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209 Cards in this Set
- Front
- Back
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Which nutrients are mandated to always be on a nutritional label?
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Vitamin A
Vitamin C Calcium Iron |
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Calorie free means fewer than ___ calories per serving
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5 calories
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Recommended intake of protein per day
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1gram / kg body weight
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What will never change on a nutritional label no matter how many kilocals consumed
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Cholesterol
Sodium Trans Fat |
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The American Heart Association recommends less than ____mg cholesterol
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< 300mg
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How much cholesterol in 1 egg?
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200mg
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Total fat recommended daily
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<30%
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Total recommended carbohydrates
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60%
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Recommended sodium intake
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2400mg /day
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Total recommended dietary fiber
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25g /day
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Abrupt and sustained decline in renal function
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Acute Kidney Insufficiency
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Decrease in 75% of renal function before its noticeable
A. AKI B. Chronic Kidney Disease |
AKI
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The duration of acute renal insufficiency is ___ weeks
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1-4 weeks
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AKI is usually ________ taking 1-3 months for a full recovery
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reversible
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AKI has a ___% survival rate in high risk patients
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50%
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Chronic Kidney Disease is irreversible eventually leading to ________
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end stage renal disease
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Nephrotoxic drugs may include:
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Antibiotics
Antifungals Antivirals Contrast agents ACE inhibitors NSAIDS Chinese Herbals |
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Electrolyte abnormalities common to AKI
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Hyperkalemia
Metabolic Acidosis |
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Signs of hypovolemia
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Tachycardia
Orthostasis (hypotension) |
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Signs of hypervolemia
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Pulmonary Edema
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Cola-colored urine suggests ________
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rhabdomyolysis
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Foamy urine indicates _________
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proteinuria
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True or False
Many AKI cases are asymptomatic |
true
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Product of muscle breakdown - 90% filtered by kidneys -
0.7-1.5mg/dL |
Scr
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Influenced by exercise, drugs, GI bleed - 50% filtered by kidneys -
8-25mg/dL |
BUN
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Estimated Creatinine clearance and glomular filtration rate =
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15ml / min
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Urine output >400mL/da
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nonoliguria
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Urine Output <400mL/da
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oliguria
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Urine output <100mL/da
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anuria
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RIFLE
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Risk
Injury Failure Loss ESRD |
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What is meant by the liver having a reserve capacity?
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it can maintain function when damaged
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The liver has 7 functional units called ______
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Lobules
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The ____ is the location for most lipid and lipoprotein metabolism
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Liver
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The liver picks up ____ _____ absorbed in the intestines and synthesizes them into proteins
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amino acids
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Where is cholesterol synthesized?
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Liver
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Primary location for detoxification of both endogenous and exogenous substances
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liver
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alcohol
meds toxins ellicit drugs can all cause _____ of the liver |
Hepatotoxicity
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inflammation
scarring bile duct obstruction clotting are possible with ____ damage |
liver
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symptoms of _____ damage
jaundice dark urine light poop pruritus weight loss/gain |
liver damage
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Albumin and coagulation parameters
test for _____ liver function |
synthetic
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Scr x 1.5 RIFLE
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Risk
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Scr x 2 RIFLE
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Injury
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Scr x 3 RIFLE
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Failure
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AKIN =
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Acute Kidney Injury Network
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AKIN
AKI based on __Scr elevations within __ hours |
2
48 |
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60-70% of AKI is where?
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Prerenal
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25-40% of AKI is where?
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Intrarenal
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5-10% of AKI is where?
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Postrenal
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BPH could be a cause of _______ AKI
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Postrenal
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"A good kidney in a bad situation"
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Prerenal AKI
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Bilirubin
alkaline phosphatase 5' nucleotidase gamma-glutamyl transpeptidase test ___________ liver function and cholestasis |
Excretory
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AST(aspartate aminotransferase)
ALT(alanine aminotransferase) LDH Test for ______ injury in the liver |
hepatocellular
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Ammonia
used to test ______ liver function and serum ammonia |
detoxifying
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LFT=?
