Dialysis is a life-sustaining renal replacement therapy for patients with end-stage renal disease (ESRD). Managing medications in this specialized population is a core competency for pharmacists, as the intermittent nature of hemodialysis and the properties of the dialyzer significantly impact drug clearance. As detailed in the Patient Care 4 curriculum’s “Transcending Concept” module on “Dosing in Dialysis,” a deep understanding of pharmacokinetic principles is required to dose medications safely and effectively. This quiz will test your knowledge on the principles of hemodialysis, the factors affecting drug dialyzability, and the clinical strategies for medication management in this patient group.
1. What are the two primary principles by which hemodialysis removes waste products and excess fluid from the blood?
- a. Osmosis and active transport
- b. Diffusion and ultrafiltration
- c. Filtration and secretion
- d. Absorption and metabolism
Answer: b. Diffusion and ultrafiltration
2. Which of the following drug characteristics would make a drug MORE likely to be removed by hemodialysis?
- a. High molecular weight
- b. High protein binding
- c. Large volume of distribution (Vd)
- d. Low molecular weight (<500 Daltons)
Answer: d. Low molecular weight (<500 Daltons)
3. For a medication that is significantly cleared by hemodialysis, when is the most appropriate time to administer a scheduled dose?
- a. Immediately before the hemodialysis session.
- b. During the hemodialysis session.
- c. After the hemodialysis session.
- d. The timing of the dose does not matter.
Answer: c. After the hemodialysis session.
4. The preferred, long-term vascular access for hemodialysis, known for its lower rates of infection and thrombosis, is a(n):
- a. Central venous catheter
- b. Arteriovenous (AV) fistula
- c. Arteriovenous (AV) graft
- d. Peripheral IV line
Answer: b. Arteriovenous (AV) fistula
5. A drug that is 98% bound to albumin will be:
- a. Highly removed by dialysis.
- b. Poorly removed by dialysis.
- c. Moderately removed by dialysis.
- d. Completely removed by dialysis.
Answer: b. Poorly removed by dialysis.
6. The “Drug Individualization-Dialysis; Hemodialysis and Peritoneal Dialysis” is a specific “Transcending Concept” in which course?
- a. PHA5784C Patient Care 4
- b. PHA5104 Sterile Compounding
- c. PHA5703 Pharmacy Law and Ethics
- d. PHA5878C Patient Care 3
Answer: a. PHA5784C Patient Care 4
7. Diffusion during dialysis describes the movement of solutes (like urea) from:
- a. An area of low concentration to an area of high concentration.
- b. An area of high concentration (blood) to an area of low concentration (dialysate).
- c. The intracellular space to the extracellular space.
- d. The dialysate into the blood.
Answer: b. An area of high concentration (blood) to an area of low concentration (dialysate).
8. Which of the following drugs has a large volume of distribution and is therefore poorly removed by dialysis, despite its small molecular weight?
- a. Gentamicin
- b. Digoxin
- c. Gabapentin
- d. Lithium
Answer: b. Digoxin
9. Patients on hemodialysis are often prescribed IV iron and erythropoiesis-stimulating agents (ESAs) to manage what common complication of ESRD?
- a. Hyperkalemia
- b. Anemia
- c. Hyperphosphatemia
- d. Metabolic acidosis
Answer: b. Anemia
10. A patient on hemodialysis is prescribed sevelamer, a phosphate binder. How should this medication be taken?
- a. Once daily in the morning.
- b. On an empty stomach.
- c. With meals, to bind dietary phosphate.
- d. Only on dialysis days.
Answer: c. With meals, to bind dietary phosphate.
11. The “Dosing in Renal Dysfunction” module is covered in the Principles of Drug Therapy Individualization course.
- a. True
- b. False
Answer: a. True
12. Ultrafiltration during dialysis is the process that primarily removes:
- a. Urea
- b. Potassium
- c. Excess water
- d. Creatinine
Answer: c. Excess water
13. Which of the following antibiotics is well-known to be significantly cleared by hemodialysis, often requiring a supplemental dose after each session?
- a. Ceftriaxone
- b. Moxifloxacin
- c. Gabapentin
- d. Azithromycin
Answer: c. Gabapentin
14. A common intradialytic complication that pharmacists may be asked to help manage is:
- a. Hypertension
- b. Hypoglycemia
- c. Hypotension
- d. Fever
Answer: c. Hypotension
15. Peritoneal dialysis (PD) differs from hemodialysis (HD) in that:
- a. PD uses an external machine to filter blood.
- b. PD uses the patient’s own peritoneal membrane as the dialyzer.
- c. PD is an intermittent therapy done 3 times a week.
- d. PD does not remove waste products.
