Duke PA Nephrology Pharmacology
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| the hallmark of increased anion gap acidosis is that the metabolic acidosis (low HCO3-) is associated with ___ so that the anion gap increases | normal serum Cl-
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| Normolchloremic metabolic acidosis generally results from addition to the blood of nonchloride acids such as | lactate, acetoacetate, beta-hydroxy-butyrate, and exogenous toxins
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| ___ is formed from pyruvate in anearobic glycolysis | lactate
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| the liver and kidneys metabolize most of the ___ in the body | lactate
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| in lactic acidosis, lactate levels are at least ___ mEq/L but commonly ___mEq/L | 4-5, 10-30
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| Type A lactic acidosis (the most common type) results from | poor tissue perfusion, cardiogenic, septic, or hemorrhagic shock, and carbon monoxide or cyanide poisoning
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| Type B lactic acidosis may be due to metabolic causes such as | diabetes, ketoacidosis, liver disease, renal failure, infection, leukemia, or lymphoma
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| ____ is characterized by hyperglycemia and metabolic acidosis | diabetic ketoacidosis
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| a common disorder of chronically malnourishe patients who consume large quantities of alcohol daily | alcoholic ketoacidosis
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| accompanying ____ which inhibits pyruvate carboxylase, further enhances lactic acid production in many cases of alcoholic ketoacidosis | thiamine deficiency
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| examples of toxins that can increase the anion gap by increasing enogenous acid production | methanol, ethylene glycol, and salicylates
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| the hallmark for this disorder is that the low HCO3- of metabolic acidosis is associated with hyperchloremia so that the anion gap remains normal | normal anion gap acidosis
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| massive diarrhea or pancreatic drainage can result in ___ | HCO3- loss and normal anion gap acidosis
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| hyperchloremic acidosis with a normal anion gap and normal GFR, and the absence of diarrhea defines | Renal Tubular Acidosis
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| rapid dilution of plasma volume by ___ may cause a mild hyperchloremic acidosis | 0.9% NaCl
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| administration of large amounts of ___ may have deleterious effects, including hypernatremia, and hyperosmolality | HCO3-
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| in alcoholic ketoacidosis ___ should be given to avoid the development of Wernicke encephalopathy | thiamine with glucose
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| in ___ alkali therapy must be started unless blood pH has already been alkalinized by respiratory alkalosis | salicylate intoxication
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| in methanol intoxication ___ has been used as a competitive substrate for alcohol dehydrogenase, which metabolizes methanol to formaldehyde | ethanol
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| treatment of Renal Tubule Acidosis is mainly treated by administration of | alkali
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| two primary causes of CKD are | DM and HTN
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| main cause of death in ESRD (dialysis) patients is | cardiovascular
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| symptoms of uremia seen when function is reduced to <__% | 10
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| Na and water retention leads to | weight gain, HTN, edema
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| Bone disease that occurs when your kidneys fail to maintain the proper levels of calcium and phosphorus in your blood | osteodystrophy
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| phophorus excretion decreases as GFR falls below __ mL/min | 25
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| increase in serum phosphorus leads to a ____ which stimulates PTH release | decrease in serum calcium
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| PTH release leads to | Mobilization of calcium from bone, Enhances absorption of calcium from the small intestine, Suppression of calcium loss in urine
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| goal phosphorus __ mg/dL | 2.5-5.5
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| target PTH __pg/ml | 150-300
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| effective phosphate binder | calcium acetate
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| 667 mg tablet contains 167 mg of elemental Ca | calcium acetate
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| GFR is used to | stage renal disease
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| Creatinine clearance is used to | adjust dosage for renal patients
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| (140-age)/Scr=nCrCl (female x 0.85) | formula for estimating creatinine clearance (modified Cockrolft-Gault equation)
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| diuretic used for stage 1-3 (GFR>30 mls/min) | thiazides
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| diuretic used for stage 4-5 (GFR<30 mls/min) | loop
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| diuretic used if volume and edema is not resolved with monotherapy | loop + thiazide
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| diuretic to be used cautiously or not at all in renal patients | K-sparing (spironolactone)
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| treatment is usually not necessary for | mild acidosis
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| K balance is usually maintained until GFR < | 10
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| Acidosis shifts | K out of cells
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| with hyperkalemia and EKG changes give | IV calcium chloride or gluconate (1 gram CaCl over 1-3 min)
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| Calcium ___ K | does not lower
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| ___ is a K binder | sodium polystryene (SPS)
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| redistributes K back into cells | insulin
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| if patient is ___ do not give glucose with insulin | hyperglycemic
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| ___ excretion decreases as GFR falls below 25 ml/min | phosphorous
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| hyperphosphatemia can cause | vitamin D deficiency
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| increase in serum phosphorous leads to a decrease in serum | calcium
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| goal phosphorous __ mg/dl | 2.5-5.5
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| Non-absorbed cationic polymer used for treatment of high phosphorus | Sevelamer (Renagel®)
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| Non-Aluminum and non-calcium based binder used for treatment of high phosphorus | Lanthanum Carbonate (Fosrenol®)
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| Used when PO4 is extremely high, Only consider for short term use (1-4 weeks) | Aluminum Hydroxide/Carbonate
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| When Ca supplements are not effective in correcting serum Ca and PTH, use | Vitamin D
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| Inhibits PTH release and promotes GI absorption of Ca and phosphorus | Vitamin D
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| Use only if measured 25-hydroxyvitamin D level is < 30 ng/ml and PTH above target | Ergocalciferol
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| Begins to develop when GFR drops below 30 ml/min | anemia
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| primary cause of anemia in CKD | Decrease erythropoietin synthesis by the failing kidney
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| supplement __ for all dialysis patients b/c __ is remove by dialysis | foic acid, folate
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| renal vitamins | nephrocaps
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| in iron deficiency anemia with CKD the goal ferritin is >=__ ng/ml | 100
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| intravenous iron | iron dextran, ferric gluconate, iron sucros
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| lowest risk of IV iron hypersensitiviy reaction | iron sucrose
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| greatest risk of IV iron hypersensitivity reaction | iron dextran
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| drugs that induce ARF (hemodynamicaly mediated) | NSAID, ACEI, ARB
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| drugs that induce ATN | Contrast, Aminoglycosides, Amphotericin B
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| drugs that induce interstitial nephritis | methicillin, NSAIDs
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| ___ is used to dose drugs for renal patients | creatinine clearance
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| Most renally eliminated drugs do not need dosage adjustment if a patients CrCl is > __ mls/min | 70
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| most common pathogen responsible for UTI's | E. coli
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| treatment for acute uncomplicated cystitis | TMP-SMX
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