Pharmacology I: Exam #4 Study Guide
10. Per 2012 KDIGO AKI guidelines, which of the following intravenous fluids is recommended as first-line therapy for the prevention of acute kidney injury? A. 0.45% saline B. 0.9% saline C. Hydroxyethyl starch D. 20% albumin E. 0.25% saline
B
11. Which of the following equations is most appropriate for estimating a patient's GFR for the purpose of determining their CKD category/stage? A. 6-Variable MDRD B. CKD-EPI equation C. CKD_cysC equation D. BISil equation
B
14. Which of the following is a potential advantage of using ferric citrate as a phosphate-binding agent compared to other sevelamer carbonate? A. It is available in a powder formulation. B. It may increase iron indices. C. It is available as a chewable tablet. D. It can be given intravenously or orally. E. It does not cause stool discoloration.
B
14. Which of the following statements about drug dosing considerations in acute kidney injury is correct? A. Drug clearances are attained by intermittent hemodialysis, continuous renal replacement therapy (CRRT), and hybrid renal replacement therapy are generally similar. B. Drug clearance is expected to increase when higher ultrafiltration rates are used during CRRT. C. Drug clearance is expected to decrease when higher dialysate flow rates are used during CRRT. D. Drug clearance between patients with acute kidney injury and chronic kidney disease is expected to be similar. E. Drug clearance is unaffected by different renal replacement therapies.
B
17. J.R. is a 68-year-old Caucasian man (60 kg, 5′7″ [170 cm]) with a history of hypertension, cerebral stroke, and benign prostatic hypertrophy. He presents to the ambulatory care clinic today for evaluation of a viral infection to be treated with acyclovir. His serum creatinine value today is 0.63 mg/dL (56 µmol/L). Which one of the following approaches should be used to assess this patient's kidney function for the purpose of renal dose adjustment for acyclovir? A. Measure a chromium-jatslabeled ethylenediaminetetraacetic acid GFR B. Estimate creatinine clearance using the CG equation C. Estimate GFR using the MDRD equation D. Conduct a timed 24-hour urine collection
B
2. Active drug secretion occurs most often in which of the following nephron segments? A. Glomerulus B. Proximal tubule C. Loop of Henle D. Distal tubule
B
20. In the clinical setting, the renal clearance of PAH is considered an index of _______. A. fractional excretion of sodium B. renal plasma or blood flow C. glomerular filtration rate D. renal tubular reabsorption
B
3. A 52-year-old (80 kg) man is in the intensive care unit with sepsis and acute kidney injury. Over the last 24 hours, his serum creatinine increased from a baseline of 0.9 to 1.9 mg/dL (80 to 168 µmol/L) and he has had 100 mL/hr of urine output for the last 6 hours. His urinalysis is positive for the presence of epithelial cells, granular casts, and WBCs. According to the Kidney Disease Improving Global Outcomes (KDIGO) AKI classification, which stage of acute kidney injury does this patient have? A. Stage I B. Stage II C. Stage III D. Stage IV E. Stage V
B
5. A 53-year-old male is receiving furosemide IV for the treatment of fluid overload. If his response to furosemide decreases, all of the following strategies can be utilized to overcome diuretic resistance EXCEPT ___ A. Increase dose of furosemide B. Change furosemide from intravenous to oral route C. Change furosemide to a continuous infusion D. Decrease dietary sodium ingestion E. Add oral metolazone
B
7. A 67-year-old female with diabetic CKD, urinary albumin-to-creatinine ratio (uACR) of 55.4 mg/g (6.3 mg/mmol), a serum potassium of 4.5 mEq/L (mmol/L), and an eGFR of 38 mL/min/1.73 m2 is started on irbesartan 75 mg po once daily. The eGFR and serum potassium levels should be monitored at what time point after initiation of therapy? A. In ≤2 weeks B. Within 2 to 4 weeks C. Within 4 to 12 weeks D. In 6 months E. If the patient notices changes in urine output
