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Therapeutics I > Block 4: K+ and Mg2+ > Flashcards

Block 4: K+ and Mg2+ Flashcards

1
Q

What is the most abundant IC electrolyte?

A

Potassium

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2
Q

What are the functions of K+?

A
  1. Regulates osmolarity of ICF (balanced with H+)
  2. Maintains action potential
  3. Buffers blood pH
  4. Facilitates glycogen storage in liver and skeletal muscle cell
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3
Q

How does inulin affect K?

A
  1. Insulin shifts K into the cell
  2. Low K affects insulin production
  3. Insulin enable the cell to uptake glucose and glycogenesis
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4
Q

What does K/H exchanger do?

A

Shift H into the cell and K outward

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5
Q

What are the normal values of K?

A

3.5-5 mEq/L

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6
Q

What is the relationship between serum K and aldosterone?

A

Indirect, aldosterone increases K excretion and Na intracellularly

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7
Q

What should you check if serum K is low?

A

Mg2+

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8
Q

What causes hyperkalemia?

A
  1. Increased intake
  2. Decreased excretion
  3. Renal dysfunction
  4. Cellular shifts
  5. Insulin def
  6. Tissue catabolism
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9
Q

What kind of drugs cause hyperkalemia?

A
  1. K sparing
  2. ACEi/ARBs
  3. NSAIDs
  4. B blockers
  5. Digoxin
  6. Cyclosporine
  7. Tacrolimus
  8. Bactrim
  9. Heparin
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10
Q

What are the presentations of hyperK?

A
  1. EKG changes
  2. Cardiac arrhythmias
  3. Heart palpitations or skipped heartbeats
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11
Q

What are the levels of hyperkalemia?

A

Mild: 5.1-5.9 (asymptomatic)
Moderate: 6-7
Severe: >7 (palpitations)

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12
Q

What are the treatment for hyperkalemia?

A
  1. Dietary mod
  2. Adjustment of contributing med
  3. Furosemide 40-80 mg IV (↑ excretion)
  4. Potassium binders
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13
Q

What are the K binders?

A

SPS (Kayexalate)
Patiromer calcium (Veltassa)
Sodium zirconium cyclosillicate (Lokelma)

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14
Q

What K binders are used for emergency?

A

SPS and Sodium zirconium cyclosilicate (Lokelma)

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15
Q

What K binders exchange sodium for K+?

A

SPS and Lokelma

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16
Q

What are the MOA for K binders?

A

↑ fecal K elimination

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17
Q

What are the similarities of all K binders?

A

Treat chronic hyperK

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18
Q

What K binders must be separtared from other meds 3 hr before and after admin?

A

Veltassa and SPS

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19
Q

What are the ADRs of SPS? Indication?

A

Intestinal necrosis with rectal admin

For acute hyperK

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20
Q

How does patiromer differ from other K binders?

A

Exchanges Ca for K
Delayed onset of 48 hr

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21
Q

How should you take Lokelma?

A

Separate other meds by 2 hours pre and post

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22
Q

What are the steps of acute and symptomatic hyperK?

A
  1. Check if EKG is abnormal
  2. Redistribution and intracellular K+ shift
  3. Eliminate K+ from body
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23
Q

What do you do about the ECG in hyperK?

A

Abnormal: 1g IV calcium gluconate

If normal don’t give IV calcium

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24
Q

How do you redistribute K?

