Mineral and Bone Disorders Flashcards
(23 cards)
Phosphate binders
- Lower phosphate levels
- Lowers PTH
Calcium Salt Phosphate Binders Adverse Effects
- Hypercalcemia
- Constipation
When do you correct calcium concentrations
-Serum albumin levels < 4
Sevelamer
- Phosphate binder
- Free of metal ions
- Also lowers TC and LDLs
Aluminum Salts
- High phosphate binding potency
- Adverse effect: aluminum toxicity, constipation, fecal impaction
- Avoid due to side effects
Drug Interactions with Phosphate Binders
- Interfere with absorption of quinolones and levothyroxine
- Space administration timing
Cinacalcet
- Binds to CaR and increases Ca sensitivity
- When Ca binds to the receptor it is activated
- PTH release is inhibited while CaR is activated
- Risk of HYPOcalcemia, avoid if Ca < 8.4mg/dL
- Inhibits CYP 2D6 (psych meds, and antiarrhythmic drugs)
Cinacalcet Monitorin
- Ca and P levels after 1 week
- PTH 1 to 4 weeks of starting
- Ca < 7.5mg/dL HOLD
- May restart once Ca > 8mg/dL
Monitoring
a) Stage 3-
- PTH q12mo
- Ca and P q12mo
b) Stage 4-
- PTH q3mo
- Ca and P q3mo
c) Stage 5
- PTH q3mo
- Ca and P q1mo
Calcium Carbonate (OsCal, Tums)
- Inexpensive
- OTC
- 40% elemental Ca
- Wide variety available
Calcium Acetate (PhosLo)
- Expensive
- Rx only
- 25% elemental Ca
- 1st line for hyperphosphotemia
Calcium Citrate
- AVOID
- Increases absorption of aluminum, leading to toxicities
Sucroferric Oxyhydroxide
- Velphoro
- Iron salt
Ferric Citrate
- Auryxia
- Iron salt
Ergocalciferol (D2)
- Inactive Vitamin D
- CKD 3 or 4
- Elevated PTH levels
- serum 25(OH) vitamin D <30ng/mL
Cholecalciferol
- Inactive vitamin D
- CKD 3 or 4
- Elevated PTH levels
- Serum 25(OH) vitamin D <30ng/mL
Calcitriol
- Active vitamin D
- CKD 4
- Elevated PTH levels
- Serum 25(OH) vitamin D >30ng/mL
- Risk for hypercalcemia
- Risk for hyperphosphatemia
Paricalcitol
- Zemplar
- Vitamin D analog
- Low incidence of hypercalcemia or hyperphosphatemia
- Serum 25(OH) vitamin D >30ng/mL
Doxercalciferol
- Hectorol
- Vitamin D analog
- Low incidence of hypercalcemia or hyperphosphatemia
- Serum 25(OH) vitamin D >30ng/mL
Calcifediol
- Rayaldee
- Vitamin D analog
- 25 hydroxy vitamin D3 (weird)
- Monitor for increased Ca and Phos levels
- Indicated for CKD stage 3 and 4 with serum 25(OH) vitamin D <30ng/mL
When to use active vitamin D or a vitamin D analog
1) CKD stage 4
- Elevated PTH
- Serum 25(OH) vitamin D >30ng/mL
2) CKD stage 5
- Elevated PTH
When to use inactive vitamin D
- CKD stage 3 or 4
- Elevated PTH
- Serum 25(OH) vitamin D <30ng/mL
ex. Ergocalciferol/Cholecalciferol
When to use a Calcimimetic
- CKD stage 5
- Elevated PTH
