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What is used as a preference clinical practice guideline for the evaluation and management of chronic kidney disease?
Answer: KDIGO guideline (Kidney Disease: Improving Global Outcomes)
Which drug can cause nephrotoxic and require dose adjustment if kidney function is impaired?
A. Amoxicillin
B. Penicillin
C. Vancomycin
D. Moxifloxacin
Answer: C. Vancomycin ( RxPrep Key drug guys on page 294)
What is (are) the complication(s) of chronic kidney disease?
A. Metabolic acidosis
B. Hypokalemia
C. Hypophosphatemia
D. Anemia
Answer: Metabolic acidosis and anemia ( RxPrep page 298, 300)
What drugs that raise potassium levels?
A. Amlodipine
B. Lisinopril
C. Valsartan
D. Hydrochlorothiazide
Answer: Lisinopril ( ACE inhibitor) and Valsartan ( ARB)
( RxPrep key drugs guy page 298)
Which vitamin D is synthesized in the skin after exposure to ultraviolet light?
Answer: Vitamin D3 ( cholecalciferol)
RxPrep page 297
What two factors do the KDIGO & KDOQI (Kidney disease outcomes quality initiative) guideline recommend using to determine the degree/ stage of renal impairment?
Answer: GFR and degree of albuminuria ( RxPRep page 292)
A 50-year-old type 2 DM patient with GFR < 30 ml/min/1.73 m2, what drug cannot give to treat her DM?
A. Saxenda
B. Farxiga
C. Januvia
D. Actos
Answer: B. Farxiga (dapagliflozin - a SGLT2 inhibitor )
JS has been using Lyrica 150 mg BID for five years. Initially, his creatinine clearance was estimated at 78 ml/min. His blood pressure has been poorly controlled for the past five years. This has worsened his renal function and the creatinine clearance has declined to 34 ml/min. Chose the correct statement:
A. Lyrica is not cleared via renal
B. The efficacy of Lyrica would decrease
C. Dizziness and somnolence would decrease
D. Dizziness and somnolence would increase
Answer:
D. Dizziness and somnolence would increase ( Side effects increase because of the clearance of drug via renal decreases )
What agent is used to eliminate K from the body?
A. Regular insulin
B. Furosemide
C. Albuterol
D. Spironolactone
Answer: Furosemide - eliminate K in the urine ( RxPrep page 299)
What is a possible side effect that a patient may experience if taking vitamin D analog?
Answer: hypercalcemia, hyperphosphatemia, N/V/D ( RxPrep page 297)
According to the KDIGO guideline, what is the target BP goal for treating a hypertension patient with proteinuria?
Answer: BP < 130/80 mmHg ( RxPrep p. 293)
Which antibiotic is contraindicated in CKD patient who has CrCl = 58 ml/min? (This antibiotic normally uses to treat UTI)
Answer: Nitrofurantoin ( Macrobid)
( RxPrep key drugs guy on page 294)
Which of the following drugs is less likely to be substantially removed during hemodialysis?
A. Cefepime ( Vd 0.26 L/kg)
B. Vancomycin ( Vd 0.7 L/kg)
C. Levofloxacin ( Vd 1.27 L/kg)
D. Gentamycin ( Vd 0.3 L/kg)
Answer: C. Levofloxacin ( Vd 1.27 L /kg)
Drug with a larger volume of distribution leaves the bloodstream to a greater degree and are not significantly removed by hemodialysis
What are the 3 steps for treating severe hyperkalemia?
1. Stabilize the heart: prevent arrhythmias
2. Move it: Shift excess K intracellularly
3. Remove it: Enhance K elimination
( Rxprep page 299)
Name two agents that increase the sensitivity of the calcium-sensing receptor on the parathyroid gland
Answer: Cinacalcet ( Sensipar), Etelcalcetide ( Parsabiv)
( RxPrep page 297)
Which drug class is/ are the first-line drug(s) to prevent progression of disease in a patient with CKD, DM and or HTN if albuminuria is present? And what we should monitor if the patient is taking this drug?
Answer:
- ACE inhibitor or ARBs
- SCr and K should be monitored 1- 2 weeks after initiating ACEI or ARB ( RxPrep page 293)
Name 2 drugs from factor Xa inhibitor that require dose adjustment in a patient with kidney impairment?
Answer:
1. Dabigatran (Pradaxa)
2. Rivaroxaban (Xarelto)
A medical resident is attempting to write post-dialysis orders for a patient under his care. He asks you what factors cause a drug to be removed during hemodialysis. What should you tell him? (Name at least 2 factors)
Answer :
A patient who was receiving enalapril & spironolactone developed renal insufficiency secondary to acute febrile illness with vomiting & diarrhea. Fluid resuscitation is begun, and an ECG is obtained in the emergency department, which demonstrates changes consistent with hyperkalemia. What should be administered immediately to this patient to prevent potentially fatal cardiac arrhythmias?
Answer: Calcium gluconate is used to stabilize myocardial cells to prevent arrhythmias. It does not decrease the potassium level ( RrPrep page 299)
What should we monitor if patient is on calcimimetic? ( Name all three)
Answer: Ca, PO4, PTH ( RxPrep page 297)