B
8. According to KDIGO guidelines, what is the target blood pressure in a patient with kidney disease secondary to long-standing hypertension and an uACR = 423 mg/g (47.8 mg/mmol)? A. ≤125/75 mm Hg B. ≤130/80 mm Hg C. ≤135/85 mm Hg D. ≤140/90 mm Hg E. ≤150/90 mm Hg
B
9. Which is the most appropriate method for initial testing of proteinuria in a patient with CKD risk factors? A. Urine protein:albumin ratio B. Urine albumin:creatinine ratio C. 24-Hour urine protein excretion D. Urine dipstick for total protein
B
TW is a 65 yo African American male 5'8', 220lbs BMI 33. He has Diabetes type II, Hypertension, GERD, Osteoarthritis. 6 months ago TW was diagnosed with stage 4 Chronic Kidney Disease. His current medications include HCTZ 25mg QD, Metformin 1000mg BID, Glipizide 10mg QD, ASA 81mg QD, Simvastatin 40mg QHS, Ibuprofen 200mg PRN, Omeprazole 20mg Qam. Today at clinic, TW's random urine spot dipstick indicated his albumin-to-creatinine ration was 30-300mg/g. What medication is most appropriate to initiate in TW at this time? A.Diltiazem B.Lisinopril C.Furosemide D.Spironolactone
B
TW is a 65 yo African American male 5'8', 220lbs BMI 33. He has Diabetes type II, Hypertension, GERD, Osteoarthritis. TW has which of the following factors that will directly result in kidney damage (initiation) and promote further decline in kidney function over his life span (progression)? A.African American Race and Hypertension B.Diabetes and Hypertension C.Obesity and Diabetes D.Obesity and Hypertension
B
Which of the following medications originally was marketed as Diamox Sequels but now is only available in generic form as 500mg ER-12 hour capsules? a.Ethacrynic acide b.Acetazolamide c.Mannitol d.Indapamide
B
With the possible exceptions of metolazone and indapamide, most thiazide diuretics are ineffective when the GFR is less than ________________mL/minute.
30-40
To avoid ototoxicity, the rate of furosemide infusions should not exceed_____________
4 mg/min
1. A 71-year-old male long-term care resident is admitted to the hospital with altered mental status. His admission laboratory values show a blood urea nitrogen (BUN) of 43 mg/dL (15.4 mmol/L), serum creatinine (Scr) of 2.8 mg/dL (248 µmol/L). Urinalysis reveals presence of white blood cells, red blood cells, and granular casts. His calculated fractional excretion of sodium (FeNa) is 2.2%. The most likely etiology of his acute kidney injury is A. Intrinsic acute kidney injury B. Bladder obstruction C. Postrenal acute kidney injury D. Functional acute kidney injury E. Volume depletion
A
1. The glomerulus is primarily responsible for ______ of unbound drug in the kidney. A. filtration B. reabsorption C. secretion D. endocytosis
A
11. A 45-year-old male with CKD category 3b (eGFR of 42 mL/min/1.73 m2) is seen in the nephrology clinic. His labs today show the following: Hb 8.5 g/dL (85 g/L; 5.28 mmol/L) (down from 10.5 g/dL [105 g/L; 6.52 mmol/L] three months ago), TSat 34% (0.34), serum ferritin 610 ng/mL (mcg/L; 1370 pmol/L). He reports feeling tired and less able to do his activities of daily living. Work-up shows no signs of active bleeding. Should this patient be started on an erythropoietic-stimulating agent (ESA) and what is the rationale? A. Yes, his Hb is below 10 g/dL (100 g/L; 6.21 mmol/L) and the extent of decline indicates a high likelihood of needing a blood transfusion. B. Yes, an ESA is indicated to enhance his quality of life and decrease mortality risk. C. Yes, his Hb is below 12 g/dL (120 g/L; 7.45 mmol/L) and the goal is to normalize the Hb in nondialysis CKD patients. D. No, an ESA will not be effective since his iron indices are low and iron should be administered first. E. No, his Hb is above 8 g/dL (80 g/L; 4.97 mmol/L) and he has not had a large decline in Hb since his last visit.