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liver function tests
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_______ disease
primary inflammation and damage to hepatocytes (hepatitis) |
Hepatocellular disease
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______ disease
Abnormality in excretory function of liver (biliary obstruction, Hepatic infiltration) |
Cholestatic disease
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True or false
Hepatocellular and cholestatic disease can overlap |
true
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What do synthetic liver function tests tell us about the liver?
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its ability to synthesize proteins that circulate in the blood
Albumin PT/INR clotting |
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An albumin test would take _____ to show liver dysfunction
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weeks
half life of 20 days |
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Acute viral hepatitis would show ____ albumin levels
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normal
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4 Major causes of Prerenal AKI
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Hypovolemia
Hypervolemia Sepsis Triple Whammy Drugs |
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Acute Tubular Necrosis (ATN) is a type of _______ AKI
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Intrarenal
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Aminoglycosides, contrast dye, Amphotericin B, cisplatin, statins, drug abuse major causes of _______ AKI
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Intrarenal
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Damage to the kidney nephron
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Intrarenal
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Urinary tract obstruction causes _____ AKI
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Postrenal
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Causes of Postrenal AKI
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Prostatic Hypertrophy
Renal Stones / Ca Drugs - Antivirals |
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Which type of AKI is easiest to diagnose?
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Postrenal
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Lab Prerenal
BUN/Cr ratio = Urinalysis = Urine Na = Urine Osm = FENa % = FEUrea % = |
>20
benign <20 >500 <1 <35 |
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Lab ATN
BUN/Cr ratio = Urinalysis = Urine Na = Urine Osm = FENa % = FEUrea % = |
10-15
granular casts >40 300 >2 >50 |
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Chronic synthetic dysfunction would show ____ albumin levels
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low
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hypoalbuminemia
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low albumin levels in blood
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What are the most common causes of hypoalbuminemia?
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Advanced cirrhosis*
alcoholism chronic inflammation protein undernutrition |
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Symptoms of hypoalbuminemia
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peripheral edema (leg swelling)
ascites (swelling cells) Pulmonary edema (fluid in lungs) |
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clotting cascade
_____ ---> Thrombin by Xa (10a) ______ ---> Clot by Thrombin |
prothrombin
fibrinogen (platelet plug) |
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the ____ is responsible for synthesis of clotting factors 2,7,9,10
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liver
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clotting factors 2,7,9,10 require ___ for activation
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vitamin K
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What are some factors that can lead to vitamin K deficiency?
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malnutrition/absorption
antibiotics warfarin |
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What are the 3 most common coagulation tests?
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PT prothrombin time
INR international normalized ratio aPTT activated partial thromboplastin time |
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prothrombin time responds within __ hours of change in hepatic status
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24
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Hyperkalemia K =
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>5.5mEq/L
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Calcium Gluconate or Calcium Carbonate used to treat hyperkalemia because
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Antagonizes K effect on heart to normalize EKG
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Kayexalate can be taken ___ or ___ to remove K in the ______
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Rectal
Oral Stool |
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Kyperkalemia with metabolic acidosis - use _____ along with Insulin / Dextrose
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Sodium Bicarbonate
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Urinalysis is used to check for ____ and is used to determine whether AKI is ________ vs. ______
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casts
Prerenal vs. ATN (intrarenal) |
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NSAIDS inhibit ________ causing constriction at the afferent arteriole decreasing perfusion to the kidney
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Prostaglandins
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Dry skin could be a sign of ______ in a patient with AKI
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Hypovolemia
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Muddy Brown Casts suggest
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ATN
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AIN =
Cause? |
Acute Interstitial Nephritis
Drugs, NSAIDs, Beta-Lactam Antibiotics |
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Testing for antibiotic induced AIN.
