Exam 2 lecture 5 Flashcards Preview

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Flashcards in Exam 2 lecture 5 Deck (69):
1

PTH effects on Ca

- intestinal absorption of Ca
- release of Ca from bones
- increased Ca reabsorption in distal tubules

2

PTH NET effect on Ca

increase in serum Ca

3

PTH effects on Phosphate

- decrease in PO4 reabsorption of proximal tubule

4

PTH NET effect on phosphate

decrease serum PO4

5

vitamin D effects on Ca

- increase intestinal absorption
- reabsorption in proximal tubule
- release of Ca from bones

6

Vitamin D NET effect on Ca

increase serum Ca

7

Vitamin D effect on phosphate

- increase intestinal absorption
- reabsorption in proximal tubule
- release from bones

8

vitamin D NET effect on phosphate

increase serum phosphate

9

calcitonin effects on Ca

- inhibits osteoclasts & stimulates osteoblasts
- increases renal excretion of Ca

10

calcitonin NET effects on Ca

decrease serum Ca

11

calcitonin effects on phosphate

- inhibits osteoclasts
- increases renal elimination of PO4

12

calcitonin NET effect on phosphate

decrease serum PO4

13

loss of nephrons

- increased phosphate retension
- inhibit renal activation of vitamin D (decreased Ca absorption in GIT)
- decreased levels of ionized Ca
- stimulates PTH secretion
- decreased production of active vit D

14

GFR

- decreased Ca reabsorption & decreased PO4 reabsorption
- increased bone resorption to maintain levels
- increased PTH-> 2* hyperPT

15

HD pts with PTH >495 associated with

- increased sudden death
- increased morbidity & mortality

16

adverse effects of secondary hyperparathyroidism

- altered lipid metabolism, insulin secretion, myocardial & skeletal muscle function, neurologic & immune function and erythopoietic therapy resistance

17

corrected Ca formula

(4-albumin)*0.8)+Ca

18

soft tissue calcification

- elevated Ca(corrected)-P product
- high when >70
uncommon below 50
- maintain

19

elevated ca P product associated with

- vascular calcification
- CVD
- cardiophyslaxis
- death

20

normal Ca

8.5-10.5

21

acute hypocalcemia symptoms

- neuromuscular: tetany, muscle cramps, laryngeal spasm
- CV: prolonged QT interval, decreased myocardial contractility

22

chronic hypocalcemia symptoms

- CNS- depression, anxiety, memory loss, confusion, hallucinations, tonic-clonic seizures
-derm: hair loss, brittle nails, eczema

23

normal albumin

4-5

24

common causes of hypocalcemia

- ICU pts
- elderly, malnourished pts
- elderly, malnourished pts
- pts who have received NaP as a bowel preparation agent
- vitamin D deficiency
- parathyroidectomy or thyroidectomy
-

25

medications causing hypocalcemia

bisphosphonates, calcitonin, furosemide, oral phosphorus therapy

26

acute, symptomatic hypocalcemia treatment

- 100-300mg elemental Ca IV over 5-10min
(calcium chloride 1g) (calcium gluconate 2-3g)
- continuous infusion 0.5-2mg/kg/hr elemental Ca
- Ca shouldnt be infused faster than 60mg/min

27

asymptomatic hypocalcemia treatment

-oral Ca 1-3g/day

28

calcitriol replacement dosing

0.5-3mcg/day

29

ergocalciferol replacement dosing

50,000 IU/day

30

calcitriol replacement dosing

0.5-3mcg/day

31

calcium

often asymptomatic

32

acute hypercalcemia

- anorexia, N/V, constipation, polyuria, polydipsia, nocturia
- hypercalcemic crisis: acute elevation >15, acute renal insufficiency & obtundation

33

chronic hypercalcemia

metastatic calcification, nephrolithiasis, chronic renal insufficiency

34

common causes of hypercalcemia

- hypercalcemia of malignancy
- primary hyperparathyroidism

35

medications causing hypercalcemia

vitamin D analogs, calcium supplements, lithium

36

treatment of hypercalcemia

- correct underlying cause
- rehydration with NS 200-300mL/h
- loop diuretics (furosemide 40-80mg IV Q1-4H
-hemodialaysis
- calcitonin bisphosphonates