Answer: b. PD uses the patient’s own peritoneal membrane as the dialyzer.
16. A drug’s dialyzability is primarily dependent on its:
- a. Color and taste.
- b. Pharmacodynamic properties.
- c. Pharmacokinetic properties (molecular weight, Vd, protein binding).
- d. Cost.
Answer: c. Pharmacokinetic properties (molecular weight, Vd, protein binding).
17. The lecture “Dosing in Dialysis” is part of the Patient Care 4 curriculum.
- a. True
- b. False
Answer: a. True
18. Vancomycin dosing in a hemodialysis patient often involves:
- a. A standard fixed dose given three times a week.
- b. A loading dose followed by maintenance doses given after each dialysis session, guided by pre-dialysis levels.
- c. Continuous infusion.
- d. Oral administration only.
Answer: b. A loading dose followed by maintenance doses given after each dialysis session, guided by pre-dialysis levels.
19. Which of the following best describes the clearance provided by conventional hemodialysis?
- a. It is continuous, 24 hours a day.
- b. It is intermittent, occurring only during the treatment session.
- c. It is equal to that of healthy kidneys.
- d. It does not provide any clearance.
Answer: b. It is intermittent, occurring only during the treatment session.
20. An active learning session on the renal system, including dialysis, is part of which course?
- a. PHA5784C Patient Care 4
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5782C Patient Care 2
Answer: a. PHA5784C Patient Care 4
21. A pharmacist’s role in the care of a dialysis patient includes:
- a. Reviewing medication profiles for necessary dose adjustments.
- b. Managing anemia and CKD-MBD pharmacotherapy.
- c. Counseling on diet and fluid restrictions.
- d. All of the above.
Answer: d. All of the above.
22. Which of the following drugs is NOT significantly removed by dialysis?
- a. Amlodipine (highly protein-bound, large Vd)
- b. Gabapentin (small, water-soluble)
- c. Atenolol (small, water-soluble)
- d. Lithium (small, not protein-bound)
Answer: a. Amlodipine (highly protein-bound, large Vd)
23. The dialysate fluid used in hemodialysis is:
- a. Sterile water.
- b. A solution of purified water, electrolytes, and bicarbonate designed to facilitate diffusion.
- c. The patient’s own filtered plasma.
- d. A colloid solution.
Answer: b. A solution of purified water, electrolytes, and bicarbonate designed to facilitate diffusion.
24. A patient on hemodialysis should be advised to take their phosphate binders:
- a. Only on dialysis days.
- b. One hour before meals.
- c. With all meals and snacks.
- d. At bedtime.
Answer: c. With all meals and snacks.
25. A major risk associated with central venous catheters for hemodialysis access is:
- a. A long time to mature before use.
- b. A low blood flow rate.
- c. A high rate of infection and thrombosis.
- d. Pain during cannulation.
Answer: c. A high rate of infection and thrombosis.
26. The “K” in the K/DOQI guidelines stands for:
- a. Potassium
- b. Kidney
- c. Kinetic
- d. Ketone
Answer: b. Kidney
27. The management of CKD complications like anemia and MBD is a key part of caring for dialysis patients.
- a. True
- b. False
Answer: a. True
28. An active learning session on dialysis is part of which course module?
- a. Module 8: Urological Disorders
- b. Module 1: PUD and GERD
- c. Module 4: Gastrointestinal Infections
- d. Module 5: Nutrition & Weight Management
Answer: a. Module 8: Urological Disorders
29. The term “dialyzer” refers to:
- a. The dialysis machine.
- b. The artificial kidney or filter.
- c. The dialysis access.
- d. The fluid used for dialysis.
Answer: b. The artificial kidney or filter.
30. The “Dosing in Renal Dysfunction” module in PHA5132 provides the foundation for understanding dosing in dialysis.
- a. True
- b. False
Answer: a. True
31. A drug with a volume of distribution of 5 L/kg would be:
- a. Primarily confined to the intravascular space and easily dialyzed.
- b. Extensively distributed into tissues and poorly dialyzed.
- c. Moderately dialyzed.
- d. Completely dialyzed regardless of other properties.
Answer: b. Extensively distributed into tissues and poorly dialyzed.
32. The primary solute responsible for the osmolarity of the dialysate is:
- a. Potassium
- b. Calcium
- c. Glucose or sodium
- d. Bicarbonate
Answer: c. Glucose or sodium
33. Which of the following statements is true?
- a. All drugs require dose adjustments for dialysis.
- b. No drugs require dose adjustments for dialysis.
- c. The need for dose adjustment depends on the drug’s properties and the type of dialysis.
- d. Only IV drugs need to be adjusted for dialysis.
Answer: c. The need for dose adjustment depends on the drug’s properties and the type of dialysis.