Would look for? |
Urine eosinophil count
(allergic reaction) |
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_________________ is used as a surrogate assay to monitor unfractionated heparin therapy and is reported in seconds
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aPTT
activated partial thromboplastin time |
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________ Xa is measured to determine anticoagulation adequacy in patients receiving agents the interfere with Xa activity
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Anti-factor Xa
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D-dimer is a clot ______ test used to asses process of fibrinolysis
can diagnose/rule out thrombosis DIC |
clot degradation test
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Bilirubin
alkaline phosphatase ALP 5' nucleotidase g-glutamyl transpeptidase GGT Test for? |
Cholestasis
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indirect bilirubin range refers to unconjugated, ________ bilirubin
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insoluble
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Direct bilirubin range refers to conjugated, __________ bilirubin
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water soluble
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_______ is a breakdown product of heme proteins excreted by the liver in its conjugated form
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bilirubin
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Increased bilirubin production
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Hemolysis
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Decreased liver uptake or conjugation of bilirubin
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Gilberts syndrome
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Decreased biliary excretion
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Cholestasis
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Hemolysis and Gilberts syndrome are _______ hyberbilirubinemias
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indirect
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Cholestasis is ____ bilirubinemia
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direct
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conjugated bilirubin in urine
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bilirubinuria
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where can alkaline phosphatase be found?
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liver
bone small intestine kidney placenta leukocytes |
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Where is 5'-nucleotidase found?
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liver
brain heart blood vessels |
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where is GGT found?
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liver
kidney pancrease spleen heart brain seminal vesicle |
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GGT is usually elevated in patients who abuse _____ and it helps determine whether an elevated ALP is of ______ etiology
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alcohol
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Why can aminotransferase tests determine if the liver is injured?
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ALT and AST are primarily located inside hepatocytes and leak when damaged
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Which test is more specific to liver injury?
ALT or AST |
ALT
more localized than AST |
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What does hepatocellular injury usually result from?
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Acute viral hepatitis
Toxins Ichemic hepatitis |
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What causes 50% of acute liver failure in the US?
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drug induced hepatic injury
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what test can be associated with detoxification?
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ammonia
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Measure of body fat based on height and weight
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Body Mass Index
kg / m2 |
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Where is the waist properly measured?
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Bellybutton
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Healthy BMI =
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18.5-24.9
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Carbohydrates can only be absorbed in what form?
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Monosaccharide
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Salivary _______ is responsible for ___% digestion of carbohydrates
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amylase
30% |
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Soluble fiber helps lower cholesterol by:
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Binding bile acids in gut - excreted in stool - body uses cholesterol to synthesize more bile acids
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Insoluble fiber is good for
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bowel movements
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Fat is digested in the mouth by lingual _______, in the stomach by ______ lipase, and the small intestine by ______
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lingual lipase
gastric lipase bile acids |
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Fat is absorbed by _________
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chylomicrons
(lymph system) |
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20 Essential Amino Acids
|
Phenylalanine
Valine Threonine Tryptophan Isoleucine Methionine Histidine Alanine Leucine Lysine |
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aPTT is used to monitor ______ therapy
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heparin therapy
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INR is used to monitor _________ therapy
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Warfarin therapy
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PT is used to assess deficiencies of
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extrinsic and intrinsic clotting pathways
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This is not a coagulation test but a clot degradation test
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D-dimer
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D-dimer test is ______ but nonspecific
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sensitive
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The 5 A's of smoking cessation
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Ask
Advise Assess Assist Arrange |
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ASK =
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About tobacco use
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ADVISE =
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All users to quit
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ASSESS =
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Readiness to quit
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ASSIST =
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Users with a quit plan
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ARRANGE =
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Follow up visits
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Withdrawal effects of smoking cessation typically subside in ____ weeks
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2-4
|
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Nicotine gum usage schedule
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1 q1-2h Week 1-6
1 q2-4h Week 7-9 1 q4-8h Week 10-12 |
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Proper way to chew nicotine gum
|
chew and park method for 30 minutes
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Nicotine lozenge delivers ___% more nicotine than gum
|
25%
|
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True or False
Do not eat or drink anything except water 15 minutes before or while using nicotine lozenge |
True
|
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True or False
It is okay to use the same spot on the skin for a nicotine patch as long as it is done 1-2 times |
False
never twice in a week |
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Nicotine Patch dosing consideration for a >10 cigarette / day smoker
|
Step 1: 21mg x 6 weeks
Step 2: 14mg x 2 weeks Step 3: 7mg x 2 weeks |
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Zyban
MOA: blocks the reuptake of ___ and ___ |
NE
DA |
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Zyban (_________) should begin treatment 1-2 weeks ______ quitting smoking to help with cravings / withdrawal
|
Buproprion (Wellbutrin)
1-2 weeks prior to quitting |
|
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Major AE considered for Zyban
|
Psychiatric issues
|
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Potential issue when taking Zyban with other drugs such as Tramadol, Antipsychotics, Theophylline
|
Lowering seizure threshold
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In order to help avoid AE of Chantix, it should be _____ and taken with ______
|
uptitrated
with food |
|
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What is the only FDA approved combination therapy for smoking cessation
|
Nicotine Patch + Buproprion SA
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Bladder contains M__ and M__ receptors
|
M2 M3
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__________ Incontinence
Urge Stress Mixed Overflow |
Chronic
|
|
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Reversible causes of urine incontinence
(DRIIIP) |
Delirium
Restricted mobility Infection Inflammation Impaction Polyuria Pharmaceuticals |
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"Can't make it on time"
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Urge incontinence
|
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Leaking when abdominal pressure increases - laughter, sneezing..