A
11. You get a call from a physician inquiring about use of N-acetylcysteine (NAC) for prevention of contrast-induced acute kidney injury (CI-AKI). Which of the following would be the most appropriate response to this question? A. Based on current evidence, NAC is unlikely to provide any benefit for CI-AKI prevention. B. Based on current evidence, NAC is more effective when used in combination with atorvastatin for CI-AKI prevention. C. Based on current evidence, ascorbic acid is more effective than NAC in preventing CI-AKI. D. Based on current evidence, NAC is not recommended for prevention but can be used for the treatment of CI-AKI. E. Based on current evidence, NAC is not recommended for prevention as it increases the risk of CI-AKI.
A
12. Which of the following dialysis modalities is/are most likely to cause hypotension? A. Intermittent hemodialysis B. CVVH C. CVVHD D. CVVHDF E. Sustained low-efficiency dialysis (SLED)
A
13. A 72-year-old critically ill male with acute kidney injury requires vancomycin for the treatment of ventilator-associated pneumonia. When determining how to individualize vancomycin dosing for this patient, all of the following parameters need to be taken into account EXCEPT A. Serum phosphorus levels B. Serum creatinine C. Urine output D. Fluid status E. Utilization of renal replacement therapy
A
13. When using the Cockcroft-Gault equation to estimate creatinine clearance in obese patients, it is recommended that lean body weight be used in patients with: A. BMI ≥40 kg/m2 B. BMI 30-39 kg/m2 C. BMI 25-29 kg/m2 D. None of the above
A
14. J.S. is a 70-year-old African American male (5′8″ [173 cm], 85 kg) with a history of hypertension and CKD. His serum creatinine today is 1.50 mg/dL (133 µmol/L)(using the IDMS calibrated assay). What is his estimated creatinine clearance? A. 55.0 mL/min (0.92 mL/s) B. 43.5 mL/min (0.72 mL/s) C. 37.2 mL/min (0.62 mL/s) D. 29.4 mL/min (0.49 mL/s)
A
16. What is J.S.'s estimated GFR when expressed in mL/min (mL/s)? A. 38.9 mL/min (0.65 mL/s) B. 45.6 mL/min (0.76 mL/s) C. 65.2 mL/min (1.09 mL/s) D. 72.1 mL/min (1.20 mL/s)
A
6. The decreased serum creatinine values observed during dobutamine therapy are likely due to: A. analytical interference B. increased tubular secretion of creatinine C. increased GFR caused by dobutamine D. increased muscle breakdown
A
7. Which of the following kidney function indices is least influenced by changes in fluid or volume status? A. Serum creatinine B. Blood urea nitrogen C. Urine specific gravity D. Urine sodium
A
8. A 82-year-old female is admitted to the medical intensive care unit with acute kidney injury (AKI). Her labs indicate the following: Na 133 mEq/L (mmol/L), K 4.8 mEq/L (mmol/L), Cl 95 mEq/L (mmol/L), CO2 22 mEq/L (mmol/L), PO4 6.6 mg/dL (2.13 mmol/L), Ca 8.1 mg/dL (2.03 mmol/L), BUN 33 mg/dL (11.8 mmol/L), Scr 2.8 mg/dL (248 µmol/L). Which of the following electrolyte abnormalities does she have that are commonly found in patients with AKI? A. Hyperphosphatemia B. Hyperkalemia C. Hyponatremia D. Hypercalcemia E. Hyperchloremia
A
9. Which of the following agents would be preferred in a hemodialysis patient with ESRD, a PTH persistently above 700 pg/mL (ng/L; 75 pmol/L), and elevated calcium levels? A. Etelcalcetide B. Cholecalciferol C. Calcitriol D. Ergocalciferol E. Calcifediol
A
KT is a 40 yo Caucasian male 5'10, 240lbs, BMI 34.4 BP 125/84 HR 90. He was recently diagnosed with type II diabetes. He has a past medical history of hyperlipidemia, obesity, and dishydrotic eczema. His medications include: Atorvastatin 40mg QD, Multi-vitamin. Today he will be starting Metformin 1000mg QD. What is the most appropriate recommendation for Chronic Kidney Disease screening and prevention for KT at this time? A.He should receive a urine spot ACR (Albumin to Creatinine ratio) today B.He should receive a 24-hr creatinine clearance test today C.He should be started on and ACE-I today to reduce proteinuria D.He should receive a 24-hr albumin excretion rate in 5 years