37

calcitonin therapy for hypercalcemia

- 4u/kg SQ or IM Q12H
- use when hydration therapy is contraindicated

38

bisphosphonates

- first line for hypercalcemia of malignancy
- zoledronate 4-8mg IV over 5 minutes
- slow onset of action- 2 days
- caution in pts with GFR

39

causes of hypophosphatemia

- decreased GI absorption
- increased urinary excretion-hyperparathyroidism
- extracellular to intracellular redistribution- refeeding syndrome

40

symptoms of hypophosphatemia

- mild/moderate: asymptomatic
- severe: arrhythmias, respiratory muscle fatigue, respiratory failure, myalgias, weakness, irritability, seizures, coma

41

hypophosphatemia severe, symptomatic treatment

- phosphorous 15-30mmol/IV

42

causes of hyperphosphatemia

- renal failure
- intracellular phosphate release- tumor lysis syndrom

43

symptoms of hyperphosphatemia

- soft tissue calcification
- N/V/D, lethargy, seizure
- renal osteodystrophy

44

when do you do dietary P restriction

-when P>4.7mg/dL
- plasma [PTH] elevated above target

45

normal phosphorus levels

2.6-4.5

46

calcium carbonate

- calcium-based phosphate binder
- most commonly used
- more hypercalcemic events
- more soluble in acidic environments- give prior to meals

47

calcium acetate

- Ca-based phosphate binder
- binds 2X more phosphorus
- more soluble, better absorbed at alkaline pH than Ca carbonate

48

calcium citrate

- Ca-based phosphate binder
- do not use with aluminum based binders

49

Mg- based phosphate binders

- Mg carbonate, Mg hydroxide
- not commonly used
- diarrhea

50

Mg- based phosphate binders

- Mg carbonate, Mg hydroxide
- not commonly used
- diarrhea

51

aluminum- based phosphate binders

- aluminum hydroxide, aluminum carbonate
- aluminum slowly removed by dialysis
- accumulates in various tissues (brain, bone, PT gland, other organs)

52

aluminum based phosphate binders toxicity

- dialysis encephalopathy
-aluminum-related bone disease
- microcytic anemia
- treated w/ deferoxamine

53

non-Ca, non-MG, non-Al-based phosphate binders

- first line when hypercalcemic, low PTH or vascular calcification

54

sevelamer HCL brand

renagel

55

sevelamer

- non-Ca, non-MG, non-Al-based phosphate binder
- polymeric compound which binds phosphate
- lowers LDL, increases HDL
- should not be broken or chewed

56

lanthanum carbonate brand

fosrenol

57

lanthanum carbonate

-non-Ca, non-MG, non-Al-based phosphate binder
- earth metal which binds phosphate
- chewable wafer

58

stage 3 & 4 hyperphosphatemia

- Ca-based first line

59

stage 5 hyperphosphatemia

- primary: calcium based or non-Ca, non-MG, non-Al-based phosphate binder
- total Ca/day should not exceed 2000mg/day (1500 phosphate binder)

60

when do you use aluminum based phosphate binders?

in pts with phosphate >7 in stage 5
-

61

compounds have to be

-activated
in the kidney
- sterols who do not

62

adverse effect of vitamin D

- increased intestinal absorption of Ca & P
- decreased iPTH-> andynamic bone disease

63

25[OH]D

- in stage 3 or 4 CKD start vitamin D compound

64

25[OH]D target

- start sterol
- only in pts who are at Ca & PO4 at goal

65

stage 3-5 CKD

- vit D sterol should be initiated if PTH progressively increases & remains high

66

calcimimetic

cinacalcet HCL (Sensipar)
- shown to significantly decrease PTH & CaXP product within 6 months

67

sensipar MOA

- acts on Ca-sensing receptors on chief cells of PT gland-> decrease PTH secretion

68

adverse effects of calcimimetics

- N/V
- hypocalcemia
- inhibitor of CYP2D6
- take with meals

69

calcimimetics place in therapy

- alternative or adjunct to vitamin D anaolgues