|
Stress Incontinence
often time = mixed along with urge |
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Hesitancy, weak stream, constantly wanting to urinate, can be caused by BPH
|
Overflow Incontinence
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Anticholinergics are most useful in ______ and _____ incontinence
|
Urge + Mixed
|
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M3 selective anticholinergics
|
Darifenacin
Solifenacin |
|
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Tolterodine is metabolized by _____ to active 5-HMT
|
2D6
|
|
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Fesoterodine is a ___ that is metabolized by plasma esterases
|
prodrug
|
|
|
Static component of the prostate
|
Smooth Muscle
|
|
|
Dynamic Component of the prostate
|
Smooth Muscle TONE
|
|
|
Prostate size and function is regulated by these sex hormones
|
Testosterone
Estrogen Dihydrotestosterone DHT |
|
|
PSA =
|
prostate specific antigen test
|
|
|
PSA is 10 times higher in _____ _____ compared to BPH
|
prostate cancer
|
|
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Developed to assess outcomes used in studies identifying effective treatment options in BPH
|
American Urologic Association Symptom Score
AUA |
|
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The highest score possible on the AUA is ___ while a score of ___ is considered mild
|
35
<7 |
|
|
FDA approved BPH treatment options
|
Terazosin
Doxazosin Tamsulosin Alfuzosin Finasteride Dutasteride |
|
|
Finasteride (Proscar)
Dutasteride (Avodart) |
5-alpha-reductase inhibitors
|
|
|
Terazosin
Doxazosin Tamsulosin Alfuzosin |
Alpha Adrenergic Receptor Antagonists
|
|
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Do to the ____ ______ effect, causes lightheadedness and syncope
The first dose of alpha1 antagonists for BPH is taken at bed time |
First-Dose Effect
|
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Tamsulosin is specific to prostate alpha-1 receptors, it is ___% absorbed on an empty stomach and ___% with food
|
90%
30% |
|
|
5 alpha-reductase inhibitors are _______ effective than alpha blockers
|
less
|
|
|
5-alpha-reductase converts ______ into ________ allowing prostate ______
|
testosterone
DHT growth |
|
|
5 alpha-reductase inhibitors may take ___weeks to __ months to show a clinical response
|
6weeks
12months |
|
|
BPH
Monotherapy fails: Whats the next step? |
Combo therapy
|
|
|
Three types of intrarenal AKI
|
ATN
AIN Acute Glomerulonephritis |
|
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When is it okay to add a thiazide diuretic along with a loop diuretic in a patient with hypervolemic pre-renal AKI?
|
If they are diuretic resistant
|
|
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Why is insulin used as part of the treatment for hyperkalemia? Why is dextrose added?
|
It causes a shift of extracellular potassium into the cells.