A
This class of diuretics are freely filtered at the glomerulus, undergo limited reabsorption by the renal tubule, and are relatively inert pharmacological. By acting as nonreabsorbable solutes that limit the osmosis of water into the interstitial space , they reduce the luminal Na+ concentration to the point that net Na+ reabsorption ceases. a.Osmotic Diuretics b.Aldosterone Antagonists c.Thiazide Diuretics d.Loop Diuretics
A
This diuretic class potently inhibits both the membrane-bound and cytoplasmic forms of an enzyme that can cause nearly complete abolition of NaHCO3 reabsorption in the proximal tubule. a.Carbonic Anhydrase Inhibitors b.SGLT-2 Inhbitiors c.Renin Inhibitors d.V1 Antagonists
A
Which of the following general statements regarding the pathophysiology of chronic kidney disease is TRUE? A.Progression of to ESRD occurs over years to decades B.Rate of GFR decline is very erratic and may even increase over years to decades C.The etiology of the initiating injury determines the mechanism of disease progression which is highly varied D.Most pathological processes in CKD are reversible
A
Which of the following medications inhibit Na+/K+/2Cl- transporter in thick ascending limb of loop of Henle causing powerful diuresis and increased Ca2+ excretion? (Select all that apply) a.Demadex b.Bumex c.Maxide d.Inspra
A,B
Thiazide diuretics cause urinary excretion of which of the following electrolytes? Select all that apply a.Na+ b.Cl- c.Mg2+ d.K+ e.Ca2+
A,B,C,D
Loop diuretics cause urinary excretion of which of the following electrolytes? Select all that apply a.Cl- b.Ca2+ c.Na+ d.K+ e.Mg2+
A,B,C,D,E
Which of the following statements is true regarding thiazide diuretics? (Select all that apply) a.Cause moderate diuresis b.Inhibit Na+/Cl- transporter in distal convoluted tubule. c.Significantly reduce blood pressure d.Reduce potassium excretion e.Efficacy reduced by NSAIDS
A,B,C,E
Which of the following are associated with an increased risk of loop diuretic ototoxicity? Select all that apply a.Ethacrynic Acid b.Oral route c.Coadministered aminoglycosides, carboplatin, paclitaxel d.Furosemide infusions rate of 2mg/min
A,C
Which of the following are potential adverse effects of thiazide diuretics? Select all that apply a.Hypotension b.Hypernatremia c.Photosensitivity d.Hyperuricemia e.Hyperkalemia f.Hypoglycemia
A,C,D
The most dangerous adverse effect of renal Na+ channel inhibitors is hyperkalemia, which can be life threatening. Consequently, amiloride and triamterene are contraindicated in patients with hyperkalemia, as well as in patients concomitantly taking which of the following medications? Select all that apply a.K-Dur b.Torsemide c.Lisinopril d.Albuterol e.ARB's
A,C,E
A healthy 26-year-old woman sustained a significant crush injury to her right upper extremity while on the job at a local construction site. She was brought to the emergency department and subsequently underwent pinning and reconstructive surgery and received perioperative broad-spectrum antibiotics. Her blood pressure remained normal throughout her hospital course. On the second hospital day, a medical consultant noted a marked increase in her creatinine, from 0.8 to 1.9 mg/dL. Her urine output dropped to 20 mL/h. Serum creatine kinase was ordered and reported as 3400 units/L. A. What are the primary causes of this patient's acute kidney injury? How should her kidney injury be categorized (as prerenal, intrarenal, or postrenal)? B.Which two types are most likely in this patient? How might they be distinguished clinically? C.How should the patient be treated?
