front 1 Drugs that require adjustment in renal impairment include: (Select ALL that apply.) | back 1 Enoxaparin Gentamicin Vancomycin Fluconazole |
front 2 Labs / Tests: Na (mEq/L) = 138 (135 – 145) Which treatment is warranted based on this patient's laboratory test results? | back 2 Nebulized albuterol (to push K+ back into the cells) |
front 3 Which of the following drugs can be initiated in a patient with an estimated GFR of 20 mL/min/1.73 m2? | back 3 Zosyn for an infection |
front 4 Which of the following is a complication of chronic renal failure? | back 4 Metabolic acidosis The ability of the kidney to reabsorb bicarbonate decreases as chronic renal disease progresses. This can cause a metabolic acidosis. |
front 5 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? | back 5 Famotidine could accumulate and cause adverse effects The efficacy may not change, but the side effects would be expected to increase due to increased drug levels. When renal clearance declines the concentration of drugs that are renally cleared will increase. |
front 6 Which label on the figure best represents the site where dapagliflozin, an SGLT2 inhibitor, exerts its mechanism of action? **picture** | back 6 A |
front 7 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? | back 7 26 mL/min Actual body weight should be used to calculate her creatinine clearance because it is less than her ideal body weight (50.1 kg). |
front 8 Which of the following is an appropriate initial treatment for hyperphosphatemia in chronic kidney disease? | back 8 Limiting dietary phosphate intake |
front 9 Labs Hgb (g/dL) = 9.8 (12 – 16) Which of TN's lab abnormalities are most consistent with the diagnosis of CKD? | back 9 Decreased hemoglobin and increase parathyroid hormone |
front 10
Labs:
Which medication is currently indicated for TN? | back 10 Renvela |
front 11 After evaluating the ultrasound findings, which reference should the pharmacist consult to determine best practices in managing TN's condition? | back 11 The KDIGO guidelines |
front 12 A new prescription is written for Sensipar. Which of TN's laboratory results is consistent with an indication for this medication? | back 12 PTH |
front 13 How should TN be counseled to take the lanthanum carbonate? (Select ALL that apply.) | back 13 Take with meals Chew tablet thoroughly Seperate from levothyroxine |
front 14 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.) | back 14 Levofloxacin Lithium Metoclopramide |
front 15
Past Medical History: hypertension, type 2 diabetes,
diabetic neuropathy, stomach ulcers, constipation 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? | back 15 Metformin ER |
front 16 Which of the following statements concerning bone metabolism abnormalities in chronic kidney disease (CKD) is correct? | back 16 Hyperphosphatemia causes an increase in the release of parathyroid hormone |
front 17 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? | back 17 Hours to days |
front 18
Admission Physical Exam
An accurate assessment of IH's clinical presentation on the day of admission would include: | back 18 Hydration |
front 19 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.) | back 19 Vancomycin Chest CT |
front 20 Which of the following interventions should the pharmacist recommend for IH today? | back 20 Change IV fluids to D5NS |
front 21 What is the indication for Renvela in TH? | back 21 It decreases phosphate absorption Hyperphosphatemia occurs most often in late-stage renal insufficiency since phosphate is renally excreted. Oral phosphate binders decrease GI absorption of dietary phosphate, binding it in the intestine. This decreases phosphate levels. Some available agents include sevelamer hydrochloride (Renagel), sevelamer carbonate (Renvela), calcium acetate (Phoslyra) and lanthanum carbonate (Fosrenol). |
front 22 Sensipar is used for what purpose in TH? | back 22 Sensipar is a calcimimetic used to treat hyperparathyrodism Cinacalcet (Sensipar) is a calcimimetic that works to decrease PTH release from the parathyroid gland. |
front 23 TH should be instructed to separate Renvela from administration of which medication? | back 23 Synthroid Phosphate binders should be separated from levothyroxine, as absorption could be affected. Ferric gluconate is administered IV, so there is not a co-administration issue with the oral medications. |
front 24 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? | back 24 Heparin plus warfarin This patient is receiving hemodialysis. Anticoagulants must be carefully selected and monitored. Fondaparinux, rivaroxaban and dabigatran are all contraindicated in severe renal impairment for DVT/PE. Enoxaparin should be avoided, if possible, in hemodialysis patients. Heparin and warfarin can be used in severe renal insufficiency. |
front 25 Which combination of TH's medications could be contributing to his hypercalcemia? | back 25 Calcium carbonate and calcitriol Calcitriol (the active form of vitamin D3) is used for hyperparathyroidism. It causes increased absorption of calcium carbonate (Tums) which can lead to hypercalcemia. Paricalcitol (Zemplar) and doxercalciferol (Hectorol) are newer active vitamin D analogues that cause less hypercalcemia. |
front 26 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? | back 26 Smaller molecules are more easily cleared by dialysis |
front 27 Which label on the figure best represents the site where bumetanide exerts its mechanism of action? **Picture** | back 27 E |
front 28 Which of the following statements is correct regarding vitamin D? | back 28 Cholecalciferol is synthesized in the skin with ultraviolet light exposure |
front 29 What is the mechanism of insulin when treating hyperkalemia? | back 29 It moves the K+ intracellularly Regular insulin is administered IV (with dextrose) to treat hyperkalemia because it causes potassium to shift into the cells (intracellularly). |
front 30 PW was prescribed lanthanum carbonate tablets. How should the daily dose be administered? | back 30 Divide the daily dose and chew before each meal |