34. What is the main reason for using a bicarbonate-based buffer in modern dialysate?
- a. To treat metabolic alkalosis.
- b. To correct the metabolic acidosis common in ESRD.
- c. It is cheaper than other buffers.
- d. To lower serum calcium.
Answer: b. To correct the metabolic acidosis common in ESRD.
35. A pharmacist is reviewing an order for enoxaparin for a patient on hemodialysis. The pharmacist should:
- a. Dispense it as written.
- b. Recognize that enoxaparin accumulates in ESRD and is generally avoided, and contact the provider.
- c. Recommend doubling the dose.
- d. Counsel the patient to inject it into their fistula.
Answer: b. Recognize that enoxaparin accumulates in ESRD and is generally avoided, and contact the provider.
36. A patient on dialysis is an example of what stage of Chronic Kidney Disease?
- a. Stage 3
- b. Stage 4
- c. Stage 5
- d. Stage 1
Answer: c. Stage 5
37. The removal of fluid during dialysis is achieved by creating a ________ gradient across the dialyzer membrane.
- a. concentration
- b. temperature
- c. pressure
- d. electrical
Answer: c. pressure
38. The lecture “Dosing in Dialysis” is a component of which course?
- a. PHA5784C Patient Care 4
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5782C Patient Care 2
Answer: a. PHA5784C Patient Care 4
39. A patient on HD is more likely to experience which of the following on their non-dialysis days?
- a. Hypotension
- b. Fluid overload and hyperkalemia
- c. Dehydration
- d. Hypokalemia
Answer: b. Fluid overload and hyperkalemia
40. The term “dry weight” in a dialysis patient refers to:
- a. Their weight before starting dialysis.
- b. Their target post-dialysis weight, when they are euvolemic.
- c. Their weight on a non-dialysis day.
- d. The weight of the dialysis machine.
Answer: b. Their target post-dialysis weight, when they are euvolemic.
41. Which of the following vitamins is water-soluble and likely removed by dialysis, often requiring supplementation?
- a. Vitamin D
- b. Vitamin E
- c. Folic Acid (a B vitamin)
- d. Vitamin K
Answer: c. Folic Acid (a B vitamin)
42. A patient with ESRD cannot activate Vitamin D. Therefore, they are often supplemented with:
- a. Standard Vitamin D2 or D3.
- b. The active form of Vitamin D, such as calcitriol.
- c. Vitamin C.
- d. Vitamin A.
Answer: b. The active form of Vitamin D, such as calcitriol.
43. A common dietary restriction for hemodialysis patients includes limiting intake of:
- a. Protein
- b. Water
- c. Sodium, potassium, and phosphorus
- d. Carbohydrates
Answer: c. Sodium, potassium, and phosphorus
44. Which of the following is NOT a form of renal replacement therapy?
- a. Hemodialysis
- b. Peritoneal Dialysis
- c. Kidney Transplant
- d. Furosemide therapy
Answer: d. Furosemide therapy
45. A patient’s medication list should be reviewed by a pharmacist at the initiation of dialysis and periodically thereafter.
- a. True
- b. False
Answer: a. True
46. What is the primary advantage of an AV fistula over an AV graft?
- a. It can be used immediately after creation.
- b. It uses the patient’s own vessels and has better long-term patency and lower infection rates.
- c. It is easier to cannulate.
- d. It does not require surgery.
Answer: b. It uses the patient’s own vessels and has better long-term patency and lower infection rates.
47. A pharmacist counseling a dialysis patient on their phosphate binder should emphasize that it must be taken:
- a. On an empty stomach.
- b. With meals.
- c. At bedtime.
- d. Only if their phosphate level is low.
Answer: b. With meals.
48. An active learning session covering dialysis is part of which course?
- a. PHA5784C Patient Care 4
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5782C Patient Care 2
Answer: a. PHA5784C Patient Care 4
49. Continuous Renal Replacement Therapy (CRRT) is a form of dialysis typically used in which setting?
- a. At home
- b. In an outpatient dialysis clinic
- c. In the Intensive Care Unit (ICU) for hemodynamically unstable patients.
- d. In a skilled nursing facility.
Answer: c. In the Intensive Care Unit (ICU) for hemodynamically unstable patients.
50. The ultimate goal of a pharmacist’s involvement in the care of a dialysis patient is to:
- a. Ensure all medications are given after dialysis.
- b. Manage the complex pharmacotherapy to improve clinical outcomes and quality of life while minimizing adverse events.
- c. Reduce the number of medications the patient is taking.
- d. Order all the necessary lab tests.
Answer: b. Manage the complex pharmacotherapy to improve clinical outcomes and quality of life while minimizing adverse events.