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