A
  1. Regular insulin 10 u IV + 25 g dextrose unless BG >250
  2. 50-100mEq IV sodium bicarbonate if pH <7.3
  3. Albuterol nebulizer 10-20 mg over 10 min if no IV access
  4. Just use insulin if hyperglycemic
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25
How should you eliminate K from the body?
1. SPS 15-30 g PO 2. IV loop diuretic if making urine 3. Hemodialysis for CKD or life-threatening
26
When would albuterol be used for hyperkalemia?
1. Tachycardia present 2. Not effective
27
What is hypokalemia?
<3,5
28
What causes hypoK?
1. GI/renal losses 2. Intracellular shifts (metabolic alkalosis) 3. Hypomagnesemia
29
What drugs cause hypokalemia?
1. Loops 2. Thiazides 3. Beta blockers 4. Laxatives 5. Insulin 6. Sodium bicard 7. K binders
30
What are the presentations and tx of mild hypoK?
3.1-3.5 Asymptomatic ↑ dietary intake
31
What are the presentations and tx of moderate hypoK?
2.5-3 Cramping, weakness, malaise, myalgia PO K
32
What are the presentations and tx of severe hypoK?
<2.5 ECG changes and arrhythmias
33
When do you start chronic supplementation of hypoK?
1. underlying conditions 2. Arrhythmia risk 3. Concomitant meds
34
What is the treatment goalsof hypoK?
K<3 mEq/L requires treatment with goal K 4-4.5 mEq/L
35
What are the IV K salts?
1. Chloride (for alkalosis) 2, Acetate (for acidosis) 3. Phosphate (for low P)
36
What are PO K salts?
1. Chloride (for alkalosis) 2. Phosphate (for low P) 3. Bicarbonate (for acidosis)
37
What are the the K-sparing diuretics?
1. Spironolacotone 2. Triamterene 3. Amiloride Use add on with loops or thiazides
38
How do you dose IV/PO K?
1.Each 10 mEq od K will ↑ Serum K bu 0.1 2. ((4-K)/sCr)x100 Round to the nearest 10 mEq
39
How should IV K be given?
Diluted in NS is preferred Administer via central line if >20mEq/100mL Cardiac monitoring is admin >10 mEq/hr
40
What are the infusion rate of IV K?
Peripheral: 10 mEq/hr Central: 20 mEq/hr
41
ADRs of IV K?
Burning (reduce rate)
42
What is the reasons for poor adherence of PO K?
Large tablets and GI intolerance
43
How do you administer PO K?
Lower and more frequent doses Microencapsulated tablets
44
What are the KCl dosage forms?
1. CR microencapsulated tabs (Kdur) 2. Elixer 3. Effervescent tabs 4. Wax-matrix ER tabs (Klor-Con)
45
What KCl has the best GI tolerability?
CR microencapsulated tabs (Kdur)
46
What Kcl is rapid acting?
Elixer
47
What KCl is easy to swallow however cause more GI erosion?
Wax-matrix ER tabs (Klor-Con)
48
What KCl is more expensive?
Effervescent tabs
49
What are K bicarb and citrate used for?
Acid/base disorders
50
How do you manage K when taking other drugs?
Daily supplant for thiazides and loops to prevent hypokalemia K-sparing can be added to counteract depletion
51
What is the most common K formulation?
Chloride
52
What is the 2nd most abundant electrolyte in ICF?
Mg
53
What is most Mg found? How is it eliminated?
bone Renal
54
What are the functions of Mg?
1. Mg helps K absorption 2. Helps Ca absorption, however, Ca inhibits Mg absorption 3. Cofactor in reactions dependent on ATP 4. Regulate PTH 5. Regulates glucose metabolism
55
What is hypermagnesiem?
>2.4 mg/dL
56
What causes hyperMg?
1. Renal failure 2. Drugs (Mg citrate and supplements)
57
What are the presentations of hyperMg?
1. Muscle weakness 2. Shallow respirations 3. Arrhythmias 4. Symptoms rare when <4.9
58
What are primary treatments for hyperMg?
1. Reduce intake 2. Enhance elimination 3. Antagonize physiologic effects
59
What are the treatment options for hyperK?
1. IV potassium 2. PO potassium 3. K sparing diuretics
60
What do we use to treat hyperMg?
1. Calcium gluconate 2g IVP until symptoms abate 2. 0.45% NaCl + Loop diuretic 3. hemodialysis
61
What are the characteristic of calcium gluconate with hyperMg?
1. May repeat Q1H prn 2. Antagonizes effects 3. PO calcium has porr F and slow onset
62
Why is 0.45% NaCl + Loop diuretic used as a combo for hyperMg?
1. Enhances elimination 2. In patients with normal renal function or CKD 1-3 3. Onset 6-12H
63
When is hemodialysis used for hyperMg?
1. Enhances elimination 2. Onset 4H
64
What are the causes of hypomagnesemia?
1. Impaired absorption 2. Increased excretion 3. Alcoholism 4. Diuretics, laxatives, PPIs
65
What are the presentations of hypoMg?
<1.5 1. Muscle weakness, paralysis 2. QT prolongation/arrhythmias 3. Hypokalemia 4. Hypocalcemia Symptoms until <1 mg/dL
66
How and when do you dose IV Mg sulfate?
If Mg <1.2 mg/dL OR s/s present Diluted in IVF Dosing: 4-6 grams in 2-3 divided doses (Max infusion rate < 150 mg/min ) 1g=8mEq
67
ADRs of IV mag?
Hypocalcemia
68
How and when do you dose PO Mg sulfate?
If Mg >1.2 mg/dL and asymptomatic 1-2 tabs PO BID-TID
69
What are the salt forms of PO mg?
Oxide, gluconate, chloride
70
ADR of PO Mg?
Diarrhea SR products improve compliance and reduce GI effects
71
Describe PO Mg replacements?
72

Therapeutics I (32 decks)

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