CKD and Mineral and Bone Disorders Flashcards
(90 cards)
1
Q
when does the parathyroid produce PTH?
A
in response to low serum calcium levels
2
Q
what are 3 ways that PTH can increase calcium levels?
A
- stimulate osteoclasts to release more calcium from bone
- decrease secretion of calcium by the kidney
- activating vitamin D
3
Q
what does calcitriol increase?
A
calcium
4
Q
how can calcitriol increase calcium? 2
A
- increase absorption in the GI tract
- increase calcium reabsorption in the distal tubules of the kidney
5
Q
what can nephron loss cause an increase in? 2
A
- plasma phosphate
- increased calcium and phosphate binding
6
Q
what are 2 things that nephron loss can decrease?
A
- vitamin D activation in the kidneys
- plasma calcium
7
Q
what can renal osteodystrophy cause an incraese in?
A
aluminum
8
Q
what are 5 symptoms of secondary hyperparathyroidism?
A
- decreased range of motion
- gritty sensation in the eyes
- calcium deposits
- redness
- inflammation
9
Q
what is the corrected serum calcium range?
A
8.4-9.5
10
Q
what is the normal serum phosphorous range?
A
3.5-5.5
11
Q
what is the range for PTH levels?
A
300-500
12
Q
what should you treat first for renal osteodystrophy?
A
phosphate
13
Q
what are 4 non-pharm treatments for renal osteodystrophy?
A
- dietary restriction of phosphorous
- hemodialysis or peritoneal dialysis
- restriction of aluminum exposure
- removal of the parathyroid glands (last resort)
14
Q
what is the range to restrict phosphorous to?
A
800-1000 mg/day
15
Q
what is hemodialysis and peritoneal dialysis insufficient for?
A
hyperphosphatemia
16
Q
if PTH levels are at ______ the removal of parathyroid glands can be considered?
A
> 800
17
Q
what is a pharmacologic treatment that can be used to treat hyperphosphatemia?
A
phosphate binders
18
Q
what are the 5 types of phosphate binders that can be used to treat hyperphosphatemia?
A
- aluminum-based
- calcium-based
- aluminum/calcium free
- iron based
- magnesium based
19
Q
what type of phosphate binder cannot be used chronically?
A
aluminum based phosphate binders
20
Q
how long can aluminum phosphate binders be used?
A
4 weeks max
21
Q
what are the 3 symptoms that show aluminum toxicity?
A
- neurotoxicity
- bone disease
- anemia
22
Q
when are the aluminum based phosphate binders used?
A
when phosphate levels are >7 and pt doesn’t respond to other binders
23
Q
what are 4 things you should monitor for aluminum based phosphate binders?
A
- PTH
- calcium
- phosphate
- serum aluminum concentrations
24
Q
what are the 2 types of calcium based phosphate binders?
A
- calcium carbonate
- calcium acetate
25
what can the ca2+ phosphate binders aid in?
metabolic acidosis
26
which of the 2 calcium based phosphate binders is more potent?
calcium acetate
27
what patients should calcium based phosphate binders not be used in? 3
1. elevate serum calcium
2. arterial calcifications
3. adynamic bone disease
28
you should not exceed how much elemental calcium per day from the calcium based phosphate binders?
1500mg
29
what are 5 side effects of the aluminum based phosphate binders?
1. constipation
2. nausea
3. poor taste
4. dialysis dementia
5. osteomalacia
30
what are 3 side effects of the calcium based phosphate binders?
1. constipation
2. nausea
3. hypercalcemia
31
what are 3 things you should monitor when taking calcium based phosphate binders?
1. calcium
2. phosphate
3. PTH
32
what are 4 common interactions seen with calcium based phosphate binders?
1. quinolones
2. tetracyclines
3. oral bisphosphonates
4. thyroid products
33
when should you monitor calcium levels closely when patients are on calcium based phosphate binders?
vitamin d supplementation
34
when can you use phosphate binders? 2
1. when serum phosphate cannot be controlled through diet
2. patients receiving dialysis
35
what are 2 aluminum/calcium free phosphate binders?
1. sevelamer
2. lanthanum carbonate
36
what phosphate binder has cholesterol benefits?
sevelamer
37
what are contraindications of sevelamer?
bowel obstruction
38
what are 5 things that should be monitored for sevelamer?
