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Naplex
Renal Disease - clinical pearl
| Question | Answer |
|---|---|
| Drugs that cause kidney disease | Aminoglycosides Amphotericin B Polymyxins Vancomycin Radiographic contrast dye* Cisplatin Cyclosporine Tacrolimus Loop diuretics NSAIDs |
| Contraindicated Drugs, if CrCI < 60 mL/min | Nitrofurantoin |
| Contraindicated Drugs, if CrCI < 50 mL/min | Tenofovir disoproxil fumarate containing products (eg, Stribild, Complera) |
| Contraindicated Drugs, if CrCI < 30 mL/min | Tenofovir alafenamide-containing products (eg, Biktarvy, Descovy), NSAIDS |
| Contraindicated Drugs, if eGFR < 30 mL/min/1.73 m2 | Metformin |
| TRUE or FALSE: Metformin is contraindicated in pt w CrCI < 30 mL/min | FALSE, metformin is contraindicated in pt w eGFR < 30 mL/min/1.73 m2 |
| Anticoagulants which require renal dose adjustment | LMWHs (eg, enoxaparin), rivaroxaban, apixaban, dabigatran |
| Gastrointestinal drugs which require renal dose adjustment | H2RAs (eg, famotidine), metoclopramide |
| Anti-infectives which require renal dose adjustment | Aminoglycosides, beta-lactams, fluconazole, quinolones, vancomycin |
| TRUE or FALSE: does Bisphosphonates require renal dose adjustment? | TRUE |
| TRUE or FALSE: does lithium require renal dose adjustment? | TRUE |
| Treat Hyperphosphatemia | Diet and phosphate binders |
| Options of phosphate binders | Aluminum-based Calcium-based (eg, calcium acetate) Other: sevelamer (Renagel, Renvela) |
| phosphate binders - Aluminum-based | risk of accumulation in renal impairment → neurotoxicity |
| phosphate binders - calcium acetate | hyperdalciumea & constipation |
| phosphate binders - | calcium based binders such as sevelamer and lanthanum. |
| Diagnostic criteria for chronic kidney disease | Progressive decline in kidney function (for ≥ 3 months), either - eGFR < 60 mL/min/1.73 m2 - Kidney damage (Urine albumin excretion rate (AER) ≥ 30 mg/24 hr or urine albumin-to-creatinine ratio (ACR) ≥ 30 mg/g) |
| Definition of Acute kidney injury (AKI) | Sudden loss of kidney function: - Serum creatinine - Urine output - Need for RRT |
| what is albuminuria if ACR (mg/g) or AER (mg/24 hr) < 30 | Normal to mild increase |
| what is albuminuria if ACR (mg/g) or AER (mg/24 hr) 30-300 | Moderate increase |
| what is albuminuria if ACR (mg/g) or AER (mg/24 hr) > 300 | Severe increase |
| TRUE or FALSE: phosphate binder is given regarding meals | FALSE, skip phosphate binder if skip meal |
| What meds should seperate use with phosphate binder | levothyroxine, fluoroquinolones, and tetracyclines (2-4 hrs apart) |
| SEs of Aluminum hydroxide | Aluminum toxicity: - CNS: cognitive impairment and seizures - bone effects: osteoporosis. |
| SEs of Calcium-based | Hypercalcemia (increase risk with concomitant vitamin D), constipation |
| names of Calcium-based | - Calcium acetate (Calphron) - Calcium carbonate (Tums) |
| TRUE or FALSE: Calcium acetate is more effectively than calcium carbonate | TRUE, Calcium acetate has higher phosphate binding, and also has less calcium element |
| options of Aluminum-free & calcium-free | - Ferric citrate - Lanthanum carbonate (Fosrenol) - Sevelamer carbonate (Renvela) - Sevelamer hydrochloride (Renagel) |
| SEs of Lanthanum carbonate (Fosrenol) | Nausea/vomiting, diarrhea, constipation |
| SEs of Sevelamer | Nausea/vomiting, diarrhea |
| Administration of Lanthanum carbonate (Fosrenol) | Must chew thoroughly |
| What lab value should monitor if pt is on Sevelamer hydrochloride (Renagel) | Total cholesterol and LDL (may reducing by 15-30%) (benefits!) |
| D2 and D3 are Active or inactive vit D | Inactive. Active form is 1,25-dihydroxy vitamin D (calcitriol), produced by kidney and essential for calcium absorption |
| CKD (stage 4 & 5), what form of vit D needed | active vit D or or vitamin D analogs |
| Calcifediol, doxercalciferol, and paricalcitol | Vit D analog |
| Calcitriol | synthetic version of active vit D |
| pro drug of calcitriol | Calcifediol |
| Warnings for active vit D or or vitamin D analogs | Hypercalcemia, Hyperphosphatemia |
| Calcifediol | only available PO |
| Calcimimetic | only for pt on dialysis. incl: Cinacalcet (Sensipar), Etelcalcetide - Warnings: Hypocalcemia - Side Effects: Muscle spasms & paresthesias (etelcalcetide) - Cinacalcet given orally & etelcalcetide given IV |
| Meds to delay progression of CKD (albuminuria) | - RAAS (stop if SCr increase > 30% vs baseline) - SGLT2 (not indicated if CrCl < 20%) - Nonsteroidal MRA (Finerenone: eGFR ≥ 25 mL/min/1.73 m2 & normal potassium level prior to initiation) |
| The Cockcroft-Gault equation may provide an unreliable estimation of true renal function in patients with | - end-stage renal disease - reduced muscle mass (eg, in the setting of malnutrition). |
| what part of the nephron leads to the development of albuminuria | Glomerulus |
| the most common causes of chronic kidney disease | Hypertension and diabetes mellitus |
