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Pharmacology- Exam #4 > CKD > Flashcards

Flashcards in CKD Deck (43)
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1

List in order the leading causes of CKD

1. DM
2. HTN
3. Glomerulonephritis

2

What is first line therapy for Diabetes + CKD? What does the urine albumin need to be to indicates use of these drugs?

ACE-1 or ARB
urine albumin >30 mg/24 hrs

3

When do you want to stop increasing the dose of an ACE-1 or ARB with DM + CKD?

1. Urine albuminuria reduced by 30-50% OR
2. Significant decrease in GFR OR
3. Hyperkalemia

4

HTN + CKD treatment and its effects on CKD?

ACE-1 and ARBs
Limits disease progression

5

Pathogenesis of Anemia in CKD

Deficiency of erythropoietin production by kidneys

6

Anemia treatment in CKD

ESA (erythropoietin stimulating agent) + Iron supplementation

7

What does ESA increase your risk of?

CV events

8

When do you initiate ESA in Non-Dialysis CKD?

If HgB <10 g/dL
DO NOT initiate if Hb ≥10 g/dL

9

When do you initiate ESA in Dialysis CKD?

HgB between 9-10 g/dL to avoid drop in HgB to <9 g/dL

10

What HgB levels do you NOT want to use ESA for?

Increase HgB over 13 g/dL OR
to maintain HgB above 11.5

11

Iron initiation indications in CKD

If TSat is ≤30% (≤0.30) and ferritin is ≤500 ng/mL

12

What is the MOA of Erythropoietin Stimulating Agents (ESA)?

1. Induces erythropoiesis by stimulating division/differentiation of progenitor cells
2. Induces release of reticulocytes from bone marrow to blood stream

13

ESA Box warning

Increased CV and CKD events with Hg > 11g/dL

14

Other ADE's of ESA

1. Cancer
2. Shortened survival/increased progression in certain CA's when HgB >12 g/dL
3. Increase risk of DVT

15

What is the net serum effect of PTH?

1. Increased serum Ca+
2. Decreased serum Phosphorus

16

What is the net serum effect of Vitamin D

Both serum Ca/P increases

17

What is the net serum effect of Firbroblast growth factor 23 (FGF23)

Decrease in serum Phosphorus

18

Management of CKD-MBD

1. Dietary Phosphorous restriction
2. Phosphate-binding agents
3. Vitam in D supplementation
4. Calcimimetic therapy

19

List the phosphate-binding agents for the treatment of hyperphosphatemia

1. Calcium-based binders
2. Resnin binders
3. Iron-based binders

20

Calcium-based binders MOA

1. Binds dietary phosphate to form insoluble calcium-phosphate
2. Excreted through feces

21

ADE's of Calcium-based binders

1. Hypercalcemia
2. Hypophosphatemia
3. Milk-alkali syndrome: HA, nausea, weakness, irritability, renal impairment, alkalosis

22

List a Resin binder

Sevelamer Hydrochloride

23

Sevelamer Hydrochloride MOA

Binds phosphate in intestinal lumen to limit absorption

24

Sevelamer Hydrochloride clinical indications

1. Tx of hyperphosphatemia in CKD pt's
2. Patients @ risk of extra-skeletal calcification

25

What does Sevelamer Hydrochloride lower?

LDL

26

Sevelamer Hydrochloride ADE's

1. Metabolic acidosis
2. N/V/D
3. Dyspepsia

27

What is unique about the Lanthanum Carbonate half life?

Half life in bones= 2-3.6 years
Potential for accumulation of lanthanum

28

Lanthanum Carbonate ADE's

1. N/V
2. Abdominal pain
3. Constipation
4. Dyspepsia
5. Bowel obstruction
6. Fecal impaction

29

Aluminum Hydroxide MOA

Binds phosphate in GI tract to prevent absorption

30

Why isn't Aluminum Hydroxide a first line agent?

Risk of aluminum toxicity

31

Who do we use Aluminum Hydroxide in?

Short-term (4 weeks) in patients w/ hyperphosphatemia that are not responding to other binders

32

Aluminum Hydroxide ADE's

1. Constipation
2. Fecal impaction
3. Hypomagnesemia
4. Hypophosphatemia

33

List the Vitamin D analogs used for ESRD

IV or PO:
1. Doxercalciferol
2. Paricalcitol
*Already activated

34

What would we use in a patient with hypocalcemia and chronic renal dialysis?

Calcitriol=active form of Vitamin D

35

List Vitamin D agents and dosing

1. Ergocalciferol D2: daily doses, active metabolite D3
2. Cholecalciferol D3: higher doses, weekly or monthly

36

Indications for Ergocalciferol D2 and Cholecalciferol D3

1. Hypophosphatemia
2. Hypoparathyroidism

37

Ergocalciferol D2 and Cholecalciferol D3 (Vitamin D agents) ADE's

Hypercalcemia

38

What vaccines is recommended annually for CKD patients?

Influenza

39

What vaccines are indicated in GFR <30?

1. Pneumococcal vaccine
2. Hepatitis B vaccine

40

Epoetin alfa dosing

3x/wk

41

Darbopoetin alfa dosing

1x/month

42

Methoxy PEG-epoetin beta dosing

Every 2 weeks
Once HgB stabilizes, double the dose and administer monthly

43

List the Phosphate binders that lower LDL

Resnin Binders
1. Sevelamer Carbonate
2. Sevelamer Hydrochloride