A. The clinical summary and the elevated creatine kinase suggest rhabdomyolysis-induced acute tubular necrosis (ATN). Crush injuries release myoglobin into the bloodstream that precipitates in the renal tubules, causing intrarenal toxicity and subsequent failure. With this underlying defect, antibiotic therapy may exacerbate the situation or may induce a separate inflammatory interstitial nephritis. The absence of documented hypotension makes ischemia-mediated ATN less likely. Thus, the patient has an intrarenal cause of acute kidney injury. B. Besides the likely intrarenal mechanism of disease, she may also have a prerenal cause as a result of dehydration from being trapped or from poor oral intake. To distinguish between these two possibilities, one can calculate the fractional excretion of sodium. The fractional excretion of sodium, FENa+, derived from measuring the urine and plasma sodium and creatinine, reflects the ability of the kidney to generate a concentrated urine. This function is essentially lost in the setting of acute tubular necrosis, and the patient's urine osmolarity is probably less than 350 mOsm/L. More commonly in the setting of myoglobinuria-induced ATN, her FENa+ would be greater than 2%; however, the FENa+ has been noted to be less than 1% in some cases of rhabdomyolysis. C. Mainstays of treatment involve maintaining a vigorous alkaline diuresis to prevent myoglobin precipitation in the tubules and adjusting renally cleared antibiotics to prevent further nephrotoxicity.
A 58-year-old obese woman with hypertension, type 2 diabetes, and chronic kidney disease is admitted to hospital after a right femoral neck fracture sustained in a fall. Recently, she had been complaining of fatigue and was started on epoetin alfa subcutaneous injections. Her other medications include an angiotensin-converting enzyme inhibitor, a β-blocker, a diuretic, calcium supplementation, and insulin. On review of systems, she reports mild tingling in her lower extremities. On examination, her blood pressure is 148/60 mm Hg. She is oriented and able to answer questions appropriately. There is no evidence of jugular venous distention or pericardial friction rub. Her lungs are clear, and her right lower extremity is in Buck traction in preparation for surgery. Asterixis is absent. A.Describe the pathogenesis of bone disease in chronic kidney disease. How could this explain the patient's increased likelihood of sustaining a fracture after a fall? B.Why was erythropoietin therapy initiated? C.What is the significance of a pericardial friction rub in the setting of chronic kidney disease?
A. This patient probably suffers from osteoporosis, accelerated by her underlying renal failure. The pathogenesis of bone disease is multifactorial. Calcium is poorly absorbed from the gut because of decreased renally generated vitamin 1,25-(OH)2D3 levels. Hypocalcemia results and is further exacerbated by high serum phosphate levels from impaired phosphate excretion by the kidney. Low serum calcium and hyperphosphatemia trigger PTH secretion, which depletes bone calcium and contributes to osteomalacia and osteoporosis. Also implicated are the diminished responsiveness of bone to vitamin D3 and chronic metabolic acidosis. B. Easy fatigability is often attributable to a worsening normochromic, normocytic anemia seen in chronic kidney disease. This occurs primarily because of impaired erythropoietin synthesis by the kidney and thus decreased erythropoiesis. To improve symptoms, exogenous erythropoietin is started to raise the hematocrit of 25-28%, typically seen in chronic kidney disease patients. 2012 KDIGO for anemia in CKD: Erythropoietin stimulating agents (Epoetin alfa/Darbepoetin alfa). Balance benefits of reducing blood trasnfusions & anemia related symptoms against risk of harm in individual patients (stroke, vascular access loss, HTN). Adult CKD pts with Hb [>10.0 g/dl] suggest that ESA therapy not be initiated. With Hb [<10.0 g/dl] initiate ESA therapy to avoid having it fall below 9.0. C. A pericardial friction rub suggests uremia-related pericarditis. This is thought to occur from uremic toxins that irritate and inflame the pericardium. The absence of this finding, lack of asterixis, and clear mentation suggest that despite underlying chronic kidney disease, the patient does not exhibit evidence of uremia at this time.
