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Renal/Hepatic
Renal Disease
| Term | Definition |
|---|---|
| 2 Most Common Causes of CKD | Diabetes and Hypertension |
| Glomerulus Info | Glomerulus - afferent arteriole supplies blood; if kidney is damaged, albumin is passed into the urine here |
| Proximal Convoluted Tubule Info | ~65% of Na & ~70% of Ca is reabsorbed here; SGLT2 is here and is the site of action for inhibitors |
| Loop of Henle Info | Water is absorbed in the descending loop, Na & Cl are absorbed in the ascending loop (roughly 25% of Na); this is where loop diuretics work via Na-K pump inhibition; chronic use of them also causes calcium depletion |
| Distal Convoluted Tubule Info | Roughly 5% of Na is reabsorbed here; site of action for thiazide diuretics via inhibition of the Na-Cl pump |
| Collecting Duct Info | Involved with water and electrolyte balance via ADH and aldosterone; K-sparing diuretics work here and in the DCT to lower Na and water absorption and increase K retention |
| Select Drugs that Cause Nephrotoxicity | AMGs Amphotericin B Cisplatin Cyclosporine Loop diuretics NSAIDs Polymxins Contrast Dye Tacrolimus Vancomycin |
| Calculating Renal Function (CrCl vs GFR) | CrCl uses the Cockcroft - Gault Equation; use ActBW is < IBW, IBW if normal, AdjBW if overweight GFR: not commonly calculated by pharmacists; provided with BMP; CKD-EPI & MDRD equations are used; used for staging CKD |
| CKD Stages (GFR) | G1: > 90 + kidney damage G2: 60-89 + kidney damage G3a: 45-59 G3b: 30 -44 G4: 15-29 G5: < 15 or dialysis dependent |
| Degree of Albuminuria (ACR) | A1/normoalbuminuria: < 30 A2/microalbuminuria: 30-300 A3/macroalbuminuria: > 300 |
| Select Drugs That Require Lowered Dose or Increased Interval in CKD | Anti-infectives: AMGs, BLs, fluconazole, FQs (except moxi), vanc CV Drugs: LMWHs, rivaroxaban, apixaban, dabigatran (last 3 for AF) GI Drugs: H2RAs and metoclopramide Others: Bisphosphonates and lithium |
| Select Drugs That Are CI'd in CKD | CrCl < 60: nitrofurantoin CrCl < 50: TDF-containing products, voriconazole IV CrCl < 30: TAF-containing products, NSAIDs, dabigatran eGFR < 30: metformin |
| Complications of CKD | 1. Hyperphosphatemia 2. Vitamin D Deficiency & Secondary Hyperparathyroidism 3. Anema |
| Treatment for Hyperphosphatemia | 1. Restrict dietary phosphate 2. Phosphate Binders* * commonly contain aluminum or calcium; alternatives such as sevelamer can be used; separate from levothyroxine, FQs, and tetracyclines |
| Treatment for Vitamin D deficiency | 1. Vitamin D supplementation 2. Calcimimetics* *Agents, such as cinacalcet, are reserved for dialysis patients |
| Treatment of Anemia of CKD | ESAs, such as epoetin, can be used with sufficient iron stores as long as Hgb<10. ESAs carry risks such as HTN and thrombosis and should be d/ced if Hgb >11 |
| Select Drugs That Raise Potassium | ACE Inhibitors Aliskiren ARBs Canagliflozin K-sparing diuretics Bactrim Transplant drugs (cyclosporine & tacrolimus) |
| Steps For Treating Hyperkalemia | 1. Stabilize heart: calcium gluconate/chloride 2. Move it: Regular insulin + dextrose*, sodium bicarb, albuterol 3. Remove it: Loop diuretics, sodium polystyrene sulfonate, patiromer, sodium zirconium cyclosilicate, hemodialysis * insulin alone if >250 |
Created by:
skelly46
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