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SG - Pharm 4 > CKD > Flashcards

CKD Flashcards

(50 cards)

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1
Q

CKD is classified based on what 3 things?

A
  • Cause of kidney disease
  • assessment of GFR
  • extent of proteinuria
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2
Q

What are frequent complications of advanced CKD?

A
  • altered Na and water balance
  • hyperkalemia
  • metabolic acidosis
  • anemia
  • CKD related mineral and bone disorder (CKD-MBD)
  • cardiovascular disease
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3
Q

What is the 1st, 2nd, and 3rd leading causes of CKD leading to ESRD?

A
  1. DM
  2. HTN
  3. Glomerulonephritis
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4
Q

Besides the top 3 (DM, HTN, and glomerulonephritis), what other 4 diseases cause CKD?

A
  • Polycystic Kidney Disease
  • Wegener’s granulomatosis
  • Vascular Diseases
  • HIV nephropathy
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5
Q

1st line therapy for CKD caused by DM?

A

ACEI or ARB

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6
Q

Tx for CKD caused by DM:

  • ACEI or ARB
    • Dose is usually increased until what 3 things happen?
A
  • Albuminuria is reduced by 30-50% (1st goal!)
  • Significant drop in eGFR
  • Hyperkalemia
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7
Q

Therapy for CKD caused by HTN?

A

ACEI and ARB

(effect on renal hemodynamic and reduction of BP)

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8
Q

Deficiency in the production of endogenous erythropoietin by the kidney (iron deficiency as a contributing factor)

A

Anemia

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9
Q

2 ways to manage anemia

A
  • erythropoietic stimulating agents (ESAs) (epoetin alfa, darbepoetin alfa)
  • Regular iron supplementation (oral or IV administration)
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10
Q

What are the “administartion limits” of treating anemia? (2)

A
  • Higher risk of cardiovascular events
  • When hemoglobin is targeted to greater than 11 g/dL
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11
Q

At which stage of CKD should you send to nephrology based on the GFR?

A

Stage 2 CKD (mildly decreased) = 60-89

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12
Q

At what stage of CKD do you need adjust dose?

A

Stage 3 CKD, GFR of 50-60

(most common GFR is at 30)

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13
Q

What stage of CKD is ESRD?

A

Stage 5

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14
Q

KDIGO recommendations for initiation of Erythropoiesis Stimulating Agents and Iron in Anemia of CKD

  • If Hb is <___ g/dL, consider the ____ of Hb prior to initiating ESA.
  • DO NOT initiate if Hb is ___g/dL or greater
A
  • 10 / rate of fall
  • 10
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15
Q
  • Do not use ESAs to intentionally increase Hb above ___ g/dL
  • Do not use ESAs to maintain Hb above ___g/dL
A
  • 13
  • 11.5
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16
Q

Initiate Iron therapy when TSat is ___% or less and ferritin is ___ or less

A
  • 30
  • 500
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17
Q

Use ESAs to avoid drop in Hb to <9 by starting an ESA when Hb is between ___ and ___ g/dL

A

9 and 10

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18
Q

What are the 3 Erythropoiesis-Stimulating Agents in CKD?

A
  • Epoetin alfa
  • Darbepoetin alfa
  • Methoxy PEG-epoetin beta
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19
Q

Which ESA?

  • Adults: 50-100 units 3x/week
A

Epoetin alfa

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20
Q

Which ESA?

  • Once every 4 weeks
A

Darbepoetin alfa

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21
Q

Which ESA?

  • Every 2 weeks, once Hb stabilizes, double the dose and administer monthly
Study These Flashcards
A

Methoxy PEG-epoetin beta

22
Q

MOA of which drug?

  • Induces erythropoiesis by stimulating the division of differentiation of committed erythroid progenitor cells
  • Induces release of reticulocytes from the bone marrow into the blood stream
Study These Flashcards
A

Erythropoetin Stimulating Agents (ESA)

23
Q

2 clinical indications for ESAs

Study These Flashcards
A
  • Anemia due to myelosuppression
  • Anemia due to CKD
24
Q

