Acute and chronic renal failure: pharmacotherapy considerations MCQs With Answer

Acute and chronic renal failure: pharmacotherapy considerations MCQs With Answer

Introduction: This quiz set is designed for M.Pharm students studying Pharmacotherapeutics II (MPP 202T) to deepen understanding of pharmacotherapy in acute kidney injury (AKI) and chronic kidney disease (CKD). It emphasizes drug dosing adjustments, mechanisms of nephrotoxicity, biomarkers, dialysis drug removal, and therapeutic strategies for common complications such as hyperkalemia, anemia, and mineral-bone disorder. Questions focus on practical decision-making: selecting or avoiding agents, modifying doses using renal function estimates, and recognizing agents affected by renal replacement therapies. Working through these MCQs will strengthen clinical pharmacology reasoning and prepare students for patient-centered pharmacotherapy in renal dysfunction.

Q1. What best distinguishes acute kidney injury (AKI) from chronic kidney disease (CKD)?

• AKI is a rapid decline in renal function over hours to days, CKD is persistent loss over months to years
• AKI always leads to end-stage renal disease, CKD never does
• CKD develops only from diabetes, AKI develops only from infections
• AKI is diagnosed solely by proteinuria, CKD solely by hematuria

Correct Answer: AKI is a rapid decline in renal function over hours to days, CKD is persistent loss over months to years

Q2. Which serum biomarker typically rises earlier than serum creatinine and can detect early declines in glomerular filtration?

• Serum creatinine
• Blood urea nitrogen (BUN)
• Serum cystatin C
• Urine glucose

Correct Answer: Serum cystatin C

Q3. For individualizing drug dosing in patients with renal impairment, which renal function estimate is most commonly used in pharmacokinetic dosing recommendations?

• Creatinine clearance calculated by Cockcroft–Gault
• Urine sodium excretion
• Random serum potassium
• Body mass index (BMI)

Correct Answer: Creatinine clearance calculated by Cockcroft–Gault

Q4. Which antibiotic is both nephrotoxic and requires careful dosing and monitoring in renal failure?

• Gentamicin
• Doxycycline
• Linezolid
• Azithromycin

Correct Answer: Gentamicin

Q5. Which commonly used oral antidiabetic drug is contraindicated or should be withheld in severe renal impairment due to risk of lactic acidosis?

• Metformin
• Glipizide
• Repaglinide
• Sitagliptin

Correct Answer: Metformin

Q6. Which combination of drug properties makes a medication most likely to be removed by conventional hemodialysis?

• Low molecular weight, low protein binding, small volume of distribution
• High molecular weight, high protein binding, large volume of distribution
• High lipid solubility, intracellular binding, large volume of distribution
• High protein binding, high hepatic clearance, long half-life

Correct Answer: Low molecular weight, low protein binding, small volume of distribution

Q7. What is the recommended approach to ACE inhibitor therapy in a patient who develops acute kidney injury with rising creatinine?

• Withhold or use ACE inhibitors cautiously until renal function stabilizes
• Increase ACE inhibitor dose to overcome reduced perfusion
• Switch immediately to a nonsteroidal anti-inflammatory drug (NSAID)
• Continue ACE inhibitor without monitoring

Correct Answer: Withhold or use ACE inhibitors cautiously until renal function stabilizes

Q8. In CKD patients with hyperphosphatemia who already have hypercalcemia or are at high risk of vascular calcification, which phosphate binder is preferred?

• Sevelamer carbonate
• Calcium acetate
• Aluminum hydroxide
• Calcium carbonate

Correct Answer: Sevelamer carbonate

Q9. When is initiation of erythropoiesis-stimulating agents (ESAs) commonly indicated in CKD-related anemia?

