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NAPLEX > Renal Disease > Flashcards

Renal Disease Flashcards

1
Q

What are the two most common causes of renal disease?

A

diabetes and hypertension

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2
Q

What is an Acute Kidney Injury?

A
  • A sudden loss in kidney function due to another condition (drugs, dehydration). Often reversible but can be permanent if not corrected
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3
Q

Chronic Kidney disease?

A
  • Progressive loss of kidney function over months or years
  • Measured by GFR CrCl, albuminuria
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4
Q

End-Stage-renal disease

A

Total and permenant kidney failure

dialysis required

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5
Q

What is the nephrons primary function?

What else does this regulate?

A

To control the concentration of sodium and water

Regulates blood volume–> in turn effects blood pressure

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6
Q

Where does a majority of Na, H2O and Cl, Ca get reabsorbed within the kidneys?

A

In the proximal tubule: closest to the bowmans capsule

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7
Q

How is blood pH regulated?

A

By the exchange of hydrogen and Bicarb ions

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8
Q

If antidiuretic hormone is present (vasopressin) what happens?

A

Water passes through the ascending limb and is reabsorbed into the blood reducing water excretion

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9
Q

What do loop diuretics do?

A
  • inhibit the Na-K pump in the ascending limb of the Loop of Henle
  • less Na is reabsorbed and increased in urine
  • By blocking this pump they also limit Ca reabsorption leading to Ca depletion which can decrease bone density
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10
Q

What is the distal convoluted tubule responsible for?

A

Regulation of, Na, K, Ca, pH

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11
Q

What do thiazide diuretics do?

What type of effect do they have?

A

Na-Cl pump inhibition

Less potent compared to loops due to small amount of Na

Facilitate Ca reabsorption so actually have a bone protection effect

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12
Q

What is the collecting duct involved with?

A

water and electrolyte balance

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13
Q

What does aldosterone do?

A

works in the collecting and distal convoluted tubules to increase Na and water reabsorption

When Aldosterone antagonists are used like spironolactone or eplerenone there is an increase in Na and H20 excretion and increased serum K

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14
Q

10 select drugs that cause kidney disease

A
  1. NSAIDs
  2. Aminoglycosides
  3. Vancomycin
  4. Amphotericin B
  5. Cisplatin
  6. Cyclosporine
  7. Loop diuretics
  8. Polymyxins
  9. Radiographic contrast dye
  10. Tacolimus
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15
Q

As kidney function declines what happens to BUN?

A

BUN increases

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16
Q

As kidney function declines what happeneds to SCr?

A
  • SCr increases
  • Normal range is 0.6-1.3 mg/dL
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17
Q

Cockcroft is not recommended in what patients?

A

in very young children or in unstable renal function

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18
Q

What drugs use GFR for dosing?

A

SGLT2 and Metformin

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19
Q

What wt to use in Cockcrauft?

A

Use Actual body wight if < IBW, use IBW if normal weight by BMI, use adjusted if pt is overweight

20
Q

What levels indicate a pt has CKD?

A

GFR < 60 ml/min/1.72 m2

Albuminuria ACR or AER >=30

21
Q

What is first line for the prevention of progression of CKD, DM and or HTN if proteinuria is present?

A

ACE or ARB

22
Q

ACE and ARB notes

A
  • SCr can increase by 30% when therapy is initiated which is ok
  • if > 30% med should be stopped
  • They iincrease potassium which can cause hyperkalemia patients should be monitors by Scr and K 1-2 wks after initiation
23
Q

What drugs need dosage adjustments or interval changes?

A
  1. Aminoglycosides increase dosing interval
  2. Beta-lactams (most)
  3. Fluconazole
  4. Quinolones (except moxifloxacin)
  5. Vancomycin
  6. LMWH
  7. Rivaroxaban
  8. H2RA (famotidine, ranitidine)
  9. Metoclopramide
  10. Bisphosphonates
  11. Lithium
  12. Ampho B
  13. Anti TB (ethambutol, pyrazinamide)
  14. Antivirals (acyclovir, valacy, ganciclovir, valgan, oseltamivir)
  15. Aztreonam
  16. NRTIs including tenofovir
  17. Polymyxins
  18. Bactrim
  19. Digoxin, disopyramide, dofetilide, procainamide, sotalol
  20. Apixaban
  21. Dabigatran
  22. Statins (most)
  23. Allopurinol
  24. Colchine
  25. gabepentin, pregabalin
  26. Morphine and codeine
  27. Tramadol ERRRR
  28. Cyclosporine
  29. Tacrolimus
  30. Topiramate
24
Q

Drugs that are contraindicated in CKD

A

CrCl < 60 ml/minute

  • Nitrofurantoin

<50

  • Tenofovir containing products (Stribild, Complera, Atripla, Symfi, Symfi Lo
  • Voriconazole IV due to the vehicle

GFR < 30

  • SGLT2 flozins
  • Metformin
  • Other meperidine
25
Q

Common CrCl cut off when looking at meds for dose adjustments?

