-29: G4, stage 4 <15 or dialysis: G5, stage 5 |
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Albumin to creatinine ratio (ACR) |
<30 mg/24hr or <3mg/mmol: A1 30-300 mg/24hr or 3-30 mg/mmol: A2 >300 mg/24hr or >30 mg/mmol: A3 |
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BP goal in CKD |
<140/90 w/ no proteinurea <130/80 w/ proteinurea Scr can increase by 30% when starting ACE/ARB monitor Scr and potassium for 1-2 weeks after initiation recommended in all patients w/ proteinurea |
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drugs contraindicated if CrCl <50 |
elvitegravir/cobicistat/emtricitabine/TDF (stribild) Voriconazole IV |
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drugs contraindicated if CrCl <30 |
avanafil bisphosphonates dabigatran duloxetine fondaparinux NSAIDs Potassium-sparing diuretics Rivaroxaban Tadalafil Tramadol ER |
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drugs contraindicated if GFR <30 |
SGLT2 inhibitors Metformin |
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complications of CKD |
bone disorders hyperphosphatemia Vit D deficiency and secondary hyperparathyroid anemia hyperkalemia |
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hyperphosphatemia |
phosphate binders -aluminum based: limit treatment to 4 weeks *aluminum hydroxide 300-600 mg TID w/meals -calcium based: first line *calcium acetate 2001-2668 mg TID w/meals *calcium carbonate 500 mg TID w/meals -aluminum and calcium free *sucroferric oxyhydroxide 500 mg TID w/ meals *ferric citrate 2 g TID w/ meals *lanthum carbonate 500-1000 mg TID w/ meals *sevelamer 800-1600 mg TID w/ meals |
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Phosphate binder drug interactions |
levothyroxine quinolones tetracyclines bisphosphonates |
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vitamin d deficiency |
calcitriol: increases calcium absorption from gut, raises serum calcium concentrations, and inhibits PTH secretion 0.25-0.5 mcg PO daily dialysis: 0.5-1 mg PO daily or 0.5-4 mcg IV 3x weekly calcifediol: CKD stage 3 or 4 300 mcg QHS doxercalciferol CKD 1-3.5 mcg PO daily dialysis10-20 mcg PO 3xweekly or 4-18 mcg IV 3xweekly Paricalcitol CKD 1-2 mcg PO daily or 2-4 mcg 3xweekly dialysis 2.8-7 mcg IV 3xweekly cinacalcet: increases sensitivity of calcium sensing receptors on parathyroid gland -dialysis: 30-180 mg PO daily w/ food |
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anemia |
Hg <13 g/dl lack of erythropoietin treat w/ ESAs -elevated BP and clotting risk -hold if Hg <11 -only effective if adequate iron is available |
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hyperkalemia |
concern w/ levels > 5-5.3 mEq/L muscle weakness bradycardia arrhythmias |
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drugs that cause hyperkalemia |
ACE/ARBS aldosterone receptor inhibitors canagliflozin drosperinone bactrim tacrolimus aliskiren cyclosporine everolimus glycopyrrolate heparin NSAIDs pentamidine |
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treating severe hyperkalemia |
stabilize heart -calcium gluconate IV move it (shift intracelluarly) -regular insulin IV -dextrose IV -sodium bicarbonate IV -albuterol nebulized remove it -furosemide IV -sodium polystyrene sulfonate oral or rectal -patiromer oral -hemodialysis |
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sodium polystyrene sulfate |
SPS, Kayexalate 15 g oral 1-4x/day 30-50 g q6h rectal |
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Patiromer |
8.4 grams oral daily w/ food packet for oral suspension delayed onset of action (7 hours |
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metabolic acidosis |
serum bicarbonate < 22mEq/L treatment: sodium bicarbonate (Neut)- monitor sodium sodium citrate/citric acid (Bicitra, Cytra, Oracit, Shohl's solution)-monitor sodium -metabolized by liver |
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dialysis |
hemodialysis: pump blood into dialyzer (3-4 hour process- 3-4 times per week) peritoneal dialysis: solution pumped into peritoneal cavity (repeated throughout the day, every day) |
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drug removal during dialysis |
smaller molecules, small Vd, not protein-bound are more likely to be removed by dialysis High flux and high efficiency filters remove more higher blood flow rate increases drug removal |