Match the adverse effect the appropriate diuretic: Metabolic Acidosis
Acetazolamide
List the potassium sparing diuretics. (Separate by comma and in alphabetical order)
Amiloride, Eplerenone, Spironolactone, Triamterene
Because of their mild natriuresis, these two diuretics seldom are used as sole agents in treatment of edema or hypertension; their major utility is in combination with other diuretics. (List in alphabetical order and separate with comma)
Amiloride, Triamterene
What is the drug class for: Acetazolamide
Carbonic Anhydrase Inhibitor
Which medications act on the Proximal Convoluted Tubule
Carbonic Anhydrous Inhibitors and Osmotic Diuretics
1. Risk factors for the development of CKD include which of the following: A. Family history of CKD and diabetes B. Obesity and hypertension C. Low birth weight and low education level D. A and B E. All of the above
D
10. Each of the following provides an accurate measure of GFR, except: A. Iohexol clearance B. Iothalamate clearance C. Inulin clearance D. Probenecid clearance
D
12. The authoritative source that provides the FDA-approved recommendations for drug dosage recommendations in renal impairment is: A. ePocrates B. Drugdex/Micromedex C. AHFS Drug Information D. Approved product labeling(package insert)
D
15. What is J.S.'s estimated GFR (in mL/min/1.73 m2)? A. 56.0 mL/min/1.73 m2 B. 49.4 mL/min/1.73 m2 C. 35.0 mL/min/1.73 m2 D. 30.2 mL/min/1.73 m2
D
19. The elevation in serum creatinine observed during cobicistat therapy is most likely attributed to: A. tubular apoptosis B. acute interstitial injury C. afferent arteriole vasoconstriction D. inhibition of OCT2- and MAT1-mediated tubular secretion of creatinine
D
2. A 56-year-old male presents to the hospital with acute kidney injury. Based on the Kidney Disease Improving Renal Outcomes (KDIGO) classification system, which of the following parameters should be used to determine the severity of his kidney injury? A. Serum creatinine B. Estimated glomerular filtration rate C. Serum creatinine or blood urea nitrogen D. Serum creatinine or urine output E. Blood urea nitrogen or urine output
D
3. Which of the following is/are involved in drug efflux at the basolateral membrane of the proximal tubule? A. MRP1 B. ENT1 C. OAT4 D. Both A and B
D
4. A 56-year-old woman with a history of Stage III chronic kidney disease is scheduled for diagnostic imaging requiring contrast dye administration. Her serum creatinine is 2.2 mg/dL (194 µmol/L), blood urea nitrogen (BUN) is 30 mg/dL (10.7 mmol/L). Her complete blood count and electrolytes are all within normal range. Which of the following medications would be most appropriate to recommend and decrease her risk of contrast-induced acute kidney injury? A. N-acetylcysteine B. Renal replacement therapy C. Furosemide D. Isotonic saline infusion E. Ascorbic acid
D
4. According to the intact nephron hypothesis, reabsorption ______ and single nephron GFR ______ in the surviving nephrons. A. increases, increases B. decreases, decreases C. increases, decreases D. decreases, increases
D
4. Patients with CKD and an eGFR<60 mL/min/1.73 m2 who have severe vomiting, diarrhea, or are dehydrated should be instructed to hold which of the following medications? A. Enalapril B. Metformin C. Furosemide D. Spironolactone E. All of the above
D
6. According to KDIGO guidelines, what is the blood pressure target in a patient with CKD and a urinary albumin-to-creatinine u(ACR) of 22 mg/g (2.5 mg/mmol)? A. ≤125/75 mm Hg B. ≤130/80 mm Hg C. ≤135/85 mm Hg D. ≤140/90 mm Hg E. ≤150/90 mm Hg
D
8. Which of the following kidney function indices is least affected by dietary protein intake? A. Serum creatinine B. Blood urea nitrogen C. Creatinine clearance D. Urine sodium
D
TW is a 65 yo African American male 5'8', 220lbs BMI 33. He has Diabetes type II, Hypertension, GERD, Osteoarthritis. 6 months ago TW was diagnosed with stage 4 Chronic Kidney Disease. Today at clinic, TW's random urine spot dipstick indicated his albumin-to-creatinine ration was 30-300mg/g. According to the KDIGO guidelines, what should TW's goal blood pressure be? A.<140/90 B.<125/70 C.<140/80 <130/80
D
Which of the following statements/conditions is consistent with the clinical presentation of stage 4 or 5 Chronic Kidney Disease? A.Patients are generally asymptomatic B.Hypokalemia C.Metabolic Alkalosis D.Hyperphosphatemia
D
____________are drugs that increase the rate of urine flow; clinically useful diuretics also increase the rate of Na+ excretion (natriuresis) and of an accompanying anion, usually Cl−.
