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37 Cards in this Set
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|
Class?
furosemide |
loop diuretic
|
|
class?
bumetanide |
loop diuretic
|
|
class?
torsemide |
loop diuretic
|
|
class?
ethacrynic acid |
loop diuretic
**useful if patient has sulfa compound allergies |
|
what is the equivalent dose of bumetanide that will equal 40 mg furosemide?
|
1 mg
(furosemide 40 mg= torsemide 20 mg= bumetanide 1 mg) |
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what is the equivalent dose of torsemide that equals furosemide 40 mg?
|
torsemide 20 mg
(furosemide 40 mg= torsemide 20 mg= bumetanide 1 mg) |
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what is the equivalent dose of torsemide that will equal 1 mg of bumetanide?
|
torsemide 20 mg (furosemide 40 mg= torsemide 20 mg= bumetanide 1 mg)
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which DOA is longer? iv or oral loop diuretics?
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oral
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name warnings and precautions of loop diuretics
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electrolyte imbalances, ototoxicity, worsened ARF (nephrotoxic), hyperuricemia, photosensitivity (furosemide only)
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which of the following is available IV and PO?
furosemide bumetanide torsemide |
ALL OF THEM
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|
Class?
metolazone |
thiazide-related
|
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contraindications for loop diuretics?
|
ANURIA
sulfa allergy (should take ethacrynic acid-- NOT furosemide, torsemide, or bumetanide) |
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MOA of loop diurectics?
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Inhibits reabsorption of sodium and chloride in the ascending loop of Henle and proximal renal tubule, interfering with the chloride-binding cotransport system, thus causing increased excretion of water, sodium, chloride, magnesium, phosphate, and calcium; it does not appear to act on the distal tubule
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MOA of thiazide diuretics?
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Inhibits sodium reabsorption in the distal tubules causing increased excretion of sodium and water as well as potassium and hydrogen ions
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class?
chlorthiazide |
thiazide
|
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dosing for metolazone vs. chlorothiazide?
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5-10 mg metolazone
500-1000 mg chlorothiazide |
|
which of the following diuretics can be taken at GFR <20 ml/min?
furosemide torsemide bumetanide ethacrynic acid metolazone chlorthiazide mannitol |
metolazone
|
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when administering diuretics to an AKI patient, what is the goal UOP?
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0.5-1 ml/kg/hr
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when treating AKI, combination therapy would include which diuretics?
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loop diuretic + diuretics from another class
(typically loop + metolazone, since only thiazide-related drug that is known to produce diuresis at GFR < 20 ml/min) (maybe loop + chlorothiazide) |
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what should sodium restriction be per day for a patient with hypernatremia due to AKI
|
</= 3 g sodium per day (from ALL sources!)
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why is hyperkalemia a common problem in a patients with AKI?
how often should serum potassium be monitored in these patients? |
because 90% of potassium is eliminated renally
**should be monitored at least Q 24 hours |
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how would you treat asymptomatic, > 6 mEq/L hyperkalemia?
|
calcium gluconate (to protect heart)
sodium bicarbonate (if patient is also acidotic) insulin + glucose -OR- albuterol by nebulizer (to drive K+ intracellular) **same regimen if patient is symptomatic (EKG changes) hyperkalemic kaexylate (polystyrene sulfonate) -OR- furosemide |
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what is the blood pressure goal for patient with CKD?
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<130/<80
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What are protein restriction requirements for patient with CKD?
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0.6 g/kg/day for patients with <25 ml/min/1.73 m2
titrate protein intake up to 0.75g/kg/day when patients cannot achieve or maintain adequate nutritional status with lower protein diet |
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why are blood transfusions avoided in CKD patients?
when would would give blood transfusion to CKD patient? |
introduction of antibodies can increase the risk of transplantation rejection in the future
if they are completely hemodynamically compromised |
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what route of admin is used for epoetin-alfa and darbopoetin-alfa?
|
SQ unless patietn is on hemodialysis and then IV
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which has a longer DOA, epoetin-alfa or darbopoetin-alfa?
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darbopoetin-alfa
**epoetin-alfa is the dame molecular structure as human EPO; darbopoetin-alfa is the same as EPO but has been modified from 3 N-linked carbohydrate chains to 5) |
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with ESAs, how quickly do you want to increase hematocrit? Hgb? What should target Hgb be?
|
goal of ESAs is to increase hematocrt by 1-2%/week and normalize iron stores
If >1g/dL increase in Hgb per 2 weeks, decrease dose by 25% If <1g/dL increase in Hgb after 4 weeks, increase dose by 25% target Hgb goal should be <12 g/dL (10ish) |
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Name SEs of Epoetin-alfa
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hypertension (5-24%)
seizures (3%) |
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How frequent do you need to dose?
epoetin-alfa darbopoetin-alfa |
epoetin: 3X/week, with best case scenario 1X/week if patient has high dose and no HD
darbopoetin: 1X/week, or best case scenario Q 3weeks in patient with higher dose and no HD |
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what are appropriate monitoring paramters for ESAs?
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Hgb Q week until stable
**then q 2-4 weeks iron studies monthly X 3 months **then quarterly blood pressure |
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why is ESA resistance so common?
|
IRON DEFICIENCY= MAIN REASON
also, infection/inflammation chronic blood loss oseitis fibrosa (complication of hyperphosphatemia) aluminum toxicity |
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What is goal ferritin and TSAT for CKD pt on ESA?
|
ferritin= 200-500 ng/mL (in normal patient 200 is at ULN)
TSAT= >20% (normal patient 20-50%) |
|
iron dextran
dose SEs test dose? |
cumulative dose =1000 mg if non-HD patient; otherwise, break up the dosing
SEs: anaphylaxis that results in death; fever; malaise; flushing; myalgias REQUIRES TEST DOSE (25 mg one time dose, wait 1 hour and observe) |
|
Ferric gluconate
dose SEs test dose? |
cumulative dose= 1000 mg
SEs that are also present with iron sucrose: cramps N/V hypotension SEs different than iron sucrose: rash flushing pruritis hypersenstivity (rare) NO TEST DOSE NECESSARY |
|
iron sucrose
dose SEs test dose? |
1000 mg cumulative dose
SEs that are also present with ferrous gluconate: cramps N/V hypotension SEs different from ferrous glucnoate: diarrhea HA NO TEST DOSE NECESSARY! |
|
Ferumoxytrol
SEs limitations of use? |
SEs:
hypersensitivity; serious rxn hypotension diarrhea LIMITATIONS -May alter MRI imaging -has only been compared to other oral therapy; has not been compared to other IV products |
