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107 Cards in this Set
- Front
- Back
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What drugs can cause Prerenal Azotemia?
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Vasopressors:
->Phenylephrine, NE |
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What clinical disorders can cause decreases circ volume and lead to prerenal azotemia?
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Cirrhosis w/ ascites
CHF |
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What drugs can cause Functional ARF?
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Aff. artery constrictrs:
---> NSAIDs & Cyclosporine Eff. Artery Dilatrs: ---> ACEIs & ARBs Calcium if leads to Hypercalcemia |
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What is fxnl ARF?
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Decr perfusion of glomerulus due to aff artery constrictn or eff artery dilation
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What drugs can cause Acute Tubular Necrosis (a type of Intrinsic ARF)?
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Contrast media
Aminoglycosides Ampho. B |
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What drugs can cause Acute interstitial nephritis (a type of Intrinsic ARF)?
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PCN
Cipro Sulfonamides |
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Is blockage of 1 kidney postrenally constitute Postrenal ARF?
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NO
Must block BOTH by definition |
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What med cndtns can cx Postrenal ARF?
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Bladder obstruction (ie BPH)
Ureter Obstruction |
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What meds can cx crystal deposits that can lead to Ureter Obstruction?
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Oxalate
Indinavir Sulonamides Acyclovir |
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Signs of ARF?
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Edema
Foamy/colored urine Orthostatic HypoTN if volume depleted |
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Type of ARF assoc w/:
Increase in urination? |
Intrinsic ARF
(Tubular can't concentrate urine) |
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Type of ARF assoc w/:
Decrease in force of urinary stream? |
Postreal ARF
(obstruction, BPH) |
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Type of ARF assoc w/:
Cola-colored urine? |
Intrinsic ARF
(glomulonephritis - blood in urine) |
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Type of ARF assoc w/:
Exc urine foaming? |
Intrinsic ARF
(Glomuler - hi protein in urine) |
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Type of ARF assoc w/:
Bilateral flank pain? |
Intrinsic ARF
(Glom or interstitium - swollen kidneys) |
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Type of ARF assoc w/:
Onset of weight gain? |
All of the ARFs
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Hearing rales indicates what?
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Pulmonary congestion or Lft Ventr dsfx->
prerenal ARF w/ NO azotemia |
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What meds will cause seizures if not appropriately adjusted to ARF cndtns?
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B-Lactam ABX
Imipenem H2 Blockers |
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What is the rate of NS infusion to rehydrate an ARF pt?
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1-2ml/kg/hr
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What class of drug is most commonly admin to pts b4 a kidney transplant to prevent nephrotox?
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CCB
Inhibits aff artery vasoconstriction |
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What is most commonly given to pts, prior to Amph B or Contrast dye, to prevent Neprhotox?
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NS
(Sodium loading activates regulatory mxm to Decr RBF) |
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Do these have evidence of nephrotoxicity PREVENTION?
Mannitol Loops Dopamine |
NO!
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Should you give fluids in Oliguric ATN?
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NO!
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Should you give fluids in Oliguric Prerenal Azotemia?
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YES!
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If pt has ARF & severe GI loss, plasma loss or mild hemorrhage, what type of fluid s/b given?
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NS or LR
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If pt has ARF & increased urination or GI losses what fluid s/b given?
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1/2 NS
(Hypovolemic solutions) |
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What are the 2 first line diuretics used in the tx of fluid overload?
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Mannitol
Loops |
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What have I learned the most from Pharmacy school?
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How to type quickly
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How is DA used in ARF?
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In ICU only, contriversially.
Low doses (0.5-2mcg/ml/min) increase urine but don't improve pt outcome |
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Tx for Acute interstitial nephritis die to meds?
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Stops offending meds, steroids
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Tx for Acute tubular necrosis due to meds?
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Stop meds, give NS
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What are the pt specific monitoring parameters for ARF?
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Weight
Vital signs Fluid intake & output Review meds & adjust doses accord. to CrCl Chem-7 CBC |
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What triggers Renin?
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Low blood volume
Low sodium |
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What effects does Renin have?
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Increases BP by vasoconstriction
Causes release of ADH & Aldosterone which Incr thirst & blood volume |
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How does Bradykinin affect Sodium reabsorption?