Diuretics
10. A patient with ESRD on hemodialysis (HD) has had a PTH of 500 pg/mL (ng/L; 54 pmol/L) for the past 3 months, a phosphorus of 7.4 mg/dL (2.39 mmol/L), a calcium of 9.8 mg/dL (2.45 mmol/L), and an albumin of 3 g/dL (30 g/L). She currently receives calcitriol 1 mcg IV three times weekly with HD, calcium acetate 1,334 mg three times daily with meals, and ergocalciferol 50,000 IU once weekly. Which of the following is most appropriate to control her CKD-MBD? A. Discontinue the calcium acetate and begin a 2-month course of aluminum hydroxide with meals B. Increase the calcium acetate to 2,001 mg with meals C. Increase the calcitriol dose to 1.5 mcg IV three times weekly D. Change the calcium acetate to calcium carbonate E. Discontinue the calcium acetate and begin lanthanum carbonate
E
6. A 36-year-old male is diagnosed with intrinsic acute kidney injury secondary to a prolonged exposure to intravenous tobramycin. Which of the following pathophysiologic processes has most likely occurred in this case? A. Glomerular damage secondary to severe inflammation B. Drug hypersensitivity reaction leading to interstitial inflammation C. Increased renal perfusion D. Bladder outlet obstruction E. Tubular epithelial cell damage
E
7. Which of the following statements regarding treatment of acute kidney injury is correct? A. Intravenous isotonic saline can reverse acute kidney injury B. Intravenous sodium bicarbonate can reverse tubular cell damage from renal ischemia C. Statins can decrease the severity of prerenal acute kidney injury D. Ascorbic acid can decrease the severity of postrenal acute kidney injury E. Supportive care targeting acid-base, electrolyte, and fluid balance is the mainstay of therapy for acute kidney injury
E
Mineralocorticoids cause salt and water retention and increase K+ and H+ excretion by binding to specific MRs. List the two MR antagonists are available in the U.S. (List in alphabetical order and separate with comma)
Eplerenone, Spironolactone
Match the adverse effect the appropriate diuretic: Ototoxicity
Furosemide
Match the adverse effect the appropriate diuretic: Increased serum glucose, lipids, uric acid
Hydrochlorothiazide
12. A patient with stage 3a CKD is to be started on oral iron for iron deficiency. This patient should be instructed to do which of the following? A. Avoid taking sucroferric oxyhydroxide within 2 hours of oral iron B. Take iron with meals to increase absorption in the GI tract C. Take at least 200 mg of elemental iron per day if tolerated D. Take an antacid with iron to minimize the risk of GI adverse effects E. Take oral iron with at least 8 ounces of water to prevent GI adverse effects
C
13. A patient with CKD 4 is noted to be iron deficient and is prescribed a full course of IV iron (1-1.5 g total). She will receive the total dose of IV iron divided over 2 clinic visits (today and one week later). Which regimen is most appropriate to administer at each visit? A. Ferumoxytol 510 mg IV push over 5 minutes B. Iron dextran 25-mg test dose followed by infusion of 500 mg over 30 minutes C. Ferric carboxymaltose 750 mg infused over 30 minutes D. Ferric gluconate 500 mg infused over 30 minutes E. Iron sucrose 1 g administered over 3 hours
C
15. According to KDIGO guidelines, statin therapy is recommended for primary prevention of cardiovascular events in which of the following patients? A. 60-year-old male with ESRD not previously on a statin B. 75-year-old female with ESRD and diabetes not previously on a statin C. 40-year-old male with CKD 3b with coronary artery disease D. 38-year-old female with CKD 2 and no cardiac risk factors E. Statins are recommended only for secondary prevention in patients with CKD
C
