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Pharmacology- Exam #4 > CKD > Flashcards

CKD Flashcards

1
Q

List in order the leading causes of CKD

A
  1. DM
  2. HTN
  3. Glomerulonephritis
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2
Q

What is first line therapy for Diabetes + CKD? What does the urine albumin need to be to indicates use of these drugs?

A

ACE-1 or ARB

urine albumin >30 mg/24 hrs

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3
Q

When do you want to stop increasing the dose of an ACE-1 or ARB with DM + CKD?

A
  1. Urine albuminuria reduced by 30-50% OR
  2. Significant decrease in GFR OR
  3. Hyperkalemia
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4
Q

HTN + CKD treatment and its effects on CKD?

A

ACE-1 and ARBs

Limits disease progression

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5
Q

Pathogenesis of Anemia in CKD

A

Deficiency of erythropoietin production by kidneys

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6
Q

Anemia treatment in CKD

A

ESA (erythropoietin stimulating agent) + Iron supplementation

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7
Q

What does ESA increase your risk of?

A

CV events

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8
Q

When do you initiate ESA in Non-Dialysis CKD?

A

If HgB <10 g/dL

DO NOT initiate if Hb ≥10 g/dL

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9
Q

When do you initiate ESA in Dialysis CKD?

A

HgB between 9-10 g/dL to avoid drop in HgB to <9 g/dL

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10
Q

What HgB levels do you NOT want to use ESA for?

A

Increase HgB over 13 g/dL OR

to maintain HgB above 11.5

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11
Q

Iron initiation indications in CKD

A

If TSat is ≤30% (≤0.30) and ferritin is ≤500 ng/mL

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12
Q

What is the MOA of Erythropoietin Stimulating Agents (ESA)?

A
  1. Induces erythropoiesis by stimulating division/differentiation of progenitor cells
  2. Induces release of reticulocytes from bone marrow to blood stream
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13
Q

ESA Box warning

A

Increased CV and CKD events with Hg > 11g/dL

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14
Q

Other ADE’s of ESA

A
  1. Cancer
  2. Shortened survival/increased progression in certain CA’s when HgB >12 g/dL
  3. Increase risk of DVT
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15
Q

What is the net serum effect of PTH?

A
  1. Increased serum Ca+

2. Decreased serum Phosphorus

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16
Q

What is the net serum effect of Vitamin D

A

Both serum Ca/P increases

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17
Q

What is the net serum effect of Firbroblast growth factor 23 (FGF23)

A

Decrease in serum Phosphorus

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18
Q

Management of CKD-MBD

A
  1. Dietary Phosphorous restriction
  2. Phosphate-binding agents
  3. Vitam in D supplementation
  4. Calcimimetic therapy
19
Q

List the phosphate-binding agents for the treatment of hyperphosphatemia

A
  1. Calcium-based binders
  2. Resnin binders
  3. Iron-based binders
20
Q

Calcium-based binders MOA

A
  1. Binds dietary phosphate to form insoluble calcium-phosphate
  2. Excreted through feces
21
Q

ADE’s of Calcium-based binders

A
  1. Hypercalcemia
  2. