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

Enoxaparin

Gentamicin

Vancomycin

Fluconazole

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?

Nebulized albuterol

(to push K+ back into the cells)

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

Zosyn for an infection

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

Metabolic acidosis

The ability of the kidney to reabsorb bicarbonate decreases as chronic renal disease progresses. This can cause a metabolic acidosis.

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?

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.

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

**picture**

A

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?

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).

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

Limiting dietary phosphate intake

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?

Decreased hemoglobin and increase parathyroid hormone

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?

Renvela

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

The KDIGO guidelines

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

PTH

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

Take with meals

Chew tablet thoroughly

Seperate from levothyroxine

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.)

Levofloxacin

Lithium

Metoclopramide

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?

Metformin ER

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

Hyperphosphatemia causes an increase in the release of parathyroid hormone

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?

Hours to days

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:

Hydration

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.)

Vancomycin

Chest CT

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

Change IV fluids to D5NS

What is the indication for Renvela in TH?

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).

Sensipar is used for what purpose in TH?

Sensipar is a calcimimetic used to treat hyperparathyrodism

Cinacalcet (Sensipar) is a calcimimetic that works to decrease PTH release from the parathyroid gland.

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

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.

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?

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.

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

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.

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?

Smaller molecules are more easily cleared by dialysis

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

**Picture**

E

Which of the following statements is correct regarding vitamin D?

Cholecalciferol is synthesized in the skin with ultraviolet light exposure

What is the mechanism of insulin when treating hyperkalemia?

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).

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

Divide the daily dose and chew before each meal