ESA half lives

  • Are half lives longer in IV or SQ?
25
3 Adverse Effects of ESAs
* Boxed warning: increased CV and CKD events w/ Hb \>11 g/dL * Cancer * Increase risk of DVT
26
What is the Hb goal / change for management of anemia in adults?
1-2g/dL in 4 weeks
27
What are the 6 abnormalities in Chronic Kidney Disease-Mineral & Bone Disorder?
* Parathyroid hormone (PTH) * Calcium, phosphorus * The calcium-phosphorus product * Vit D Bone turnover * Soft tissue calcifications
28
What effect does PTH have in regards to CKD-MBD?
* **Serum Ca increased\*\*** * **Serum Phosphate decreased\*\*** ## Footnote **(Net effect on serum levels)**
29
What effect does Vit D have in regards to CKD-MBD?
* **Serum Ca increased\*** * **Phosphate increased\*** ## Footnote **(net effect on serum levels)**
30
What effect does FGF23 have in regards to CKD-MBD?
* **Decreased serum phosphate\*** ## Footnote **(Net effect on serum levels)**
31
4 ways to manage CKD-MBD?
* Dietary phosphorus restriction * Phosphate-binding agents * Vit D supplementation * Calcimimetic therapy
32
Give examples of foods high in phosphorus
* Pumpkin seeds * Ground mustard seeds * Parmesan cheese * Brazil nuts * Cocoa powder * Edamame * Baker's yeast * Bacon * Beef liver * Canned sardines
33
What 2 drugs are Calcium Based Binders used to tx Hyperphosphatemia in CKD patients?
* Calcium acetate (PhosLo) * Calcium carbonate (Tums)
34
What 2 drugs are Iron-based binders used to tx Hyperphosphatemia in CKD?
* Ferric citrate (Auryxia) * Sucroferric oxyhydroxide (Velphoro)
35
What are 2 Resin binders used to tx Hyperphosphatemia in CKD pts?
* Sevelamer carbonate (Renvela) * Sevelamer hydrochloride (Renagel)
36
What are 2 "other elemental binders" used to tx hyperphosphatemia in CKD pts?
* Lanthanum carbonate (Fosrenol) * Aluminum hydroxide (AlternaGel)
37
**Which drug?** * **MOA:** Binds w/ dietary phosphate to form insoluble calcium phosphate: excreted in feces * **Clinical indication:** CKD hyper-phosphatemia
Calcium Based Phosphate-Binding Agents for tx of Hyperphosphatemia in CKD pts. * Calcium acetate (PhosLo) * Calcium carbonate (Tums)
38
**Adverse effects of which drug?** * Hypercalciumia * Hypophosphatemia * Milk-alkali syndrome
**Calcium Based Phosphate-Binding Agents for tx of Hyperphosphatemia in CKD pts.** * Calcium acetate (PhosLo) * Calcium carbonate (Tums)
39
**These sxs are apart of which adverse effect for which drug?** * HA * Nausea * Irritability * Weakness or Alkalosis * Hypercalciumia * Renal impairment
**Milk-Alkali Syndrome** (from Calcium based Phosphate Binding agents for tx of hyperphosphatemia in CKD pts) * Calcium acetate (PhosLo) * Calcium carbonate (Tums)
40
**Which drug?** * **MOA:** binds phosphate within intestinal lumen limiting absorption and decreasing serum phosphate concentrations * **Clinical indications:** Hyperphosphatmia tx, lowers low-density lipoprotein cholesterol, consider in pts at risk for "extraskeletal calcification"
Sevelamer Hydrochloride (Renagel) | (Resin Binder to tx hyperphosphatemia)
41
**Adverse effects of which drug?** * Metabolic acidosis (greater in children) * N/V/D * Dyspepsia
Sevelamer hydrochloride (Renagel) (Resin Binder to tx Hyperphosphatemia)
42
**Which drug?** * **MOA:** binds dietary phosphate resulting in insoluble lanthanum phosphate complexes with net decreases in phosphate and Ca levels * **Clinical indications:** hyperphosphatemia tx, bone half life is 2 - 3.6 yrs, potential for accumulation of lanthanum
Lanthanum carbonate (Fosrenol) "other elemental binder)
43
**Adverse Effects of which drug?** * N/V * Abd pain * Bowel obstruction * Constipation * Dyspepsia * Fecal impaction * Ileus
Lanthanum carbonate (Fosrenol) to tx hyperphosphatemia "other elemental binders"
44
**Which drug?** * **MOA:** binds phosphate in GI tract preventing absorption of phosphate * **Clinical indications:** not a first line agent, reserve for short term use (4 weeks) in pts w/ hyperphosphatemia not responding to other binders
**Aluminum Hydroxide (AlternaGel)** Used to tx hyperphosphatemia in CKD "Other elemental binders"
45
**Which drug?** * Risk of aluminum toxicity * Constipation, fecal impaction * Hypomagnesemia * Hypophosphatemia
**Aluminum hydroxide (AlternaGel)** Used to tx hyperphosphatemia in CKD "Other elemental binders"
46
What are the 2 "nutritional Vitamin D" drugs?
* Ergocalciferol (Drisdol) * Cholecalciferol
47
What are the 3 "Vitamin D & Analogs?"
* Calcitrol (Rocaltrol) * Doxercalciferol (Hectorol) - analogs * Paricalcitol (Zemplar) - analogs
48
Production of Vitamin D requires what?
Conversion of 7-dehydrocholesterol to cholecalciferaol (vit D3) by sunlight
49
* The first hydroxylation step of Vitamin D occurs where? * The final conversion step of Vitamin D occurs where?
* 1st: Liver, to form 25-hydroxyvitamin D3 * Final: Kidney, to form 1,25-dihydroxyvitamin D3 or calcitriol
50
Recommendations for CKD * Adjust med doses for kidney function * Seek pharmacist or medical advice before using OTC meds / nutritional supplements * Are herbal medicines recommended? * ___ is suggested for pts at risk for atherosclerotic events unless there is an increased bleeding risk * Avoid ______ in people w/ a GFR \<60 or in those known to be at risk of phosphate nephropathy
* Herbal meds NOT recommended * ASA * oral phosphate-containing bowel preparations

SG - Pharm 4 (16 decks)

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