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Therapeutics 2 exam4
| Question | Answer |
|---|---|
| COPD Clinical Presentation | chronic cough sputum production dyspnea/decreased exercise tolerance Hx smoking |
| COPD Risk Factors | tobacco smoke occupational dust pollution genes lung growth and development oxidative factors gender age respiratory infection socioeconomic status nutrition comorbidities |
| COPD High Risk | 2 or more exacerbation within one year FEV1 <50% of predicted value |
| COPD Exacerbation Treatment | Beta-agonist w/ or w/o anticholinergic Systemic corticosteroids Antibiotics if s/s infection |
| Urology- Urge | Bladder Overactivity s/s: urinary frequency, urgency, nocturia |
| Urology- Stress | Urethral inactivity Most common in females s/s: urine leakage with exercise, lifting, coughing, sneezing |
| Urology- Overflow | Urethral overactivity and/or bladder Bladder is filled but cannot be emptied completely BPH, neurogenic bladder s/s: lower abdominal fullness, hesitancy, straining to void, decreased stream |
| Urology - Functional | Caused by factors extrinsic to the urinary tract s/s: immobility, cognitive impairment, DM, constipation/impaction |
| BPH- Behavior Modification | Limit caffeine and alcohol Limit fluids after dinner Take diuretics in the AM Frequent emptying of the bladder Void before bed Avoid meds that can exacerbate (alpha agonists, androgens, anticholinergics, diuretics) |
| BPH- Alpha Blockers | Reduce DYNAMIC factor Cause: relaxation of the bladder neck, prostate smooth muscle Onset: days-weeks ADEs: hypotension and syncope (dose limiting) |
| BPH- 5-alpha reductase inhibitor | Reduce static factor Shrinks the prostate by decreasing conversion of the active androgen that stimulates prostate tissue growth ADEs: gynecomastia, decreased libido, ED, ejaculatory disorders |
| AKI- lab tests | Increased SrCr and BUN Decreased CrCl Change in urine output Electrolyte abnormalities Metabolic acidosis Urinalysis (sediment, casts, proteinuria, eosinophiluria, hematuria, WBCs) |
| AKI- physical s/s | HTN, JVD, pulmonary edema, rales Hypotension/ othrostatic hypotension Rash, abdominal flank pain Signs of Uremia (N/V, weakness, confusion, anorexia, fatigue, weight loss, pruritis, mental status changes, SOB) |
| AKI- Pre-Renal | Reduced blood delivery to the kidney Cause: Intravascular volume depletion, reduced cardiac output, drugs that interfere with adaptive mechanism, renal artery stenosis |
| AKI- Instrinsic | Damage to the tubules, glomerulus, insterstitium, or blood vessels Causes: ATN, Glomerulonephritis, lupus, interstitial nephritis, vasculitis |
| AKI- Post-Renal | Obstruction of urinary bloodflow Cause: BPH, pelvic tumors, precipitation of renal caliculi |
| AKI- urine output | Non-oliguric (>400mL/24H) Oliguria (<400mL/24H) Anuria (<50mL/24H) |
| AKI- CrCL | Dosage adjustments are not based off of Cockcroft-Gault |
| AKI- Prerenal Treatment | Correct hemodynamics NS to correct volume depletion Pressure management Blood Products if needed |
| AKI- Postrenal Treatment | Relieve obstruction (stents) Treat BPH Avoid meds with anticholinergic effects |
| AKI- Intrinsic Treatment | Eliminate cause Fluid/electrolyte management Maintain kidney perfusion and production of urine (fluid bolus) Loop Diuretics (oliguric, euvolemic, hypervolemic) |
| AKI- Indication for RRT | A: acid base abnormalities (metabolic acidosis) E: Electrolyte imbalance (hyperkalemia, hypermagnesemia) I: Intoxication (Salicylates, methanol, lithium) O: fluid overload (post-operative fluid gain) U: Uremia (high catabolism of AKI) |
| ESKD- MDRD | Staging for CKD based on this equation |
| ESKD- Stage Classification | Based on GFR 1: >90 2: 60-89 3: 30-59 4: 15-29 5: <15 or dialysis |
| ESKD- Initiation Factors | DM HTN Autoimmune Disease Polycystic Kidney Disease Drug Toxicity Urinary Tract Abnormalities MOST COMMON: DM, HTN, glomerulonephritis |
