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Flashcards in Exam 2 lecture 3 Deck (42):
1

fibroblast GF23 aka

phosphatonin
- released from bones in response to high phospate

2

as kidney function declines, there is

- increased phophate retension (HyperP)
- inhibition of renal activation of vit D
- stimulation of PTH secretion
- Ca levels are maintained by bone resorption
- elevated CaxP product can cause soft tissue calcification

3

as kidney function declines, there is

- increased phophate retension (HyperP)
- inhibition of renal activation of vit D
- stimulation of PTH secretion
- Ca levels are maintained by bone resorption
- elevated CaxP product can cause soft tissue calcification

4

CKD stage 3

corrected Ca: normal
P: 2.7-4.6mg/dL
CaXP:

5

CKD stage 4

corrected Ca: normal
P:2.7-4.6
CaXP:

6

CKD stage 5

Corrected Ca: 8.4-9.5
P: 3.5-5.5
CaXP:

7

CKD stage 5

Corrected Ca: 8.4-9.5
P: 3.5-5.5
CaXP:

8

hypocalcemia

9

PTH ranges for what stages are above normal range to prevent over suppression of PTH & reduce risk of adynamic bone disease?

stage 4 & 5

10

PTH ranges for what stages are above normal range to prevent over suppression of PTH & reduce risk of adynamic bone disease?

stage 4 & 5

11

first line intervention for CKD patients

dietary phosphate restriction
- 800-1000mg/day

12

nonpharm treatment for CKD

- dietary phosphate restriction
- dialysis
- parathyroidectomy

13

nonpharm treatment for CKD

- dietary phosphate restriction
- dialysis
- parathyroidectomy

14

phosphate binding agents MOA

- bind dietary phosphorous in the GIT & form an insoluble product that can be excreted in feces
- lowers phosphorous absorption
- lowers serum phosphate concentration

15

phosphate binding agents

elemental calcium, lanthanum, aluminum & magnesium containing compounds & a nonelemental agent sevelamer carbonate

16

phosphate binding agents

elemental calcium, lanthanum, aluminum & magnesium containing compounds & a nonelemental agent sevelamer carbonate

17

what phosphate binding agent is more soluble in acidic environments?

calcium carbonate
- given before meals

18

which phosphate binding agent binds 2x more phosphorous as calcium carbonate?

calcium acetate

19

which phosphate binding agent binds 2x more phosphorous as calcium carbonate?

calcium acetate

20

sevelamer carbonate

- phosphate binding agent
- nonabsorbable nonelemental hydrogel

21

lanthanum carbonate

-phosphate binding agent
- approved for ESRD

22

aluminum salts

-phosphate binding agent
- restricted to 4 week therapy if used at all

23

magnesium containing antacid

- phosphate binding agent
- use is limited in CKD pts due to GI side effects & potential for MG accumulation

24

magnesium containing antacid

- phosphate binding agent
- use is limited in CKD pts due to GI side effects & potential for MG accumulation

25

phosphate binding agents adverse effects

- all limited by GI side effects
- constipation, diarrhea, N/V & abdominal pain
- hypercalcemia
- CNS toxicity & worsened anemia with aluminum
- hyperMG & hyperK with MG binders

26

phosphate binding agents adverse effects

- all limited by GI side effects
- constipation, diarrhea, N/V & abdominal pain
- hypercalcemia
- CNS toxicity & worsened anemia with aluminum
- hyperMG & hyperK with MG binders

27

vitamin D therapy MOA

- activated vit D (calcitriol) suppresses PTH secretion by stimulating absorption of calcium by intestinal cells, stimulating reabsorption of Ca by proximal tubular cells & through direct activity on PT gland.

28

vitamin D therapy MOA

- activated vit D (calcitriol) suppresses PTH secretion by stimulating absorption of calcium by intestinal cells, stimulating reabsorption of Ca by proximal tubular cells & through direct activity on PT gland.

29

ergocalciferol

- vitamin D2
- must be converted to active form in kidney

30

cholecalciferol

- vitamin D3
- must be converted to active form in kidney

31

calcitriol

- 1-25-dihydroxyvitamin D3
- most active form & available in IV (Calcijex) or oral (Rocaltrol)

32

vitamin D analogs

paricalcitol & doxercalciferol

33

what vitamin D agent(s) can you use in severe renal disease?

- Calcitriol or analogs
- bc they do not require activation in the kidney

34

IV calcitriol is more practical in

hemodialysis pts

35

PO calcitriol is more practical in

nondialysis CKD & peritoneal dialysis pts

36

calcimimetics

- cinacalcet hydrochloride is approved for the treatment of 2* hyperPTH in ESRD pts & for treatment of hyperCa in pts with PT carcinoma

37

cinacalcet hydrochloride brand

sensipar

38

sensipar MOA

- acts on the Ca- sensing receptor on the surface of chief cells of the PT gland to mimic effect of extracellular ionized Ca & increase the sensitivity of the receptor to Ca

39

sensipar does NOT

increase intestinal Ca & Phosphorous ABSORPTION

40

sensipar does NOT

increase intestinal Ca & Phosphorous ABSORPTION

41

sensipar (calcimimetic) efficacy

- in HD pts, cincacalcet significantly decreased PTH & CaXP product within a 6 mo period

42

sensipar adverse effects

- nausea & vomitting