Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PHARM 343 > Chronic Kidney Disease Mineral Bone > Flashcards

Chronic Kidney Disease Mineral Bone Flashcards

1
Q

Calcium Role

A

99% in bone

Bone, Kidney, Intestine maintain homeostasis of Calcium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Phosphate Role

A

Maintain mineralization of Bone

Bone, Kidney, Intestine maintain homeostasis of Phosphate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Vitamin D3 Role

A

Inactive Form
- First hydrolyzed by the liver
- Then activated by the kidneys to produce Calcitriol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Calcitriol Role

A

Active Form
- Intestines: Increases absorption of Calcium and phosphate
- Bone: Promotes resorption of Calcium and phosphate
- Parathyroid: Inhibits PTH production
–> Increased calcium production will inhibit PTH secretion

Summary:
- Increases Calcium and Phosphate
- Decreases PTH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Parathyroid Hormone
- Production

A

PTH is produced when
- Low calcium (Main regulator)
- High phosphate
- Low calcitriol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Parathyroid Hormone
- Role

A

Kidney:
- Increases Phosphate excretion
- Increases Calcium reabsorption (Decreased Calcium excretion)

Bone:
- Increases Calcium and Phosphate resorption

Intestinal:
- Increases Calcium and Phosphate reabsorption

Calcitriol:
- Increases production of Calcitriol (More Calcium and Less Phosphate)
- Inhibits itself (Less PTH)

Summary:
- Increase Calcium
- Decrease Phosphate
- Increase Calcitriol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

FGF-23 Role
- Production

A

FGF-23 is produced when
- High Calcitriol
- High Phosphate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

FGF-23 Role
- Role

A

Decreases Phosphate
- Less Phosphate reabsorption
- More Phosphate excretion

Decrease Calcitriol
- Decrease production
- Increase catabolism

Inhibits PTH

Summary:
- Decrease Phosphate
- Decrease Calcitriol
- Inhibit PTH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Secondary Hyperparathyroidism and CKD

A
  1. Kidney decreases in function leading to reduced phosphate excretion
    –> Increased Serum Phosphate
  2. High Phosphate suppresses Calcitriol
  3. High Phosphate leads to more FGF-23 leading to low Calcitriol
  4. Reduced kidney mass leads to less Calcitriol production
  5. Decreased Calcitriol with reduced Calcium absorption leads to Hypocalcemia
  6. Steps 1-5 lead to more PTH and proliferation of parathyroid cells
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Mild Hyperparathyroid-Related Bone Disease

A

Bone Turnover
- Medium

Bone Mineralization
- Normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Advanced Hyperparathyroid-Related Bone Disease (Osteitis Fibrosa)

A

Bone Turnover
- High

Bone Mineralization
- Normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Adynamic Bone Disease

A

Caused by oversuppression of PTH by medicines that lower PTH (Calcium, Active Vitamin D)

Bone Turnover
- Low

Bone Mineralization
- Normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Secondary Hyperthyroidism
- Causes what to develop

A

Medium-High Bone Turnover

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Secondary Hyperthyroidism
- Management

A

Reducing Hyperphosphatemia

Normalizing Calcium Levels

Suppressing PTH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Adynamic Bone Disease
- Management

A

Allow PTH to rise and return to increase bone turn over

Reduce Vitamin D analogues and Calcimimetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Osteomalacia

A

Results from aluminium deposition
- Stop aluminium phosphate binders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Phosphate Binder Considerations

A

Use only if patient has excessive Phosphate levels (In CKD 3-5 patients)

Must be taken in with food to maximize efficiency

18
Q

Calcium Salt
- What are they

A

Most commonly used

% of Elemental Calcium
- Citrate < Acetate < Carbonate

Give bigger dose with larger meals

19
Q

Calcium Salt
- Adverse Effects

A

Hypercalcemia

GI Side Effects
- Nausea
- Constipation

Interacts with the absorption of Iron and Fluoroquinolone Antibiotics

20
Q

Sevelamer
- What is it

A

Non-Calcium based Phosphate Binder
- Can be used in patients with hypercalcemia
- Can be used along with other phosphate binders

Also decreases LDL Cholesterol

21
Q

Sevelamer
- Adverse Effects

A

Metabolic Acidosis

GI Side effects

22
Q

Lanthanum
- What is it

A

Dissociates in upper GI into ions which bind phosphate

Can be used with other phosphate binders

23
Q

Lanthanum
- Adverse Effects

A

Unknown Long-Term Safety (Can accumulate in bone and tissues)

GI Side Effects

24
Q

Aluminium Salt
- What is it

A

Used for acute treatment of severe hyperphosphatemia

Limit to only 4 weeks

No longer first line therapy

25
Q

Aluminium Salt
- Adverse Effects

A

Aluminium Toxicity
- CNS Toxicity
- Worsening of Anemia

Expensive

26
Q

Magnesium Salt
- What is it

A

Less effective than Calcium Salt

Used as an adjuvant or short term when other phosphate binders fail

27
Q

Magnesium Salt
- Adverse Effects

A
  • Diarrhea
  • Hypermagnesemia
28
Q

Sucroferric Oxyhydroxide
- What is it

A

Reduces dietary phosphate absorption
- Is a iron based bidner that exchanges hydroxide with phosphate in the gut

29
Q

Sucroferric Oxyhydroxide
- Adverse Effect

A

GI Side Effects

Black Stools

Expensive

30
Q

Treating Hyperparathyroidism

A

Should only initiate Calcimimetics, Calcitriol or Vitamin D analogues in patients at CKD G5D to lower PTH

31
Q

Calcitriol Treatment
- When to use

A

Use when patient’s PTH levels are still elevated even when on Phosphate binders

32
Q

Calcitriol Treatment
- What is it

A

Decreases Parathyroid Gland production of PTH

Causes an increase in Calcium and Phosphate reabsorption leading to a decrease in PTH

33
Q

Calcitriol Treatment
- Considerations

A

Ideal that Phosphate is controlled prior to initiation
- Will increase phosphate along with calcium

Use only if:
- Calcium less than 2.6
- Phosphate less than 2.0

34
Q

Calcitriol
- Adverse Effects

A
  • Hypercalcemia
  • Hyperphosphatemia
  • Hypermagnesemia
  • Headache
  • Nausea
  • Pruritus
35
Q

Synthetic Vitamin D3 Analogue Treatment
- What is it

A

Alfacalcidol

Greater affinity for Kidney receptors

May result in less calcium and phosphate reabsorption compared to Calcitriol

36
Q

Calcimimetics
- What is it

A

Cinacalcet

Use in patients that have elevated PTH despite already trying phosphate binders and vitamin D analogue

Increases sensitivity of parathyroid gland to calcium leading to less PTH

37
Q

Calcimimetics
- Adverse Effects

A

Hypocalcemia

GI Upset

QT prolongation leading to arrhythmia

38
Q

Summary of Treatments
- Calcium-based Phosphate Binders

A

Calcium Increases

Phosphate Decreases

Decreases

39
Q

Summary of Treatments
- Non-Calcium-based Phosphate Binders

A

Calcium neutral

Phosphate decreases

PTH neutral

40
Q

Summary of Treatments
- Vitamin D Analogue

A

Calcium Increases

Phosphate increases

PTH greatly decreases

41
Q

Summary of Treatments
- Calcimimetics

A

Calcium decreases

Phosphate decreases

PTH greatly decreases

42
Q

Parathyroidectomy

A

Calcium decreases

Phosphate decreases

PTH greatly decreases

PHARM 343 (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions