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38 Cards in this Set
- Front
- Back
what are the 2 primary types of dialysis
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HD-hemodialysis
and PD-peritoneal dialysis |
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whats the diff between HD and PD
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HD= done 3 x a week, blood is filtered through a machine via diffusion and convection
PD= glucose soln (dialysate) is pumped into perioteneal cavity and peritoneal membrance acts as the dialyzer, done by the patient daily |
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factors that effecr drug removal in dialysis
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1) molecular size- high flux dialyzers have larger pore size-improved vanco clearance
2) Protein binding- dialysis only removes the unbound portion of drug 3) VD, if drug has a large VD, dialysis is not really effective-digoxin + amiodarone 4)plasma clearance-hepatic drugs won't really be cleared via dialysis 5) dialysis membrane- low-flux, med, high flux-pore size |
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what is an indicator of kidney damage
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protein or albumin (micro or macroalbunuria) in the urine- the filter or glomerulous isn't working to keep it out of urine
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what is used as a marker of renal function
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serum creatinine, but not precise cause it's due to degree of muscle
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what is BUN
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blood urea nitrogen measures amount of nitrogen that comes from waste product urea.
increases with renal impairment, but not an independent marker |
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what occurs in the proximal tubule
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water, Na, and Cl are mainly reabsorbed here
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where do loop diuretics work?
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they inhibit Na K, pump in the ascending limb of the loop of henle- 25% of Na is reabsorbed here, making it a potent drug
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what meds work on the distal convoluted tubule
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thiazides, only 5% of Na is reabsorbed here, thus thiazides are weaker diuretics than loops
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thiazides also effect what other cation
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Calcium, it increases it, so it has a positive effect on bone
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some common drugs that should not be used in severe renal impairment
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bisphosphonates, dabigatrin, duloxetine, Li, glyburide, metformin, NSAIDs
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Stages of CKD
Stage 1 GFR |
>90 mL/min
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Stages of CKD
Stage 2 GFR |
60-89 ml/min
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Stages of CKD
Stage 2 GFR |
30-59 ml/min
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Stages of CKD
Stage 3 GFR |
15-29
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Stages of CKD
Stage 4 GFR |
<15 or dialysis, yeah you are screwed
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gabapentin should have a dose reduction when the CrCl is what?
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when CrCl <60 to minimize sedation and accumulation of the drug
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reglan or metoclopramide should also be dose adjusted in renal dysfunction, why?
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drug conc increases, causing dopamine blockade....EPS and drowsiness
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what drugs have been shown to prevent the progression of nephropathy in diabetes and non-diabetic patients with proteinuria
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ACEI + ARB
note they help in non-diabetics with proteinuria |
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what is the goal BP for a kidney disease patient
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<130/80
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what happens initially with the start of an ACEI and ARB
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a 30% increase in serum creatinine
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Is a 30% increase in serum creatinIne due to ACEI initiation a reason to stop therapy?
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NO!
if >30% then need to stop |
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when starting an ACEI or ARB in CKD pt how long should you monitor labs and what labs should be monitored
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monitor 1-2 weeks
K and SCr |
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patients with CKD should have what else monitored
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Ca, PTH, PO4 and watch for signs of anemia
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what happens to Phosphorous and PTH levels in CKD
how to help alleviate |
phosphorous is not eliminated, so builds up- dumb body cranks up PTH to help, causing hyperparathyroidism
tx of hyperparathyroidism is control dietary phosphorous and maybe use phosphate binders |
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3 examples of phosphate binders
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1) aluminum based agent- alternagel, Al is dangerous in CKD-only use short term, but MOST effective
2) Ca based- 1st line, but most CKD ppl are taking vit D-which raises Ca 3) Al and Ca free agents- effective, but most expensive |
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when to use phosphate binders
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use as meal time- bind dietary phosphorous
if miss dose, taking it later or doubling is no good |
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name 2 Al-Ca free phosphorous medication
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lanthanum carbonate (Fosrenol)
must chew thoroughly Sevelamer carbonate-also has benefit of decreasing cholesterol and LDL by 15-30% |
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once the hyperphosphatemia is controlled, how do you control excess PTH
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By increasing Ca, by using Vitamin D
calcitriol is active form of Vitamin D3 and is used to increase Ca gut absorption, decreasing PTH secretion |
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how does a calcimimetic work
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Cinacalcet or sensipar- increases sensitivity of ca-sensing receptor on parathyroid gland= less, PTH, less Ca, less Phos
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treatment of vitamin D deficency
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<5 give 50,000 IU weekly x 12 weeks, then monthly
5-15 give 50,000 IU weekly x 4 weeks, then monthly 16-30 50,000 IU monthly ALL FOR 6 MONTHS |
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whats the K level for hyperkalemia
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>5 mEq/L
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K excretion is increased by
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aldosterone, diuretics, and loops
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what is most common cause of hyperkalemia
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decreased renal fxn, can be due to combo of renal dysfxn and excess K levels from other drugs
but hyperkalemia generally NOT from a excessive intake of K |
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common drugs that raise K
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ACEI, ARB, NSAIDs, Bactrim, heparin, OC with drospiernone (YAZ)
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what may need to be done to monitor for cardio toxicity with hyperkalemia
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ECG, may need to give IV Ca to stabilize cardiac tissue
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methods to lower K in hyperkalemia
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insulin drives K into cells, so give insulin
glucose, which increases insulin Na Bicarb if metabolic acidosis possibly albuterol consider cation exchange resin, sodium polystyrene sulfonate (Kayexelate)-can be give PO or PR |
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when to initiate Na bicarb drugs and what are the drugs
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when Na Bicarb <22 mEq/L
Na Bicarb Na citrate/citric acid Oracrit |