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75 Cards in this Set
- Front
- Back
Prostaglandins @ aff and eff
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aff - vasodialation
efferent arterioles - No effect |
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Angiotensin II
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aff - vasoCONSTRICT
eff - vasoCONSTRICT |
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what % of Na is normally eliminated?
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0.5%
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What is primarily absorbed in the proximal tubule?
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Na, K, and HCO3 are 1' absorbed where?
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What is primarily absorbed in the loop of henle?
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magnesium is absorbed where?
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Where does aldosterone act?
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what acts on the collecting duct? This is also where antagonists act.
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What acts on the collecting duct?
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Where does ADH act? antagonists of ADH have a less anti-diuretic effect = diuretic
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Where does acetazolamide act?
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CARBONIC anhydrase inhibitor acting on proximal convuluted tubule. weak diuretic
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Where do the thiazides work?
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inhibit the reabs of Na and Cl in the distal convuluted tubule. Most commonly used
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Where do bumetanide, furosemide, and ethacrynic acid act?
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These diuretics act at the ascending loop of henle, inhibiting the Na/K/2Cl cotransport. Most efficacious
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Where do spironolactone, amiloride, and triamterene act?
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These diuretics act at the collecting duct. These agents prevent the loss of K that occurs w/thiazide or loops.
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How do kidneys maintain acid base regulation>?
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Kidneys regulate NaHCO3 in the PROXIMAL tubule. rate of this abs or H+ secretion is dependent on Pco2 conc.
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How can CAinhibs cause metabolic acidosis?
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Diamox prevents NaHCO3 reabs and is eliminated
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What 2 major hormones can be affected in CKD?
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EPO and vitamin D activation leading to PTH overproduction
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When is glucose present in the urine?
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when the FSBS is >180mg/dL
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What products are found in the Urine for people with UTI?
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leukocyte esterase, nitrite, and some sediment
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high / low osmolal mean what?
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same as specific gravity
high - volume depletion low - inability to conc. urine |
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what are normal albumin levels in the urine?
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<30 mg/day = normal
30-300 = microalbuminuria >300 = proteinuria |
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What is azotemia?
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increased BUN
normal BUN=8-20mg/dL |
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what's the normal BUN:Cr
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normal: 10:1
>20:1 = volume depletion means prerenal azotemia |
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what's normal for Scr?
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0.5-1.5 with wider range possible related to muscle mass
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What is the gold standard of kidney function?
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GFR! cannot be directly measured
inulin, iothalamate, and iohexol creatinine is most common |
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what's with the cockcroft-gault?
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male pt w/stable renal function
sick old woman, then CC-G is not a good measure. also not good for special pop |
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What is the definition of CKD?
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kidney damage for >=3months
w/same or decreased GFR patho abnormal or urine,blood,imaging abnormal OR GFR <60ml/min for >=3months |
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What initiates CKD?
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Diabetes Mellitus
HTN, drug toxicity autoimmune disease Polycystic kidney disease |
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define stage 1 kidney disease
ClCr? Sympt? urinalysis? signs? Complications? |
>=90ml/min, uncommon to have symptoms; microalbuminuria present
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treat stage 1 CKD?
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ACEi or ARB,
protein restricted to 0.8-1 g/kg/day tx HTN, Smoking, dyslipid |
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define stage 2 kidney disease
ClCr? Sympt? urinalysis? signs? Complications? |
60-89ml/min - mild
proteinuria at risk for increased Na |
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define stage 3 kidney disease
ClCr? Sympt? urinalysis? signs? Complications? |
Moderate = 30-59ml/min
proteinuria and decreased urine output maybe nocturia/edema mild anemia and sHPT present fatigue malaise and nausea |
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define stage 4 kidney disease
ClCr? Sympt? urinalysis? signs? Complications? |
Severe = 15-29ml/min
fatigue malaise and nausea proteinuria and decreased urine output high Na/K low pH in urine anemia/sHPT |
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define stage 5 kidney disease
ClCr? Sympt? urinalysis? signs? Complications? |
<15mL/min or Dialysis
KIDNeY FAILure SOB, confusion, bleeding, itch proteinuria,edema, nocturia Na/K/pH abnormalities anemia/sHPT |
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at what stage does renal dose adjustment begin?
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stage 3! CrCl<60mL/min
dialysis begins @ stage 5 |
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what about vitD causes sHPT
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The LOSS of Vit D activation causes sHPT
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Absorption in CKD?
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abs is decreased w/ GI edema in CKD
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Distribution in CKD?>
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decreased albumin in CKD
more available acidic drugs: phy, warf so you would get supratherapeutic levels. |
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elimination in CKD?
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dose adjustment needed for renally eliminated drugs
NOTE: pt will have more body water |
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What is the preferred adjustment of renal dosing?
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usual dose, decreased interval
can also do decreased dose @ usual inter. |
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what causes volume overload in CKD?
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decreased GFR results in
dec Na and inc Na retained along w/ total body water so normal Na, but w/edema |
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Normal vs. CKD change urine concentrations
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normal urine conc/dilutes urine 50-1500.