1. calcium
2. phosphate
3. HCO3
4. Cl
5. PTH
39
what are 4 common drug interactions with sevelamer?
1. quinolones
2. mycophenolate
3. tacrolimus
4. thyroid products
40
what must patients do when taking lanthanum carbonate?
chew tablet thoroughly to prevent GI SE
41
what is a warning seen when taking lanthanum carbonate?
GI perforation
42
what are 3 things that should be monitored with lanthanum carbonate?
1. calcium
2. phosphate
3. PTH
43
what are 3 common drug interactions seen with lanthanum carbonate?
1. quinolones
2. thyroid products
3. anatacids
44
what are 2 iron based phosphate binders?
1. ferric citrate
2. sucroferric oxyhydroxide
45
how should patients take sucroferric oxyhydroxide?
chew and then swallow
46
how should patients take ferric citrate?
do not crush or chew to avoid teeth discoloration
47
what is there a high risk of when taking ferric citrate?
increased iron absorption
48
absorption of iron is ___ with sucroferric oxyhydroxide
minimal
49
what are 5 things that should be monitored for with sucroferric oxyhydroxide?
1. iron
2. ferritin
3. TSAT
4. phosphate
5. PTH
50
what are 3 common interactions with the iron based phosphate binders?
1. quinolones
2. thyroid products
3. doxycycline
51
what agents should **NOT** be used with the iron phosphate binders?
thyroid products
52
when can magnesium based phosphate binders be utilized?
to decrease the amount of calcium containing binders required to manage phosphate
53
why is the use of magnesium based phosphate binders limited?
GI effects (diarrhea)
54
when is vitamin D therapy utilized?
after hyperphosphatemia is controlled
55
what is used to treat elevated PTH levels?
vitamin D therapy
56
what do exogenous vitamin D compounds mimic?
the activity of calcitriol
57
what are the 2 vit D precursors that can be used?
1. ergocalciferol
2. cholecalciferol
58
what are the vitamin D precursors effective in?
patients with stage 3 CKD
59
when cant you use the vit D precursors?
in patients with CKD stages 4-5
60
what is teh most active form of vit D?
calcitriol
61
what 2 things can calcitriol and calcifediol cause?
1. hypercalcemia
2. hyperphosphatemia
62
what are the 2 active vit D analogs?
1. calcitriol
2. calcifediol
63
what are the 2 vitamin D analogs?
1. paricalcitol
2. doxercalciferol
64
what do the vit d analogs have a decreased effect on?
intestinal absorption of calcium and phosphate
65
what are 2 contraindications of vitamin D analogs?
1. hypercalcemia
2. vitamin d toxicity
66
what are 4 things that should be monitored with the vit d analogs?
1. calcium
2. phosphate
3. PTH
4. 25-hydroxyvitamin D (calcifediol only) goal: 30 and 100 ng/ml
67
what do calcimimetics increase the sensitivity of?
the parathyroid gland to serum calcium levels
68
what do calcimimetocs decrease?
serum calcium and phosphorous levels
69
what patients are calcimimetics great for?
patients with:
1. elevated PTH levels
2. Elevated calcium and phosphate levels
70
what are 2 calcimimetics that can be used?
1. cinacalcet
2. etelcalcetide
71
what is a contraindication for calcimimetics?
hypocalcemia
72
what is a warning for the use of calcimimetics?
pt with seizure history
73
what 3 things should be monitored when using calcimimetics?
1. calcium
2. phosphate
3. PTH
74
what type of phosphate binders should you use first when treating hyperphosphatemia?
aluminum/calcium free agents
75
CALCIUM CARBONATE
TUMS
76
CALCIUM ACETATE
PHOS-LO
77
SEVELAMER HCL
RENAGEL
78
SEVELAMER CARBONATE
RENVELA
79
LANTAHNUM
FOSRENOL
80
SUCROFERRIC OXYHYDROXIDE
VELPHORO
81
FERRIC CITRATE
AURYXIA
82
ERGOCALCIFEROL
VITAMIN D2
83
CHOLECALCIFEROL
VITAMIN D3
84
CALCITRIOL
CALCIJEX, ROCALTROL
85
CALCIDFEDIOL
RAYALDEE
86
PARICALCITOL
ZEMPLAR
87
DOXERCALCIFEROL
HECTOROL
88
CINACALCET
SENISPAR
89
ETELCALCETIDE
PARSABIV
90