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It inhibits it at the CD
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The presence of XXX in a urinalysis is considered a principal marker for kidney damage
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protein or albumin
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Abnormal pH, nitrites, or luekocytes esterase in a UA is indicative of what?
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Bacterial infx
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High BUN implies what?
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Kidneys not filtering Urea as they should
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Rise in SCr implies what?
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a decline in GFR
Also reliant on pts muscle mass (so don't use as only marker) |
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What 3 meds can alter CrCl?
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Trimethoprim
Cimetidine Probenecid |
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Disadvantages of mannitol for ARF?
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Parenteral only
No renal clearance->may cx edema in oliguric pt |
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Disadvantages of loop in ARF?
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Myalgia
Hearing loss Ortho HypoTN Hypo electrolytes Metab. Alkalosis |
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What is better admin of loops for ARF: continuous or intermittent?
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Continuous
b/c more natriuresis & lower [ ]s |
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What is most common loop used?
Dosage forms avail? |
Furosemide
Oral & parenteral |
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Symptoms of late stage CKD?
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Hand tremor/jerks
Pruritis Taste Impairment N/V Anorexia Encephalopathy Bleeding |
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Symptoms of early stage CKD?
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None- early stage CKD is asymptomatic!
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How many stages of kidney disease?
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5, 1 best 5 worst
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What electrolytes are important to monitor for renal fx?
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Na
K HCO3 Cl |
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What 2 urinary enzymes are early predictors of rejection in kidney transplant pts?
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NAG
AAP |
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Does evidence back the use of the MDRD to estimate GFR?
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Yes, but only the version w/ 4 variables & ONLY in CKD pts
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Does evidence back the use of Cockroft-Gault eq to estimate GFR?
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YES
This measures inulin clearance |
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Do we NTK the Cockroft-Gault eq for the exam?
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Not sure....
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Define ARF in terms of SCr
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Incr of 0.5 mg/dL from normal
Incr >1mg/dL in pts w/ CKD |
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What is urine output in:
Anuria? Oliguria? Nonoliguria? |
Anuria: <50ml/day
Oliguria: 50-450ml/day Nonoliguria: >450ml/day |
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List 4 chronic med cndtns assoc w/ development of kidney disease
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Poorly controlled HTN
Diabetes CHF Liver failure |
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The presence of RBCs & RBC casts in UA indicate what?
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Glomerular injury
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How is kidney disease reflected in FE of Na %
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FE-Na% increases as Kidney disease worsens
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FE of Na% >2 indicated which type of ARF?
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Intrinsic ARF
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What agents have evidence of preventing hephrotoxicity when administered b4 contrast dye?
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NS
Theophylline Acetylcysteine |
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What agent has evidence of preventing nephrotoxicity in critically ill patients?
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Insulin
- enough to maintain serum glucose of 80-110 mg/dL |
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What are the clinical indication for RRT (renal replacement therapy)?
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A Acid base abnormality
E Electrolyte Imbalance I Intoxications; ie salicylates, theophylline, phenobarb O fluid Overload U Uremia (waste products in blood) |
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What is RRT?
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Renal replacement therapy refers to life-supporting treatments for renal failure, including:
hemodialysis peritoneal dialysis hemofiltration renal transplantation |
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Which drugs show evidence of improved clinical outcome & Decr mortality in ARF?
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NONE!
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What is the tx in fluid overloaded non-oliguric pt w/ ARF?
What is the goal of this tx? |
Loop diuretic
Prevention of pulmonary edema is an important goal |
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Which loop diuretic is used for ARF pts w/ a sulfa allergy?
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Ethacrynic acid
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If aggressive tx w/ one loop doesn't help pt w/ ARF, should you try another?
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NO all are equipotent
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If cirrhosis is causing diuretic resistance, how tx?
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High-volume paracentesis
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If pt has ATN in ICU & has developed diuretic resistance, how do you tx?
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Higher dose of diuretic
Diuretic combo therapy Add low-dose Dopamine |
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What is the most common physiological finding in ARF?
Which Pharmacokinteic aspect can it influence? How would it affect drug dosing? |
Edema
Influences Vd Would need a higher dose but pts recieving CRRT will have excess fluid removed! |
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Normal range for: Calcium
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8.5-10.5 mg/dL
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Normal range for: Potassium
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3.5-5 mEq/L
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Normal range for: Chloride
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92-109 mEq/L
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Normal range for: Bicarb
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24-31 mEq/L
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Normal range for: Phosphorus
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2.5-4.5 mg/dL
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If pt w/ Renal Failure has UA, what type of RF does the presence of casts point to? If there are no casts?