• When hemoglobin is persistently below ~10 g/dL despite iron repletion
• When hemoglobin is above 13 g/dL
• Only in acute kidney injury, never in CKD
• As first-line therapy before checking iron stores

Correct Answer: When hemoglobin is persistently below ~10 g/dL despite iron repletion

Q10. The most evidence-based prophylaxis to reduce risk of contrast-induced nephropathy in high-risk patients is:

• Intravenous isotonic saline hydration before and after contrast exposure
• High-dose oral N-acetylcysteine alone
• Routine loop diuretics during contrast administration
• Giving contrast without any hydration

Correct Answer: Intravenous isotonic saline hydration before and after contrast exposure

Q11. Which immediate therapy is most appropriate to rapidly lower serum potassium by shifting potassium intracellularly in life-threatening hyperkalemia?

• IV insulin with glucose
• Oral sodium bicarbonate only
• Oral potassium supplements
• Topical nitroglycerin

Correct Answer: IV insulin with glucose

Q12. For dialysis patients with iron-deficiency contributing to renal anemia, which iron formulation is most commonly administered to achieve reliable repletion?

• Intravenous iron sucrose
• Oral ferrous sulfate only
• Topical iron gel
• Oral ferric maltol only

Correct Answer: Intravenous iron sucrose

Q13. Which diuretic class is generally ineffective as monotherapy for diuresis when GFR is severely reduced (<30 mL/min/1.73 m2)?

• Thiazide diuretics (e.g., hydrochlorothiazide)
• Loop diuretics (e.g., furosemide)
• Osmotic diuretics (e.g., mannitol)
• Carbonic anhydrase inhibitors (e.g., acetazolamide)

Correct Answer: Thiazide diuretics (e.g., hydrochlorothiazide)

Q14. Which antihypertensive drug class is first-line for reducing proteinuria and slowing progression of diabetic kidney disease?

• ACE inhibitors
• Alpha blockers
• Hydralazine
• Direct renin inhibitors only

Correct Answer: ACE inhibitors

Q15. When using Cockcroft–Gault to estimate creatinine clearance for drug dosing in an obese patient, which body weight should often be used?

• Adjusted body weight (to account for excess adiposity)
• Actual body weight always
• Ideal body weight always for all patients
• Height only, ignoring weight

Correct Answer: Adjusted body weight (to account for excess adiposity)

Q16. Which common class of analgesics is associated with decreased renal prostaglandin synthesis and can precipitate or worsen renal impairment?

• Nonsteroidal anti-inflammatory drugs (NSAIDs), e.g., ibuprofen
• Acetaminophen (paracetamol)
• Topical capsaicin
• Low-dose opioids

Correct Answer: Nonsteroidal anti-inflammatory drugs (NSAIDs), e.g., ibuprofen

Q17. In severe, symptomatic hyperphosphatemia or life-threatening electrolyte derangements due to renal failure, what definitive therapy rapidly removes phosphate?

• Hemodialysis
• Oral aluminum hydroxide only
• High-dose oral calcium supplementation only
• Bisphosphonate infusion

Correct Answer: Hemodialysis

Q18. Which antimicrobial agent commonly requires supplemental dosing after a hemodialysis session because it is significantly removed by dialysis?

• Vancomycin
• Fluconazole
• Linezolid
• Doxycycline

Correct Answer: Vancomycin

Q19. For most adults with diabetes and CKD, what general glycemic control target (HbA1c) is typically recommended to reduce progression of microvascular complications while minimizing hypoglycemia risk?

• Aiming for an HbA1c around 7% (individualized)
• Aiming for HbA1c <5% for best outcomes
• No glycemic control is needed in CKD
• Aiming for HbA1c above 9% to avoid hypoglycemia

Correct Answer: Aiming for an HbA1c around 7% (individualized)

Q20. Which anticoagulant is preferred when long-term anticoagulation is required in a patient with severe renal impairment because it is not primarily renally cleared?

• Warfarin
• Dabigatran
• Rivaroxaban
• Edoxaban

Correct Answer: Warfarin

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