| ESKD- Progression Factors | Hyperglycemia HTN Proteinuria Tobacco Smoking |
| ESKD- Susceptibility Factors | Increased Age Reduced Kidney Mass Low birth weight Racial/ethnic minority Family history Low income/education Systemic Inflammation Hyperlipidemia |
| ESKD- Stage 5 CKD symptoms | Pruritis Dysgeusia N/V Constipation Muscle pain Fatigue Bleeding Abnormalities |
| ESKD- Signs | HTN Edema Cramping Mental Status Changes GERD GI bleeding Changes in urine volume Foaming (proteinuria) |
| ESKD- Lab Findings (stage 3-5) | Increased: K, phos, Mg, PTH Decreased: Bicarb(metabolic acidosis), Albumin, RBC, Hgb, Hct |
| ESKD- Anemia | Hgb <11 g/dL Risk Factors: - decreased EPO production - shorter lifespan of RBCs (uremia) - Bloodloss during dialysis - Iron deficiency - Anemia of chronic disease - Renal osteodystrophy |
| ESKD- Anemia Treatment | Iron Supplementation EPO stimulating agents |
| ESKD: Iron Supplementation | Required if ferritin and TSAT below Goal PO less effective than IV |
| ESKD: EPO Stimulating Agents | Synthetic EPO Black Box Warning: CV complications Target Hgb: 11-12 g/dL SC route preferred HTN most common ADE |
| ESKD: TSAT, Ferritin, Hct and Hgb Goals | TSAT: 20-50% Ferritin: 100-500ng/mL Hgb: 11-12g/dL Hct: 33-36% |
| ESKD: Renal Osteodystrophy (ROD) | Driving force: hyperphosphatemia Nephron loss leads to decreased D3 and phos-retention Increased Phos: inhibition of vitD activation (decreased Ca abs. in gut), decreased ionized Ca, direct stimulation of PTH secretion |
| ESKD: Goal Ca plus Phos Product | <55 |
| ESKD: ROD Treatment | NON-Drug: Dietary restriction(800-1200), dialysis removes some Pharm: phosphate binders, vitamin D analogs, Calcimimetic (Cinacalcet) |
| ESKD: Phos Binders | Take with meal Avoid Mg/Al products Calcium Carb/Acetate Sevelamer(non-absorbable) Lanthanum carbonate |
| ESKD: Vitamin D analogs | CaPhos <55 before starting therapy |
| ESKD: Cinacalcet | Useful in pts with high CaPhos and PTH Do NOT start if Ca <8.4 |
| ESKD: HD membranes | Convectional/Low-Flux: Small pores, limited solute removal High-Efficiency:smaller pores, increased surface area High-Flux: larger pores, removes larger particles |
| ESKD: HD Access | Arteriovenous fistula (AVF): preferred Arteriovenous Graft (AVG): synthetic graft - increase risk of stenosis, thrombosis and infection Catheter: temporary Complications: catheter>AVG>AVF |
| ESKD: Characteristics of dialyzable drugs | Low Molecular Weight Water Soluble Low Protein Bound Low Vd High Renal Clearance |
| ESKD: HD - Hypotension | Trendelenburg Position Decrease Filtration Rate Fluid Bolus Determine dry weight Maintain constant ultrafiltration rate Midodrine, levocarnitine |
| ESKD: HD - Muscle Cramping | Due to excessive ultrafiltration Hypotension and electrolyte and acid/base imbalances Decrease filtration rate Determine dry weight |
| ESKD: HD - Thrombosis | Saline Flushes Thrombolytics (alteplase, reteplase) |
| ESKD: Drug Prescribing Guide | Detailed Initial Assessment Evaluate degree of renal impairment (determine CKD stage and estimated CrCl) Review med list and select meds with no/minimal nephrotoxicity Select dose Monitor |
| ESKD: Dosage Adjustments | Loading Dose: generally NOT adjusted Maintenance: reduce dose, lengthen dose interval Dialysis: accumulation due to kidney failure and/or procedure may remove drug from circulation |
| ESKD: CKD Classification | Stage GFR 1: 90 or higher 2: 60-89 3: 30-59 4: 15-29 5: <15 or dialysis |
| ESKD: Target levels | Corrected Ca: 8.4-9.5 Phos: 3.5-5.5 Ca-P Product: <55 Intact PTH: 150-300 |
| ESKD: Pruritis | Adequate dialysis is 1st line Antihistamines (hydroxizine or diphenhydramine) Cholestyramine |
| ESKD: Vitamin Replacement | Water soluble vitamins removed by HD Need replacement of water soluble vitamines Multivitamin B complex with Vitamin C supplements NOT ADEK (fat soluble and accumulate) |
Created by:
ehunter
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