Renal Pharmacology for Dialysis Nurses Flashcards

Heparin is administered at the start of hemodialysis primarily to prevent:

Answer: Clotting in the extracorporeal circuit

Heparin prevents thrombus formation in the blood tubing, dialyzer, and needle during passage of blood through the extracorporeal circuit.

A dialysis patient is prescribed active vitamin D therapy. Which laboratory values must be monitored to prevent complications?

Answer: Serum calcium and phosphorus

Active vitamin D (calcitriol or paricalcitol) can cause hypercalcemia and hyperphosphatemia, which must be monitored to prevent vascular calcification.

Which medication requires dose adjustment or avoidance in dialysis patients due to accumulation of active metabolites that can cause neurological toxicity?

Answer: Meperidine (Demerol)

Meperidine's active metabolite normeperidine accumulates in renal failure and can cause seizures, making it contraindicated in dialysis patients.

When should phosphate binders be administered to achieve maximum effectiveness?

Answer: With or immediately after meals

Phosphate binders must be taken with meals to bind dietary phosphate in the gut before it is absorbed, reducing serum phosphorus levels.

A dialysis patient on warfarin for atrial fibrillation requires more frequent INR monitoring. Why?

Answer: Altered protein binding and volume of distribution affect drug levels

Uremia alters plasma protein binding and drug metabolism, making anticoagulation levels unpredictable and requiring more frequent INR monitoring.

What is the rationale for timing the administration of intravenous antibiotics in hemodialysis patients?

Answer: Antibiotics should be dosed after dialysis to prevent removal by the procedure

Many antibiotics are dialyzable, so post-dialysis dosing prevents drug removal and ensures therapeutic blood levels persist until the next session.