A

<60 ml/min

26
Q

What needs to be monitored in patients with CKD?

A

parathyroid PTH, phosporus, Ca, Vitamin D levels

27
Q

How is hyperphosphatemia treated in CKD patients?

A

First dietary restrictions and then phosphate binders are likely required

If you miss a phosphate binder dose you should skip it

28
Q

What are the 3 types of phosphate binders?

A
  1. Aluminum based
  2. Calcium-based
  3. aluminum free, calcium free agents
29
Q

Aluminum based phosphate binders

A

Potent but rarely used to due to aluminum accumulations which can cause nervous system and bone toxicities

Treatment is limited to 4 wks

SIDE effects: dialysis dementia

30
Q

Calcium based phosphate binders

A

First line:

SIde effects: Hypercalemia

Monitor Ca

Hypercalemia can be even more problematic when Vitamin D is used

Tums, PhosLo

31
Q

Aluminum free calcium free binders, less side effects more expensive

Sucroferric (velphoro), Ferric citrate (Auryxia

A

Iron absoprtion occurs with ferric citrate and IV iron may need to be reduced

32
Q

Lanthanum

A

Al free Ca free

SEs: N/V/D/constipation

33
Q

Sevelamer

A

Carbonate better than hydrocholoride in maintaining bicarb

Not systemiccally aborbed phosphate binder also reduces cholesterol and LDL by 15-30%

SEs: N/V/D > 20% very common

Reduce dietary absorption of vitamins DEK and folic acid

34
Q

Phosphate binder drug interactions

A

Separate administration of levothyroxine and antibiotics that chelate (quinolones, tetracyclines)

35
Q

CKD first treat hyperphosphatemia then treat _____ with?

A

elevations in PTH are treated with Vitamin D

  • Vit D def occurs when the kidney is unable to hydroxylate Vit D into the active form 1,5-dihydroxy Vit D
  • Vit D3 cholecalciferol which is synthesized in the skin after exposure to ultraviolet light
  • Vit D2: ergocalciferol produced from plant sterols PRIMARY DIETARY Source
  • Active form of vitamin D3 Calcitriol (used in later stages CKD or ESRD)
  • Cincacalcet: Calcimimetic mimics the action of calcium on the parathyroid gland which further reduces PTH (ONLY USED FOR PATIENTS ON Dialysis
36
Q

Vitamin D analogs: 4

A
  1. Calcitriol Rocaltrol
  2. Calcifediol (rayaldee) ER
  3. Doxercalciferol (Hectorol)
  4. Paricalcitol (Zemplar)

SIDE effects hypercalemia

Monitor Ca

37
Q

Calcimimetics

A

Cincacalcet (Sensipar)

Hypocalemia

Etelcalcetide (Parsabiv): warning for hypocalemia, muscle spasms, paresthesia (burning sensation on skin)

38
Q

How is anemia caused in CKD?

A

lack of erythropoeitin which is produced by the kidneys, which causes the stimulation of the production of RBCs

39
Q

What can limit the need for blood transfusions in CKD anemia

A

ESA

Erythropoeisis Stimulating Agents

  • Epoetin Alfa (procrit,epogen) and longer lasting darbepoetin (Aranesp)
  • Risks: elevated blood pressure, should only be used inf Hgb <10g/dL
  • Then should be held if hgb exceeds 11
  • Only works if there is enough Iron so look at iron levels
40
Q

Hyperkalemia in CKD

A

Considered at levels > 5 mEq/L

Renal potassium is increased by aldosterone, diuretics (loop>thiazide)

Pts with DM are at an increased risk due to insulin deficiency reducing the ability to shift potassium into the cell

41
Q

Key drugs that increase potassium levels 8

A
  1. ACE
  2. Aldosterone receptor antagonists
  3. Aliskeren
  4. ARBs
  5. Canagliflozin
  6. Drospirenone-containing COCs
  7. Bactrim
  8. Transplant drugs (cyclosporine, everolimus, tacrolimus)
42
Q

Treatement of Hyperkalemia

A

DC in potassium agents

Stabilize the mycardial cells and to rapidly shift potassium in cells or eliminate

  • Stabilize heart with calcium gluconate
  • Move K into cells, regular insulin, dextrose, sodium bicarb, ALbuterol
  • Remove it: Furosemide, Sodium polystyrene, Patiromer, zirconium, hemodialysis
43
Q

Sodium polystyrene

A

SPS, kayexalate

Bind to other drugs watch DIs

44
Q

Patiromer (Veltassa)

A

Hypomagnesia

Binds to many drugs separate by 3 hours

Not for emergency use neither is sodium zirconium

45
Q
A

NAPLEX (64 decks)

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