renal-drug-induced

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Ambestul
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13289
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renal-drug-induced
Updated:
2010-04-06 18:40:50
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exam 2
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exam 2
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  1. patient related risk factors
    >60, intravasc vol dep, dec EABV, GFR <60 ml/min
  2. co-morbidities causing risk factors
    DM, HF, sepsis
  3. ACE and ARB increasing SCr is ok until
    increase by >30% beyond baseline
  4. tubular cell toxicity
    impairment of mitochondrial fxn, interference w tubular transport, increased oxidative stress, free radical formation, most common is acute tubular necrosis
  5. inflammation-pathogenic mechanism of drug-induced nephrotoxicity
    glomerulonephritis, acute interstitial nephritis, chronic interstitial nephritis
  6. crystal nephropathy
    crystal production precipitates and obstructs causing interstitial rxn
  7. rhabdomyolysis
    myoglobin causes direct toxicity, tubular obstruction, alterations in GFR, statins and illegal drugs of abuse
  8. NSAIDs, ACE, ARBs cause nephrotoxicity by:
    altering intra-glomuler hemodynamics
  9. pts at risk, NSAIDs, ACEs and ARBs causing nephrotoxicity
    DRUGS ALTERING INTRA-GLOMERULAR HEMODYNAMICS-underlying renal insufficiency, intravascular vol depl, elderly, concomittant use of NSAIDs, ACE, ARBs, cyclosporine, and/or tacrolimus
  10. prevention for DIN w NSAIDs, ACE and ARBs
    DRUGS ALTERING INTRA-GLOMERULAR HEMODYNAMICSuse analgesics with less PG effect, correct vol depl prior, esp if chronic dep, monitor renal fxn and vital signs following init or dose inc esp if w pts at risk, e.g. SCr q 2 weeks
  11. pts at risk for DIN w cyclosporine, tacrolimus
    DRUGS ALTERING INTRA-GLOMERULAR HEMODYNAMICSunderlying renal insuff, intravasc vol dep, elderly, concomitt NSAIDs, ACE, ARB cyclosporine, and tacrolimus AND excessive dose, concomitant with other nephro drugs or drugs that inhibit cyclosporin or tacrolimus metabolism
  12. prev for DIN with cyclosporine, tacrolimus
    DRUGS ALTERING INTRA-GLOMERULAR HEMODYNAMICSmonitor serum drug concentrations and renal fxn, use lowest effective dose, calc channel blockers to dilate afferent arteriole
  13. pts at risk for DIN w AGs
    DRUGS ASSOCIATED WITH TUBULAR CELL TOXICITY-5-15% of pts, underlying renal insuffic, dur >10d, trough conc >2mcg/ml, concom liver disease, hypoalbuminemia
  14. preven for DIN w AGs
  15. DRUGS ASSOCIATED WITH TUBULAR CELL TOXICITY--use extended interval
    • - admin during active period of day
    • -Limit duration of therapy
    • -Monitor serum drug levels and renal function 2-3
    • times a week
    • -Maintain trough levels < 1 mcg/ml
  16. pts at risk for DIN w Amp B
  17. DRUGS ASSOCIATED WITH TUBULAR CELL TOXICITY-underlying renal insuff, rapid inf, lg daily doses >3gm,
    deoxycholate>lipid formulations, prolonged duration
  18. prevention for DIN for Amp B
  19. DRUGS ASSOCIATED WITH TUBULAR CELL TOXICITY-saline hydration before and after dose admin, consider administering as a continuous inf over 24 hours, use liposomal formulation, limit duration of therapy and cumulative dose
  20. pts at risk for DIN for contrast dye
  21. DRUGS ASSOCIATED WITH TUBULAR CELL TOXICITY-underlying renal insuff, age >70, diabetics, heart failure, vol depl, repeated exposures
  22. prevent for DIN in contrast dye
  23. DRUGS ASSOCIATED WITH TUBULAR CELL TOXICITY-use low osmolar contrast in the lowest possible dose and avoid multiple procedures in 24-48 hrs, 0.9% saline or sod bicarb (154mEq/L) inf pre and post procedure, withold NSAIDs and diuretics at least 24 hours pre and post procedrure(preventative), monitor renal fxn 24-48 hrs post procedure, consider N-acetylcystein peri-proc
  24. Pts at risk for DIN-APAP, ASA, NSAIDs
    CAUSING CHRONIC INTERSTITIAL NEPHROPATHY-HISTORY OF CHRONIC PAIN, OLDER AGE WOMEN, CUMULATIVE CONSUMPTION OF ANALG >1GM/DAY FOR >2 YRS
  25. prevention for DIN caused by APAP, ASA and NSAIDs, causing chronic insterstitial nephropathy
    avoid long term use, particularly more than 1 analgesic simulataneously, use alt agents in pts with chronic pain
  26. pts at risk for DIN caused by lithium
    causing chronic interstitial nephropathy, elevated drug levels
  27. prevention for DIN caused by lithium
    causing chronic interstitial nephropathy, maintain drug levels within the therapeutic range, avoid vol depletion
  28. pts at risk for DIN caused by acyclovir, sulfa abx, mtx, triamterene, cipro
    causing crystal nephropathy, vol depl, underlying renal insufficiency, excessive dose, IV route
  29. prevention of DIN caused by acyclovir, sulfa abx, mtx, triamterene, cipro
    causing chronic interstitial nephropathy, d/c or reduce dose, ensure hydration, establish high urine flow, use the oral route
  30. Aristolochia fangchi
    interstitial renal fibrosis, urothelial carcinoma
  31. Djenkol bean (pithecellobium labatum)
    tubular and glomerular cell necrosis
  32. Impila (Callilepis laureola)
    necrosis of proximal tubule and loop of Henle
  33. Wild mushrooms
    tubular interstitial nephritis and fibrosis
  34. Cat's clow (uncaria tomentosa)
    Acute renal failure
  35. Licorice (Glycyrrhiza glabra)
    hypernatremia, hypokalemia
  36. Senna, cascara sagrada, rhubarb
    hypokalemia
  37. Noni fruit
    hyperkalemia
  38. Juniper berry, parsley, dandelion, horsetail, asparagus root, lovage root, goldenrod, Uva ursi, stinging nettle leaf; alfalfa
    increase diuresis of water without electrolytes
  39. some asian, chinese, and ayurvedic herbal products may contain heavy metals and unlisted drugs(NSAIDs)
    nephrotoxicity
  40. Echinacea
    increased probablity of transplant rejection
  41. St. John's Wort
    increased probability of transplant rejection

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