NAPLEX - Ch. 18 Renal Disease

JS has been using pregabalin 150 mg BID for 5 years. Initially, his creatinine clearance was estimated at 78 mL/min. His blood pressure has been poorly controlled for the past 5 years. This has worsened his renal function and the creatinine clearance has declined to 34 mL/min. Choose the correct statement: A. Dizziness and somnolence would increase B. Pregabalin does not cause CNS effects C. Pregabalin is not cleared renally D. Dizziness and somnolence would decrease E. The efficacy of pregabalin would decrease

A. Dizziness and somnolence would increase

PW was prescribed Fosrenol tablets. Which of the following statements is correct regarding administration? A. The daily dose should be divided and chewed with meals to prevent dietary phosphate from being absorbed. B. The daily dose should be divided and swallowed between meals; they work by binding phosphate in the serum and are not well-absorbed if food is taken concurrently. C. The daily dose should be chewed in the evening, at bedtime. D. The daily dose should be swallowed in the morning, half an hour before breakfast. E. The daily doses should be divided and chewed with meals; they work by binding phosphate in the serum and are not well-absorbed without food taken concurrently.

A. The daily dose should be divided and chewed with meals to prevent dietary phosphate from being absorbed.

Which of the following statements is correct regarding vitamin D? A. Vitamin D3 is the primary dietary source of vitamin D. B. Cholecalciferol is synthesized in the skin with UV light exposure. C. Vitamin D analogs (paricalcitol and doxercalciferol) cause more hypercalcemia than calcitriol. D. Calcitriol is used to decrease dietary phosphate absorption. E. Calcitriol is the active form of vitamin D2.

B. Cholecalciferol is synthesized in the skin with UV light exposure.

Many drugs are renally cleared and must have their doses adjusted if significant renal impairment is present. Drugs that require adjustment in renal impairment include: Select ALL that apply. A. Moxifloxacin B. Gentamicin C. Vancomycin D. Enoxaparin E. Fluconazole

B. Gentamicin C. Vancomycin D. Enoxaparin E. Fluconazole

Which of the following statements concerning bone metabolism abnormalities in CKD is correct? A. Initially, bone metabolism abnormalities are caused by a rise in calcium. B. Hyperphosphatemia causes an increase in the release of PTH. C. A benefit of hyperphosphatemia is improved bone health. D. Hyperphosphatemia can lead to anemia. E. To counteract the increase in phosphate levels, it is necessary to give injectable phosphate binders.

B. Hyperphosphatemia causes an increase in the release of PTH.

Many drugs must be "dose-adjusted" with renal impairment. 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. A. Indomethacin B. Levofloxacin C. Rivaroxaban D. Estradiol E. Famotidine

B. Levofloxacin C. Rivaroxaban E. Famotidine

Which of the following is a complication of chronic renal failure? A. Hypophosphatemia B. Metabolic acidosis C. Hypokalemia D. Hyperthyroidism E. Respiratory acidosis

B. Metabolic acidosis

Which of the following agents requires dose adjustment with impaired renal function? A. Tigecycline B. Metoclopramide C. Oxacillin D. Nafcillin E. Clindamycin

B. Metoclopramide

A patient who was receiving enalapril and spironolactone developed renal insufficiency secondary to acute febrile illness with vomiting and diarrhea. Fluid resuscitation is begun and an ECG is obtained in the emergency department, which demonstrates changes consistent with hyperkalemia. What should be administered immediately to this patient to prevent potentially fatal cardiac arrhythmias? A. Sodium bicarbonate B. Dextrose C. Calcium gluconate D. Albuterol E. Kayexalate

C. Calcium gluconate

Which of the following statements concerning hyperphosphatemia in CKD is correct? A. Limiting dietary phosphate intake is first line treatment and is usually sufficient for most patients long-term. B. Calcium-based agents are cheap, work well and side effects are minor. C. Lanthanum is a calcium-free, aluminum-free phosphate binder. D. Sevelamer products (Renvela, Renagel) are aluminum-free, calcium-free phosphate binders that have the added benefit of lowering LDL cholesterol. E. Auryxia contains ferric citrate, a form of iron that is systemically absorbed.

C. Lanthanum is a calcium-free, aluminum-free phosphate binder. D. Sevelamer products (Renvela, Renagel) are aluminum-free, calcium-free phosphate binders that have the added benefit of lowering LDL cholesterol. E. Auryxia contains ferric citrate, a form of iron that is systemically absorbed.

SC has lupu-related renal disease. her SCr today is 2.7 g /dL and the potassium is 6.2 mEq/L. In order to reduce the potassium the physician has prescribed SPS to be given orally. Choose the correct statement concerning SPS: A. The brand name is Valtessa. B. The potassium should be lowered to 3.2 mEq/L. C. This drug may stabilize cardiac tissue to reduce arrhythmia risk. D. This drug is a cation exchange resin that binds potassium in the gut. E. The potassium will decrease quickly, as the onset of action is around 15 minutes.

D. This drug is a cation exchange resin that binds potassium in the gut.

Which of the following drugs cannot be used in patients with severe renal impairment? A. Fluoxetine B. Levothyroxine C. Enoxaparin D. Voriconazole tablets E. Jardiance

E. Jardiance

Which of the following drugs is less likely to be substantially removed during hemodialysis? A. Gentamicin (Vd 0.3 L/kg) B. Cefepime (Vd 0.26 L/kg) C. Vancomycin (Vd 0.7 L/kg) D. Methotrexate (Vd 0.8 L/kg) E. Levofloxacin (Vd 1.27 L/kg)

E. Levofloxacin (Vd 1.27 L/kg)

A pharmacist is asked by a medical resident what factors cause a drug to be removed during HD. The resident is attempting to write post-dialysis orders for a patient under his care. Which of the following statements concerning drug removal are correct? A. Highly protein bound drugs are easily removed by dialysis, versus drugs with little protein binding, as the membrane has high affinity for proteins. B. The dialysis has substantial effect on the clearance of drugs that are largely cleared by the liver. C. High-flux dialysis membranes (or filters) are less efficient at removing drugs. D. The larger the volume of distribution (Vd) the larger the effect of drug clearance by dialysis; drugs with a larger Vd are cleared more easily than drugs with a smaller Vd. E. Smaller molecular compounds (smaller drugs) are more easily cleared by dialysis.

E. Smaller molecular compounds (smaller drugs) are more easily cleared by dialysis.

Which of the following statements concerning vitamin D supplementation in CKD is correct? A. The newer vitamin D analogs such as doxercalciferol and paricalcitol are associated with higher degrees of hypercalcemia, which makes them of little use. B. Vitamin D3 is ergocalciferol C. Calcitriol (Rocaltrol) is the active form of vitamin D2 D. Vitamin D works to decrease calcium levels, which in turn decreases PTH release E. Vitamin D supplementation is often required in renal disease, but results in increased dietary calcium absorption, which can be harmful

E. Vitamin D supplementation is often required in renal disease, but results in increased dietary calcium absorption, which can be harmful

Which of the following drugs can be given to a patient with a GFR of 25? A. Invokana B. Meperidine C. Metformin D. Stribild E. Zosyn

E. Zosyn