Flashcards
Med Complex 2.1
Flashcards do conjunto (35)
- 1functional unit of the kidneynephron
- 2functions of the kidneywater and electrolyte regulation
extracellular vol/press regulation
acid-base homeostasis
endocrine/metabolic reg (kinins, EPO, phosphate, vit D, renin)
blood plasma filtration (glucose, Ca, Phos)
metabolic waste excretion
urine production
Pg production - 3causes of acute kidney diseaseprerenal: decreased kidney perfusion
intrinsic: infection. drugs that damage units of nephron
postrenal: obstruction of urinary tract - 4causes of chronic kidney diseasediabetes (bidirectional)
HTN (bi directional)
chronic glomerulonephritis
SLE
neoplasms
polycystic kidney ds
AIDS nephropathy
others - 5risk factors for chronic kidney ds60+
smoking
obesity
poorly controlled HTN
Db (50% of T2D)
Chronic inflamm
nephrotoxins/drugs
infections
low birthweight - 6pathogenesis of kidney diseasenephron hypertrophy --> loss of 50% of nephrons causes GFR decrease --> fibrosis and atrophy of kidney
- 7definition of chronic kidney diseaseabnormalities of kidney structure or function for longer than 3 mo due to direct damage to nephrons or chronic bilateral deterioration
- 8dx criteria for CKDGFR <60 ml/min (ESRD < 15)
urinary albumin/creatine >30 mg/g
urinary albumin >30 mg/day - 9complications of CKDfluid and electrolyte imbalance
HTN
CVD
endocrine dysfunc
normocytic, normochromic anemia
hyperuricemia and uremia
dyslipidemia
metabolic acidosis
mineral bone disorder - 10aspects of bone mineral disease in CKDdecreased vitamin D levels
dysregulation of Ca and Phos
incr PTH and FGF23
renal osteodystrophy
secondary hyperPTH (lytic lesions in mandible)
calciphylaxis - 11values for CKD managementHbA1c <8%
HTN <140/90
LDL <100 mg/dl
BMI 18.5-24.9 - 12oral manifestations of CKDxerostomia
dysgeusia
infections
enamel defects (kids)
osteodystrophy: loss of LD, demineralization "ground glass" appearance, expansile RL's
uremic stomatitis
petechiae and ecchymosis - 13kidney replacement therapyinitiated in ESRD to remove uremic toxins
includes hemodialysis and periotoneal dialysis - 14hemodialysisvenous access via an AV fistuala (preferred), AV graft, or central venous catheter (short-term, special cases)
machine filters blood every 2-3 days, 3-4 hrs/session
heparin used
risk of Hep B and C - 15peritoneal dialysishypertonic solution in peritoneal cavity
peritoneal membrane used for exchange
3-5x/day or overnight at home - 16when to tx ESRD ptday AFTER hemodialysis
- 17organ transplantrequires ABO + HLA matching, > 5yr life expectancy, live>dead donor
NO Aids or active hepatitis pts
rejection via cytotoxic t cells, alloantibodies, delayed hypersensitivity - 18immunosuppression drugs during inductionantithymocyte globulin
alemtuzumab (anti-CD52) - 19long-term maintenance immunosuppression drugs (not needed if identical twin donor)azathioprine
mycophenolate mofetil
steroids
calcineurin inhibitors
mTOR inhibitors
belatacept - 20adverse effects from immunosuppresion drugscytopenias from bone marrow suppression--> bleeding, infection
increased risk of skin and hematologic cancers
oral: gingival hyperplasia (cyclosporine), apthous-like ulcers (mTOR) - 21severe thombocytopenia<50,000 platelets
- 22severe leukopenia/neutropeniaWBC <2000
ANC<500 - 23oral adverse effects of immunosupp drugscyclosporine: gingival hyperplasia
mTORi: apthous like ulcers - 24considerations for dental tx for CKDdetermine level of renal impairment and disease control
assess bleeding risk (bleeding and thrombosis)
asses need for abx
asses drug interactions - 25POSSIBLE indications for abx prophy for CKDstage 4 or ESRD
synthetic AV graft
definitely: hemodialysis performing I and D
NOT: peritoneal dialysis - 26nephrotoxic drugs (avoid)acyclovir
NSAIDs
asprin
aminoglycosides
tetracylcine - 27considerations for acetaminophennephrotoxic at hi doses (give 2 mg max instead of 4/day)
increase dosing interval:
q6h for GFR 10-50
q8h for GFR <10 - 28considerations for NSAIDSavoid (except ASA for CVD); esp long term use
interacts with anti-HTN and impairs pg production - 29opiod considerationsAVOID--risk of accumulation of toxic metabolites
may use tramadol with dose adjustment/incr interval (consult phys) - 30benzodiazapene considerationsCAUTION
consider half lives and active metabolites
single dosing and consult with physician - 31acyclovir considerationsincr dosing interval q8 or q12h
- 32antibiotics NOT excreted renally--no adjustment requiredclindamycin
doxycycline
erythromycin
metronidazole
nystatin (antifungal) - 33abx excreted renally (adjustment required)amoxicillin (q12, 24)
cephalexin (q6-18, q12-24)
azithromycin (avoid if GFR <10)
fluconazole (antifungal: 50-25% dose) - 34goals of pre-transplant dental clearancetreat active foci of infection (SRP, endo, restorations)
extract teeth with questionable prognosis
asses caries risk and fluoride
educate pt - 35post-transplant dental careemergency care only <6 mo post transplant (specialized center)
after that: dental maitenance and surveillance (opportunistic infec, ADRs, cancer)
Informações
- Descrição
- SP D2 (med complex) FlashCards sobre Med Complex 2.1, criado por Katie Hayes em 31-03-2020.
- Criado por
- Katie Hayes
- Visualizações
- 3
- Avaliação