Depression
Pt with MDD and HTN should be started on what class of drugs?
SNRI
Pt is on paroxetine 20 mg daily for GAD, which is uncontrolled. They are also on diazepam. What should you do?
Where would 250 mL albumin go?
ALL 250 mL to intravascular space
M Pt CKD on HD with Hgb=11, TSAT of 28%, and serum ferritin of 320 mg/dL should be started on:
Iron supplementation (either ferric gluconate or iron sucrose)
What lab value will you try to correct first in CKD MBD?
Phosphorus
Pt with MDD is taking paroxetine. They are also taking metoprolol. Are you concerned? Why?
Paroxetine is CYP2D6 inhibitor, which would increase metoprolol concentrations.
80 y/o M has uncontrolled GAD and is on escitalopram. Which benzodiazepine would be most appropriate for combination therapy?
LOT (lorazepam, oxazepam, temazepam)
What fluid given intravenously behaves like free water?
D5W
M Pt with CKD on HD with Hgb=9.5, TSAT = 31%, serum ferritin=550 should be started on:
ESA therapy
Typical loading/maintenance dose for IV iron therapy?
1000 mg; 200 mg split in 2-3 doses
Pt with MDD and neuropathic pain is currently taking venlafaxine 75 mg. His depressive symptoms have improved somewhat, but his pain has not subsided at all. What should you do?
Increase dose to 150 mg or more
Why would you not want to use clonidine or hydroxyzine in an 80 y/o pt?
Both on Beer's list (hydroxyzine for anticholinergic side effects, clonidine for bradycardia)
Person with SIADH will present with:
Hyponatremia
How does CKD cause decreased iron?
Inflammation leads to hepcidin release, which blocks iron release/absorption
Pt with CKD3 and PO4=2.2, PTH=50, Ca2+=9 should initially be treated with:
Phosphate binder
Pt with MDD and neuropathic pain is taking sertraline and amitriptyline. The pt has been hoarding amitriptyline. What should you do?
D/C both sertraline and amitriptyline and initiate treatment with SNRI
25 y/o pt with GAD is currently taking sertraline 200 mg. They are having problems sleeping (insomnia). What would be a good agent to add?
Hydroxyzine
Pt who requires 7 L for fluid resuscitation should be administered:
Lactated ringers (NS at large volumes = metabolic acidosis risk)
Main difference between EPO and Darby therapy?
Darby has a longer half-life (can be dosed less frequently)
Which first-line phosphate binder has a decreased risk of hypercalcemia?
Sevelamer
Pt with MDD is taking sertraline, but is now having issues with sleep (insomnia). What is the best adjunctive therapy for this pt?
Mirtazapine
Pt with controlled GAD on paroxetine 40 mg and alprazolam is being taken off of alprazolam. How should you go about this?
Taper (decrease 25% per week until 50% total; 12.5% per week until off of med)
Pt with hepatic dysfunction needs resuscitation. What would you administer?
Normal saline (lactated ringers needs to be metabolized)
Pt with CKD NOT on HD is beginning ESA therapy. What route should it be administered by?
SubQ
If a pt is on a phosphate binder and activated Vitamin D (calcitriol or analogues), and their PTH is still high, you would consider adding:
Cinacalcet