15. Electronic health record alerts may prevent acute kidney injury by helping healthcare providers ___ A. Distinguish between patients with acute kidney injury and those with chronic kidney disease B. Stage a patient's acute kidney injury C. Identify patients at risk for acute kidney injury D. Renally dose medications E. Identify patients requiring renal replacement therapy
C
18. An appropriate clinical monitoring plan to evaluate renal protective therapy in patients with CKD should include each of the following items except: A. Estimated creatinine clearance B. Urinary albumin:creatinine C. Urinary cystatin C concentration D. Estimated GFR
C
2. A 51-year-old female with an eGFR of 37 mL/min/1.73 m2 and a urinary albumin-to-creatinine (uACR) ratio of 20.1 mg/g (2.3 mg/mmol) would be classified in which albuminuria and KDIGO category of CKD? A. 3a, A1 B. 3a, A2 C. 3b, A1 D. 3b, A2 E. 4, A1
C
3. A 44-year-old female with a history of CKD due to type 2 diabetes presents to your primary care clinic. Her most recent uACR is 113 mg/g (12.8 mg/mmol), her eGFR is 44 mL/min/1.73 m2, and blood pressure is 137/88 mm Hg. She is on chlorthalidone 12.5 mg po daily as her only antihypertensive drug. Which one of the following recommendations is most appropriate? A. No changes, blood pressure is at target B. Increase chlorthalidone to 25 mg po daily C. Start ramipril 2.5 mg po daily D. Start amlodipine 5 mg po daily E. Change chlorthalidone to hydrochlorothiazide 25 mg po daily
C
5. Hypertensive patients with CKD should limit dietary sodium to less than: A. 1 g/day B. 1.5 g/day C. 2 g/day D. 2.5 g/day E. 3 g/day
C
5. The kidney is responsible for synthesizing each of the following hormones, except: A. Erythropoietin B. Prostaglandin C. PTH D. Renin
C
9. Which of the following medications is most likely to cause of prerenal acute kidney injury in a 75-year-old hospitalized patient? A. N-acetylcysteine B. Acyclovir C. Lisinopril D. Contrast dye E. Simvastatin
C
John Doe is a 45 yo Caucasian male 6'3, 220lbs BMI 27.5. He has Stage 3 CKD, Hypertension, low back pain, and hyperlipidemia. His current medications are amlodipine 10mg QD, Atorvastatin 40mg QD, Hydrocodone/APAP 5mg/325mg Q4h PRN. At his last visit his Labs indicated: SrCr 1.8, eGFR 44mL/min, K+ 4.8mEq/dL. Additionally, a urine spot dipstick indicated his albumin-to-creatinine ration was >300mg/g.Lisinopril 20mg QD was initiated at that time. 10 days later John Doe returns to clinic for a repeat chemistry panel. Results indicate: SrCr 2.6, eGFR 28.5ml/min, K+ 5.0 mEq/dL. What is the most appropriate course of action? A.Discontinue Lisinopril and repeat eGFR & K+ in 2 weeks B.Increase Lisinopril to 40mg QD and repeat urine spot albumin test in 2 weeks C.Reduce Lisinopril to 10mg QD and repeat eGFR in 5 days D. Discontinue Lisinopril and repeat eGFR in 5-7 days
C
What is the drug class for: Bumetanide
Loop Diuretic
What is the drug class for: Ethacrynic Acid
Loop Diuretic
What is the drug class for: Furosemide
Loop Diuretic
What is the drug class for: Torsemide
Loop Diuretic
Which medications act on the Ascending Limb of Loop of Henle
Loop Diuretics
The effectiveness of thiazide diuretics to cause diuresis and lower blood pressure may be reduced by ______________
NSAIDs
What is the drug class for: Mannitol
Osmotic Diuretic
Which medications act on the Descending Limb of Loop of Henle
Osmotic Diuretics
What is the drug class for: Spironolactone
Potassium Sparing Diuretic
Which medications act on the Collecting Duct
Potassium sparing diuretics, osmotic diuretics, and vasopressin antagonists
Match the adverse effect the appropriate diuretic: Gynecomastia
Spironolactone
What is the drug class for: Chlorthalidone
Thiazide Diuretic
What is the drug class for: Hydrochlorothiazide
Thiazide Diuretic
Which medications act on the Distal Convoluted Tubule
Thiazide diuretics
What is the drug class for: Metolazone
Thiazide-Like Diuretic
Which diuretic drug class, when added to loop diuretics, has synergism of diuretic activity leading to profound diuresis?
Thiazides