| Meds have Decreased efficacy in pt w y in renal impairment | • Thiazide diuretics • Nitrofurantoin |
| Increased risk for adverse drug effects due to decreased drug clearance | • Anti-infectives: Aminoglycosides, Beta-lactam antibiotics, Fluconazole, NRTIs, Quinolones, Vancomycin • Anticoagulants: LMWH, Rivaroxaban, Dabigatran, Apixaban • Histamine-2 receptor antagonists • Bisphosphonates • Lithium • Metformin |
| which Anti-infectives do not increase risk for adverse drug effects due to decreased drug clearance | • antistaphylococcal penicillins (nafcillin, oxacillin) & ceftriaxone • abacavir • moxifloxacin |
| Renal impairment can Decreased efficacy of the drug | • Thiazide diuretics • Nitrofurantoin |
| Drug can worsen or cause kidney injury | • Anti-infectives • Aminoglycosides • Vancomycin • Amphotericin B • NSAIDs • RAAS inhibitors • Calcineurin inhibitors |
| In Treatment of hyperkalemia, Calcium gluconate IV role: | • Stabilization of myocardial cell membranes to prevent arrhythmia • No decrease in potassium level • Onset of action: Rapid (1-2 min) |
| In Treatment of hyperkalemia, roles of Regular insulin (+ dextrose if BG above 250)*, Sodium bicarbonate, Albuterol | • Shifting of potassium intracellularly • Onset: Intermediate (within 30 min) |
| Potassium-sparing diuretics (eg, spironolactone) work primarily in the collecting duct of the nephron and can cause electrolyte abnormalities including | hyperkalemia and hyponatremia |
| Patiromer is | a potassium binding resin used for the management of chronic hyperkalemia, which can cause gastrointestinal effects, hypomagnesemia, and drug interactions requiring separate administration. |
| Calcimimetics (eg, cinacalcet) | reduce PTH release by increasing sensitivity of the calcium-sensing receptor on the parathyroid glands; results in a decrease in calcium levels and may even cause hypocalcemia ( ideal for patients with secondary hyperparathyroidism with hypercalcemia) |
| does Urine albumin excretion ratio affect the calculation of CrCI. | Although the presence of macroalbuminuria (based on the albumin excretion ratio) supports the diagnosis of chronic kidney disease, it does not affect the calculation of CrCI. |
| Which of comorbid conditions most likely contributed to the development of chronic kidney disease? | Diabetes mellitus Hypertension |
| Role of Calcimimetics? | Are drugs that treat hyperparathyroidism by activating calcium-sensing receptors (CaSR) in the parathyroid gland, which decreases parathyroid hormone (PTH), calcium, and phosphorus levels. They are primarily used in dialysis |
| Common calcimimetics include: | Cinacalcet (Sensipar) and Etelcalcetide (Parsabiv) |
| When calcium or Caleifediol is NOT indicated for Treatment of secondary hyperparathyroidism in chronic kidney disease? | Elevated calcium level. Calcifediol is a vitamin D analog that increases calcium absorption, whereas calcium acetate is a phosphate binder that also provides elemental calcium. |
| Common drug causes Acute kidney injury - Prerenal | • Loop diuretics • NSAIDs • RAAS inhibitors • Calcineurin inhibitors |
| Common drug causes Acute kidney injury - Intrinsic | • Aminoglycosides • Amphotericin B • Cisplatin • Polymyxins • Vancomycin • Intravenous contrast dye* |
| Patiromer is | a potassium binding resin used for the management of chronic hyperkalemia, which can cause gastrointestinal effects, hypomagnesemia, and drug interactions requiring separate administration. |
| Management of hyperkalemia includes medications: | Management of hyperkalemiaShifting of potassium intracellularly (Regular insulin +dextrose*; Sodium bicarbonate, Albuterol) • Removal of potassium from the body via the urine (loop diuretics) * dextrose if BG < 250 |
| TRUE or FALSE: insuline + dextrose are given to management of hyperkalemia if blood glucose > = 250 | FALSE, if • BG > = 250: insuline alone • BG < 250: insuline together w dextrose |
| When Calcium gluconate is given to management of hyperkalemia | Counteracting the effect of potassium on myocardial cells with calcium gluconate to prevent arrhythmias, especially if ECG changes (eg, peaked T waves) are present |
| When Potassium-binding resins (eg, patiromer, sodium polystyrene sulfonate) is given to manage hyperkalemia | • Removal of potassium from the body via the GI tract for chronic treatment. It is for Chronic management or Adjunct therapy |
| Role of Hemodialysis in hyperkalemia management | • Removal of potassium from the body via blood filtration • Dialysis requires vascular access, for very serve situation |
| Loop vs thiazide diuretics in electrolyte abnormality | • Loop: Hyponatremia, Hypokalemia (more severe), Hypocalcemia • Thiazide: Hyponatremia, Hypokalemia, Hypercalcemia • Loop HYPO calcemia, Thiazide HYPER calcemia |
| Paricalcitol | brand name Zemplar, is a synthetic vitamin D analog used to treat and prevent secondary hyperparathyroidism |
Created by:
dao.vo11017