5.8 Pharm: Renal Failure

Question 1

Goal of ACEI and ARB

Answer 1

ACE inhibitor and ARB treatment: goal is to decrease urine protein level, decrease BP, and Decrease the GFR decline

Question 2

ACEI

MOA
Agents
ADR

Answer 2

• MOA: Inhibit Peptidyl Dipeptidase, and plasma kinase which inactivates bradykinin (Potent vasodilator) , decrease PVR
• Agents: -Pril
o Enalapril, Lisinopril
ADR: Hyperkalemia

Question 3

ARB

MOA
Agents
ADR

Answer 3

• MOA: Block Ang II type 1 receptors, Decrease PVR
• Agents: -sartan
o Losartan

ADR: Hyperkalemia

Question 4

Sodium Polystyrene sulfonate

MOA
Use
CI
ADR

Answer 4

• MOA: Resin removes K+ ions in GI by replacing them with Na+
• Use: Hyperkalemia
• PK: Oral and rectal; Takes a long time to onset
• CI: Serum K+<5mmol/L; Obstructuve bowel disease
• ADR: GI distress, fecal impaction
o Metabolic nutrition disorder: Hypokalemia and hypocalcemia; retention of Na+

Question 5

Tx: metabolic acidosis

Answer 5

• Total CO2: Measures CO2 in the blood, Contributed to by HCO3 concentration and CO2 gas; Portion from CO2 gas = pCO2*0.03
• Anion gap: Kidneys responsible for removing acids. →MUDPILES→high anion gap
Sodium Bicarbonate
• Use: Metabolic acidosis

Question 6

Goal for Hyperparathyroidism, Hyperphosphatemia

Answer 6

Tx: Hyperparathyroidism, Hyperphosphatemia

• Therapeutic goal: Prevent hyperparathyroidism, Keep Ca*P<55; Maintain normal bone remodeling and bone

Question 7

Phosphate binder: Calcium carbonate/acetate:

Use:
ADR:

Answer 7

Calcium carbonate/acetate:
• Indications: Hyperphosphatemia, treat hypocalcemia
• PK: Oral
• ADR: GI effect, hypercalcemia, soft tissue calcification, suppress PTH

Question 8

Phosphate Binder: Sevelamer Carbonate

Use:
ADR:

Answer 8

Sevelamer Carbonate
• Indications: Hyperphospatemia; Lowers LDL-C
• PK: Oral
• ADR: Bowel obstruction and perforation, GI effects

Question 9

Phosphate Binder: Lanthanum

Use:
ADR:

Answer 9

Lanthanum
• Indication: Hyperphosphatemia
• PK: Oral
• ADR: Accumulation of lanthanum, GI effects

Question 10

Vit. D agents

Agents: 
MOA: 
Use: 
PK
ADR

Answer 10

Vitamin D Agents 
•	Calcitriol, Cholecalciferol, Ergocalciferol, Doxercalciferol, Paricalcitol 
•	MOA: Provide Calfitriol 
•	Indications: Hyperparathyroidism 
•	PK: Oral and injectable 
•	ADR: Hypercalcemia, Hyperphospatemia

Question 11

Cinacalcet

MOA:
Indications
Type of activator 
DRug interactions 
ADR
CI

Answer 11

Cinacalcet
• MOA: Increases sensitivity of Ca+2 of CASR on parathyroid gland
• Allosteric activator
• Indications: Secondary Hyperparathyroidism (HPT) with CDK on dialysis
• PK: Oral
• Drug interactions: Inhibitor of CYP 3A4 and CYP2D6
• ADR: GI: N/V/D, Hypocalcemia
• CI: Hypocalcemia