Renal Dosing & Adjustments Flashcards
7 cards from real MTM practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Renal Dosing & Adjustments flashcards as text
A patient with CrCl of 15 mL/min develops a urinary tract infection. Which antibiotic should be AVOIDED due to inadequate urinary concentrations in severe renal failure?
Answer: Nitrofurantoin
Nitrofurantoin is ineffective in severe renal failure because it cannot achieve adequate urinary concentrations and may accumulate to cause toxicity.
Which aminoglycoside monitoring strategy is most appropriate in a patient with fluctuating renal function?
Answer: Traditional multiple daily dosing with peak/trough levels
Patients with unstable renal function require traditional dosing with frequent peak and trough monitoring to safely individualize therapy.
A pharmacist reviews a patient's regimen and notes they are on apixaban 5 mg BID with a CrCl of 25 mL/min. What action is most appropriate?
Answer: Discontinue apixaban and switch to warfarin
While apixaban has limited renal elimination, patients with severe CKD (CrCl < 25 mL/min) were excluded from ARISTOTLE trial; switching to warfarin is often recommended.
Which electrolyte abnormality is most commonly associated with progressive CKD and affects drug therapy choices?
Answer: Hyperkalemia
Hyperkalemia is common in CKD and restricts use of drugs that increase potassium, such as ACE inhibitors, ARBs, and potassium-sparing diuretics.
A patient on hemodialysis three times weekly needs pain management. Which opioid is considered SAFEST in this population?
Answer: Fentanyl
Fentanyl is preferred in dialysis patients because it has inactive metabolites and is not significantly renally eliminated.
The prescribing information for a drug states 'reduce dose by 50% when CrCl is 30-60 mL/min.' A patient's estimated CrCl is 45 mL/min. What is this adjustment based on?
Answer: Pharmacokinetic studies measuring drug exposure at different renal function levels
Renal dose adjustment recommendations derive from pharmacokinetic studies that measure AUC and clearance at varying levels of kidney function.
Which proton pump inhibitor requires the LEAST concern for dose adjustment in severe renal impairment?
Answer: All PPIs require equal adjustment in renal failure
PPIs are primarily hepatically metabolized with minimal renal elimination, so none require dose adjustment for renal impairment.