CKD has constant 300mosmol/L |
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Tx for volume overload?>
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Na restricted to 2 grams/day
loop diuretics |
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How does hyperkalemia occur in CKD?
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less GFR, then less K filtered
more tube secretion and more GI elimination is not enough to compensate K buildup ACEi are also risk for hyperK |
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CKD hyperK prevent?
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loop diuretics
low K diet prevent constipation AVOID NSAIDs |
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How does hyperkalemia occur in CKD?
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less GFR, then less K filtered
more tube secretion and more GI elimination is not enough to compensate K buildup ACEi are also risk for hyperK |
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CKD hyperK prevent?
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loop diuretics
low K diet prevent constipation AVOID NSAIDs |
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Metabolic acidosis values and complications?
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dec buffer sys, then dec acid secretion
occurs @ bicarb levels of 12-20meq/L presents w/ <30ml/min causes bone disease, less albumin, hyperK, arrhythmias |
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Goals of tx for MA?
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serum CO2 = 22 mEq/L
prevent hypokalemia that occurs w/tx maintain fluid balance - tx may cause Na retent |
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Metabolic acidosis values and complications?
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dec buffer sys, then dec acid secretion
occurs @ bicarb levels of 12-20meq/L presents w/ <30ml/min causes bone disease, less albumin, hyperK, arrhythmias |
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Goals of tx for MA?
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serum CO2 = 22 mEq/L
prevent hypokalemia that occurs w/tx maintain fluid balance - tx may cause Na retent |
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chronic MA tx?
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divide sodium citrate or Na/K citrate bid-tid
after meals refridge and dilute 1:1 to inc palate n/v/diarrhea |
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chronic MA tx?
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divide sodium citrate or Na/K citrate bid-tid
after meals refridge and dilute 1:1 to inc palate n/v/diarrhea |
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How does hyperkalemia occur in CKD?
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less GFR, then less K filtered
more tube secretion and more GI elimination is not enough to compensate K buildup ACEi are also risk for hyperK |
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CKD hyperK prevent?
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loop diuretics
low K diet prevent constipation AVOID NSAIDs |
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Metabolic acidosis values and complications?
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dec buffer sys, then dec acid secretion
occurs @ bicarb levels of 12-20meq/L presents w/ <30ml/min causes bone disease, less albumin, hyperK, arrhythmias |
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Goals of tx for MA?
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serum CO2 = 22 mEq/L
prevent hypokalemia that occurs w/tx maintain fluid balance - tx may cause Na retent |
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chronic MA tx?
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divide sodium citrate or Na/K citrate bid-tid
after meals refridge and dilute 1:1 to inc palate n/v/diarrhea |
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Pathophys of anemia in CKD
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normocytic normochromic anemia
due to dec kidney EPO produce low Fe stores, low protein, low abs of Fe, inc blood loss |
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What Tsat indicates anemia?
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measure of Fe for making RBC
<20% means iron deficient normal is 20-50% t=transferrin |
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What ferritin level indicates anemia?
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measure of Fe storage
normal= 100-800ng/mL <100 means low Fe store low TsatANDferritin=ABS Fe def! |
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Citrate products are CI with what?
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Al containing P binders are CI with what?
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EPO or iron 1st?
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replace Fe def before EPO admin
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What is oral place in therapy
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early CKD w/o IV access: 1-4
patients w/o abs Fe def 200mg elemental in divided doses AE GI upset/constipation |
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ferrous sulfate
ferrous gluconate ferrous fumarate polysaccharide Fe |
feosol
fergon hemocyte Fe-tinic, Nu-iron |
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what oral salt requires 17 tabs/day
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heme Fe polypeptide
(Proferrin-ES) |
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what is IV place in therapy
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patients wit Abs Fe Def
generally used w/IV access 1000mg Abs Fe Def in div dose 50mg q weekly |
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Iron dextran - BBW test dose
Ferric Gluconate iron sucrose |
InFeD
Ferrlecit Venofer |
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Epoetin alpha
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epogen, procrit
4-13 hour t1/2 titrate for 1 month do not give SC! |
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when to decrease dose by 25%?
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Hgb>12
increased>1g/dL in any 1 week withholding dose is not recommen |
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increase dose by 25%
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Hgb increase of <2 after 8 weeks
patients requiring transfusions at ANY level |
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Dose of Procrit?
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50-100 units/kg IV! 3x week
give q 2-4 weeks in stages 3-4 |
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Darbepoetin alfa
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Aranesp
Much longer IV halflife of 21h regardless of EPO therapy, pt must be on Fe replacement |
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what is aranesp dose?
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0.45mg/kg q weekly IV
consider q 3-4 weeks in stage3-4 |
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1st line therapy for sHPT?
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P restriction
<800mg/day instead of 1200 recommend nutrition counseling |
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what is the corrected Ca formula?
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=((4-alb)x0.8) + Measured Ca
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What should the CaxP product be?
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<55
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Ca intake NTE?
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2000mg/day total
1500 mg/day from supplements |