Pharmacology of CKD

Question 1

As kidney function declines

Answer 1

PO4 increases
Inhibited Vit D
Increased PTH secretion
Calcium is maintained through bone resorption
Soft tissue calcification

Question 2

Goals of CKD Management

Answer 2

Normalize Ca, PO4 Ca X P and PTH

Prevent the progression to renal ostedystrophy CV and extravascular calcification and associated morbidity and mortality

Question 3

HypoCa =

Answer 3

Less than 8.5

Question 4

CaXP

Answer 4

Less than 55

Question 5

PTH range for stage 4 and 5 CKD

Answer 5

Above normal range to prevent over suppression of PTH and reduce risk of adynamic bone disease

Question 6

Non-pharmacologic therapy

Answer 6

Phosphate restriction to 800-100 mg/d
Dialysis- HD/PD lower serum P and Ca
Parathyroidectomy: for severe CKD-MBD

Question 7

MOA of Phosphate binding agents

Answer 7

Bind dietary phosphorous in the GI tract and form an insoluble product to be pooped out

Question 8

Phosphate binding agents include:

Answer 8

Elemental Ca, lanthanum, aluminum and magnesium and nonelemental agent sevelamer carbonate

Question 9

First line product =

Answer 9

Oral calcium compounds for control of PO4 and Ca

Question 10

Calcium carbonate

Answer 10

More soluble in acidic environments (before meals)

Question 11

Calcium acetate

Answer 11

binds 2X more PO4

Question 12

Sevelamer carbonate

Answer 12

Nonabsorbable, non-elemental hydrogel

Question 13

Lanthanum carbonate

Answer 13

ESRD pts

Question 14

Aluminum salts

Answer 14

Restricted to 4 week therapy

Question 15

Mg containing antacid

Answer 15

Limited in CKD bc of GI side effects and Mg accumulation

Question 16

Phosphate binding agents ADRs

Answer 16

Gi side effects
Hypercalcemia
CNS toxicity and anemia with Al binders
Hypermg and hyper K with Mg binders

Question 17

Vit D MOA

Answer 17

Activated Vit D (calcitriol) suppresses PTH secretion by stimulating absorption of Ca by intestinal cells, reabsorption in the proximal tubule and act on the parathyroid gland

Question 18

Ergocalciferol and Cholecalciferol

Answer 18

Must be converted to active form in kidney

Question 19

Calcitriol

Answer 19

Most active and available IV or oral

Question 20

Paricalcitol or doxercalciferol

Answer 20

Analogs of calcitriol

Question 21

Treatment for pts with severe kidney disease?

Answer 21

Calcitriol or analogs bc they don’t have to be converted

Question 22

Treatment for hemodialysis pts

Answer 22

IV calcitriol

Question 23

Treatment for non-hemodialysis pts and peritoneal dialysis pts

Answer 23

Oral calcitriol

Question 24

Calcimimetics MOA

Answer 24

Acts on the Ca-sensing receptors on the surface of the cief cells of the parathyroid gland to mimic the effect of extracellular Ca and increase the sensitivity of the receptors to Ca

Question 25

Calcimimetics =

Answer 25

Cinacalcet HCl (Senispar)

Question 26

Senispar is used for

Answer 26

Treatment of secondary hyperparathyroidism in ESRD pts and hypercalcemia in pts with parathroid carcinoma

Question 27

Sensipar (Cinacalcet) does NOT

Answer 27

increase intestinal Ca and PO4 absorption

Question 28

Calcimimetics ADR

Answer 28

N/V