Renal Disease Flashcards

Drugs that require adjustment in renal impairment include: (Select ALL that apply.)

Labs / Tests:

Na (mEq/L) = 138 (135 – 145)
K (mEq/L) = 6.1 (3.5 – 5)
Cl (mEq/L) = 99 (95 – 103)
HCO3 (mEq/L) = 24 (24 – 30)
BUN (mg/dL) = 15 (7 – 20)
SCr (mg/dL) = 1.6 (0.6 – 1.3)
Glucose (mg/dL) = 126 (100 – 125)
Ca (mg/dL) = 8.9 (8.5 – 10.5)
WBC (cells/mm³) = 6.5 (4 – 11 x 10³)
Hgb (g/dL) = 14.8 (13.5 – 18 male, 12 – 16 female)
Hct (%) = 45 (38 – 50 male, 36 – 46 female)
Plt (cells/mm³) = 130 (150 – 450 x 10³)
Albumin (g/dL) = 3.8 (3.5 – 5)
A1C (%) = 7.3

Which treatment is warranted based on this patient's laboratory test results?

Which of the following drugs can be initiated in a patient with an estimated GFR of 20 mL/min/1.73 m²?

Which of the following is a complication of chronic renal failure?

JS has been using famotidine 20 mg BID for five years. Initially, his creatinine clearance was estimated at 78 mL/min. His blood pressure has been poorly controlled, which has worsened his renal function and the creatinine clearance has declined to 26 mL/min. Which of the following statements is correct regarding his famotidine use?

Which label on the figure best represents the site where dapagliflozin, an SGLT2 inhibitor, exerts its mechanism of action?

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LM is a 73-year-old female. She is 5'2" and weighs 102 pounds. Her serum creatinine today is 1.4 mg/dL. What is LM's creatinine clearance?

Which of the following is an appropriate initial treatment for hyperphosphatemia in chronic kidney disease?

Labs

Hgb (g/dL) = 9.8 (12 – 16)
Hct (%) = 26.8 (36 – 46)
Plt (cells/mm³) = 215 (150 – 450 x 10³)
AST (IU/L) = 15 (10 – 40)
ALT (IU/L) = 18 (10 – 40)
TSH (mIU/L) = 3.2 (0.3 – 3)Amylase (units/L) = 182 (60 – 180)Lipase (units/L) = 165 (5 – 160)PTH (ng/L) = 126 (10 – 65)

Which of TN's lab abnormalities are most consistent with the diagnosis of CKD?

Labs:
Na (mEq/L) = 132 (135 – 145)
K (mEq/L) = 4.8 (3.5 – 5)
Cl (mEq/L) = 102 (95 – 103)
HCO3 (mEq/L) = 28 (24 – 30)
BUN (mg/dL) = 28 (7 – 20)
SCr (mg/dL) = 2.8 (0.6 – 1.3)
Glucose (mg/dL) = 287 (100 – 125)
Ca (mg/dL) = 7.7 (8.5 – 10.5)
Mg (mEq/L) = 2.1 (1.3 – 2.1)A1C (%) = 9.2
PO4 (mg/dL) = 5.2 (2.3 – 4.7)

Which medication is currently indicated for TN?

After evaluating the ultrasound findings, which reference should the pharmacist consult to determine best practices in managing TN's condition?

A new prescription is written for Sensipar. Which of TN's laboratory results is consistent with an indication for this medication?

How should TN be counseled to take the lanthanum carbonate? (Select ALL that apply.)

Which of the following drugs can require a decrease in dose or an increase in the dosing interval with impaired renal function? (Select ALL that apply.)

Past Medical History: hypertension, type 2 diabetes, diabetic neuropathy, stomach ulcers, constipation

Medications: metformin extended-release 1,500 mg PO daily, Levemir FlexTouch 10 units SC QHS, Accupril 20 mg PO daily, Neurontin 900 mg PO TID, esomeprazole 20 mg PO daily, Linzess 72 mcg PO daily, aspirin 81 mg PO daily

Physical Exam / Vitals:
Height: 5’5”, Weight: 121 pounds
BP: 176/96 mmHg, HR: 91 BPM
RR: 15 BPM, Temp: 100.8°F, Pain: unable to assess, O2 Sat: 96% on room air

Several days later, KL is ready to be transferred for stroke rehabilitation. Her labs and vitals have remained relatively unchanged since admission to the hospital. Which of her home medications is contraindicated?

Which of the following statements concerning bone metabolism abnormalities in chronic kidney disease (CKD) is correct?

SC has lupus-related renal disease. Her serum creatinine today is 2.7 g/dL and the potassium is 6.2 mEq/L. In order to reduce the potassium, the physician has prescribed oral sodium polystyrene sulfonate. When can the physician expect the drug to take effect?

Admission Physical Exam
General: ill-appearing female
HEENT: A&O x 3, PERRLA, dry mucous membranes, no signs of thrush or mucositis
Lungs: decreased breath sounds, R > L
CV: RRR
GI: no abdominal tenderness, decreased bowel sounds
Extremities: rheumatoid-like bone deformities in both hands, decreased range of motion in hands but no obvious swelling, poor skin turgo

An accurate assessment of IH's clinical presentation on the day of admission would include:

Which of the following drugs and/or procedures could have contributed to the change in renal function noted on the lab report today? (Select ALL that apply.)

Which of the following interventions should the pharmacist recommend for IH today?

What is the indication for Renvela in TH?

Sensipar is used for what purpose in TH?

TH should be instructed to separate Renvela from administration of which medication?

After complaining of leg pain and increased shortness of breath on hospital day 2, a lower extremity ultrasound was performed and a deep vein thrombosis was found in his left calf. A CT of the chest revealed a pulmonary embolism. Which of the following regimens is appropriate to start in TH to treat the acute DVT and PE?

Which combination of TH's medications could be contributing to his hypercalcemia?

A medical resident is writing post-dialysis orders for a patient under his care. She asks the pharmacist what factors cause a drug to be removed during hemodialysis. Which of the following statements concerning drug removal is correct?

Which label on the figure best represents the site where bumetanide exerts its mechanism of action?

**Picture**

Which of the following statements is correct regarding vitamin D?

What is the mechanism of insulin when treating hyperkalemia?

PW was prescribed lanthanum carbonate tablets. How should the daily dose be administered?