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Pharm 2: Exam 4 > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

1
Q

Staging of Chronic Kidney Disease
(CGA)

A

Cause
Glomerular Filtration Rate
Albuminuria

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2
Q

What is used to approximate GFR?

A

Creatinine Clearance

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3
Q

Pharmacokinetic Changes in CKD

A

Phosphate binders ↓ absorption of medications
- Warfarin
- Tetracycline
- Fluoroquinolones
- Digoxin

Low Albumin ↓ protein binding and ↑ free fraction of drug

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4
Q

Causes ↑ Excretion of Na⁺, K⁺, and Ca²⁺

A

Loop Diuretics
- Furosemide
- Bumetanide
- Torsemide

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5
Q

What should be monitored when taking Loop Diuretics?

A

Serum Electrolytes
- including Cl⁻

Renal Function

Weight

Fluid Input and Output

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6
Q

Indications for Urgent Dialysis

AEIOU

A

Acidosis (pH < 7.1)
Electrolytes (K⁺ > 6.5)
Intoxication
Overload of Fluids
Uremic Symptoms

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7
Q

Causes of Hyperkalemia

A

Renal Insufficiency
- missed Dialysis

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8
Q

What Drugs can cause Hyperkalemia?

A

Digoxin
Succinylcholine
Potassium
NSAIDs
Trimethoprim
Cyclosporine

ACE-Inhibitors

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9
Q

Non-Pharm Treatment of Hyperkalemia

A

Diet
Avoid K⁺ Sparing Diuretics
Avoid ACE-I and ARBs

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10
Q

Medication that lowers K⁺ by stabilizing the myocardial membrane potential

A

Calcium Gluconate

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11
Q

Medication that lowers K⁺ by driving it into the cells via the Na⁺/K⁺ ATPase Pump

A

Insulin + Glucose
Albuterol

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12
Q

Medication that lowers K⁺ by Alkalinizing the blood and shifting K⁺ into cells

A

Sodium Bicarbonate

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13
Q

Medications that bind K⁺ and allow it to be excreted through the GI tract.

A

Cation Exchangers

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14
Q

Ion-exchange resin that binds potassium in the gut for excretion

A

Kayexalate
(Sodium Polystyrene Sulfonate)

RISK OF BOWEL NECROSIS

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15
Q

Cation Exchanger that may worsen edema due to the exchange of sodium for potassium.

A

Sodium Zirconium Cyclosilicate
(Lokelma)

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16
Q

Cation Exchanger that may cause Hypomagnesemia

A

Patiromer
(Veltassa)

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17
Q

Chronic manifestations are due to secondary hyperparathyroidism.

Presents as joint pain with soft tissue and joint calcifications.

A

Hyperphosphatemia

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18
Q

When do you typically see Hyperphosphatemia?

A

Stage 5 CKD

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19
Q

How do you treat Hyperphosphatemia?

A

Diet Restriction (800 - 1000 mg)
- dairy, meat, fish, grains
- soft drinks

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20
Q

When do these occur Mineral Bone Disorders occur?

  • Hyperphosphatemia
  • ↓ 25 dihydroxyvitamin D
  • ↓ absorption of Calcium
  • ↓ free Calcium
  • Direct stimulation of PTH secretion
A

GFR < 60

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21
Q

Signs and Symptoms of Mineral Bone Disorder

A

Fatigue
Musculoskeletal or GI Pain
Bone Pain
Fractures

Insidious Onset

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22
Q

What are the consequences of Mineral Bone Disorder?

A

Renal Osteodystrophy
Vascular Calcification

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23
Q

Medications for treating Mineral Bone Disorder

A

Phosphate Binders
- Calcium Carbonate (Tums)
- Calcium Acetate (Phos-Lo)

Do not use in calcium-based dialysis patients with hypercalcemia

24
Q

What medication is 1ˢᵗ line in treating Mineral Bone Disorder with Stage 5 CKD or if the patient has Hypercalcemia?

25
Mineral Bone Disorder medication that dissociates in the upper GI so Lanthanum Ions can find to phosphorus in the GI tract.
Lanthanum Carbonate
26
Lanthanum Carbonate Considerations
Must Chew Completely Take with Food Contraindicated - GI Obstruction - Fecal Impaction - Ileus
27
Used to treat Mineral Bone Disorders Binds iron in the GI tract. ONLY for Dialysis patients.
Phosphate Binders + Oral Iron
28
Causes an insignificant increase in Serum Iron. Side Effect: Dark Stool
Sucroferric Oxyhydroxide (Velphoro)
29
Reduces IV Iron needs by 50% due to Iron Absorption.
Ferric Citrate
30
Stimulates calcium absorption and suppresses Parathyroid hormone synthesis.
Vitamin D Analogues - Calcitriol - Paracalcitol
31
What should you do if a patient is taking a Vitamin D Analogue and their Calcium goes above 10.2 mg/dL?
Discontinue Calcium
32
What are the two inactive forms of Vitamin D?
Ergocalciferol (D2) - weekly or monthly Cholecalciferol (D3) - dose daily
33
Active Vitamin D3
Calcitriol
34
Adverse Effects of Calcitriol
↑ Phosphorus - MUST balance Calcium, Phosphorus, and PTH levels.
35
Medication that is indicated when: Dialysis patients + PTH > 300 + Ca²⁺ > 8.4
Calcimimetics (Cinacalcet)
36
Adverse Effects of Calcimimetics
Hypocalcemia Caution with Seizures
37
Side Effects of Phosphate Binders
Constipation Hypercalcemia
38
Side Effects of Vitamin D Analogues
Hypercalcemia Hyperphosphatemia Vitamin D Toxicity
39
Side Effects of Calcimimetics
Hypocalcemia
40
How can you maximize the efficacy of Phosphate binders?
Take with Meals
41
How do you treat Mild Acidosis? Serum Bicarb < 22
Sodium Bicarbonate Sodium Citrate or Citric Acid
42
How do you treat Severe Uncompensated Acidosis? pH < 7.2
IV Sodium Bicarbonate
43
Side Effects of Sodium Bicarbonate
Hypernatremia Hypocalcemia Hypokalemia Metabolic Alkalosis Edema
44
What is the most important consequence of Stage 3-5 CKD?
Decreased Erythropoietin Production - anemia
45
Labs for CKD + Anemia
CrCl < 60 Hgb < 13 (men) or < 12 (women) Reticulocyte Count (immature cells) Iron Studies Serum B12 Folate
46
Stimulates red blood cell production in the bone marrow, counteracting anemia in CKD.
Erythropoiesis-Stimulating Agents (ESAs)
47
Production of healthy RBCs requires what?
EPO Bone Marrow Iron Vitamin B12 Folate
48
When are Erythropoiesis-Stimulating Agents used?
Hgb < 10
49
Recombinant Human EPO
Epoetin alfa (Epogen)
50
Long acting version of Epoetin alfa
Darbopoetin alfa (Aranesp)
51
Black Box Warning of ESAs (Erythropoiesis-Stimulating Agents)
Increased Risk of: - death - heart attack - stroke - cancer
52
Monitoring Parameters of ESAs (Erythropoiesis-Stimulating Agents)
Hgb Target (10 - 11) - increased death if > 11 Iron Status Blood Pressure - may cause hypertension
53
Target HbA1C for CKD + Diabetes
< 7%
54
Inhibit the renin-angiotensin-aldosterone system Decreases urinary protein excretion and are renoprotective.
ACE-I + ARB
55
Non-Dialysis BP Goal
SBP < 120
56
Renal Transplant BP Goal
130/80

Pharm 2: Exam 4 (4 decks)

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