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Casts-->kidney injury/ATN
No casts-->prerenal azotemia ARF or functional ARF |
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What are the OBJECTIVE differences b/w prerenal azotemia & ATN?
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Presence of casts
FE-Na% is different |
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Is Heart failure a risk factor for ARF?
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No, it could potentiate it, but is not a risk factor! *
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What is the most common type of community-acquired renal failure?
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Prerenal azotemia
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Is there any way I am going to pass this exam?
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Only if miracles happen!
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What type of ARF is most commony caused by medications?
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Acute interstitial nephritis
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Examples of aminoglycosides (which can cause ATN) are:
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Gentamycin
Tobramycin Amikacin |
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How do diltiazem & verapamil affect renal blood flow?
What class are they? |
They decrease it by dilating the efferent arteriole
CCB |
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When should Mannitol NOT be used for ARF?
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When pt does not have good urine output
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Whys loop used in ARF pts?
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for symptomatic control only, no improvement in recovery.
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Examples of aminoglycosides (which can cause ATN) are:
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Gentamycin
Tobramycin Amikacin |
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How do diltiazem & verapamil affect renal blood flow?
What class are they? |
They decrease it by dilating the efferent arteriole
CCB |
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When should Mannitol NOT be used for ARF?
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When pt does not have good urine output
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Whys loop used in ARF pts?
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for symptomatic control only, no improvement in recovery.
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What is the target BP for people w/ Stage 1-4 chronic renal dysfunction?*
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130/80
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What is the target BP for pts w/ ESRD?*
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150/90
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What is a treatment option for anemic pts with CKF?*
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Epoetin Alpha (Epogen or preferrably Procrit)
80-120U/kg/wk SC (preferred)in divided doses or Darbopoetin alpha (Aranesp) AND Iron supplementation, even if pt doesn't have low iron |
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What is a possible ADR with erythropeitic agents?
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HTN
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What oral iron supplements are avail & what are dosages/freq?* (Note want 200mg elemental iron daily)
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Ferrous sulfate: 50-75mg B-QID
Ferrous fumarate: 20-115mg 2-10x/d Ferrous gluconate: 27-36mg Q4H Polysaccharide ion: 50-150 QD-QID Heme Iron polypeptide: 12mg 17x/d |
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What causes Renal Osteodystrophy if untreated?*
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CKD
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What is the Primary CAUSE of CKD?
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Diabetes
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What is the primary cause of DEATH in pts w/ CKD?
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Heart Attack
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What is the eq for Corrected Calcium?
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Ca(corr)=Measured total Ca + [(4.0-pt albumin)x0.8)
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Which 3 types of drugs interfere w/ absorption of iron?
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PPIs
H2As Antacids |
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Fluoroquinolone absorption is interfered with by what?
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Iron
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Calcium-containing Phosphate Binders decrease absorpt of which agents?
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Iron
Fluoroquinolone Abx Zinc |
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If pt has hyperPTH & hypercalcemia, how do you treat it?
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cincalcet (Sensipar)
This is a calcimimetic that decr circ calcium |
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What is an ADR of a calcimimetic?
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N/V
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T or F: Food increases the absorption of cincalcet
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TRUE
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What are tx options for uremic bleeding?
What are each meds MofA? |
Cryoprecipitate-> includes clotting factor
Desmopressin->mimics ADH (incr water resorpt) & incr Factor VIII release (Improves clotting) Estrogen- Decr NO & eventually increases clotting |
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sevelamer (Renagel): What is:
Indication, MofA? Administration/Dosing/Freq? ADRs? |
Indication/MoA: Hyperphosphatemia/Binds phosphate to decr absorptn
Admin/Dos/Freq: 400/800mg tabs, take w/ meals level of 5.5-7.5=800mg TID w/ meals 7.5+ = 1600mgTID ADRs=N/V/D & assoc sxs |
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Is it physically impossible to learn all this?
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ABSOLUTELY!
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What causes the damage in a hyperacute infxn after a transplant?
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Complement being activated
Hyperacute is Cytotoxic Tcell mediated |