Dextrose is added to prevent hypoglycemia |
|
|
A FENa
<1 suggests _______ AKI >2 suggests _______ AKI |
<1 Prerenal
>2 ATN |
|
|
ACE inhibitors cause ________ of the efferent arteriole
|
vasodilation
|
|
|
Indications for dialysis during unmanageable AKI
(vowels) |
A - Acidosis
E - Electrolyte disturbance I - Intoxications O - Overload U - Uremia (BUN>100) |
|
|
BUN > 100
|
Uremia
|
|
|
Some risk factors for Contrast Dye ATN
|
Age
Diabetic Whammy Drugs |
|
|
Dark Urine
Muscle Weakness BUN:Scr 5:1 FENa > 2% Casts History of Alcohol Abuse Taking Statins for cholesterol |
Rhabdomyolysis
|
|
|
Measures associated with synthetic liver function
|
Albumin
Coagulation Parameters |
|
|
Patient with prolonged PT / INR.
Given Vitamin K to correct. No change. This suggests? |
Liver Failure
|
|
|
Normal PT time
|
10-13seconds
|
|
|
What is the INR used for?
normal range? |
To standardize PT results making them easier to interpret
0.9 - 1.1 |
|
|
When after LMWH therapy, is Anti-factor Xa drawn?
|
4 hours
|
|
|
Abnormal, excessive generation of thrombin and fibrin over weeks to months
|
Disseminated Intravascular Coagulation (DIC)
|
|
|
Increased levels of D-dimer suggests
|
DIC
|
|
|
Hemolysis and Gilberts syndrome would be ________ hyperbilirubinemia
|
indirect
|
|
|
More specific than ALP and only elevated in hepatic disease
|
5 - Nucteotidase
|
|
|
Increased levels of Alkaline Phosphatase (ALP) suggests __________, however levels vary with age do to _____ growth
|
Cholestasis
bone growth |
|
|
Tests associated with hepatocellular injury:
|
ALT
AST LDH |
|
|
Waist measurements should be
Male: Female: |
Males : <40"
Female : <35" |
|
|
Urge Incontinence
Type of Med? |
Anticholinergic
|
|
|
Overflow incontinence with BPH
Med? |
Alpha 1 Antagonist
|
|
|
Oxybutynin =
|
Anticholinergic
|
|
|
Tolterodine =
|
Anticholinergic
|
|
|
Fesoterodine =
|
Anticholinergic prodrug
|
|
|
Darifenacin =
|
M3 Selective Anticholinergic
|
|
|
Solifenacin =
|
M3 Selective Anticholinergic
|
|
|
Trospium =
|
Anticholinergic (quaternary)
|
|
|
alpha 1a is the most common adrenergic receptor in the _____
|
prostate
|
|
|
Short Acting A1a antagonist
Initial: 0.5 - 1mg QHS Maintenance: 0.5mg - 2mg BID Max: 40mg daily Available: 1mg, 2mg, 5mg |
Prazosin (Minipress)
|
|
|
Long Acting A1a Antagonist
Initial: 1mg QHS Maintenance: 1-10mg daily Max: 20mg daily Available: 1mg, 2mg, 5mg, 10mg |
Terazosin (Hytrin)
|
|
|
Long Acting A1a Antagonist
Initial: 1mg daily Maintenance: titrate Q1-2wks Max: 8mg daily Available: 1mg, 2mg, 4mg, 8mg |
Doxazosin (Cardura)
|
|
|
Long Acting A1a Antagonist
Initial: 0.4mg daily Maintenance: titrate 2-4wks Max: 0.8mg Available: 0.4mg 30 minutes after meals |
Tamsulosin (Flomax)
|
|
|
Long Acting A1a Antagonist
Dose: 10mg daily Metabolized by CYP-3A4, O-demethylation, N-demethylation |
Alfuzosin (Uroxatral)
|
|
|
Nonselective alpha antagonist
Dose: 5 - 20mg daily Long half-life AE: Hypotension, tachycardia |
Phenoxybenzamine (Dibenzyline)
|
|
|
5A-Reductase Inhibitor
Dose: 5mg daily may combine with A-Blocker Inhibits type-2 5A-Reductase enzyme |
Finasteride (Proscar)
|
|
|
5A-Reductase Inhibitor
Dose: 0.5mg daily Inhibits type 1 and 2 5A-Reductase Enzyme |
Dutasteride (Avodart)
|
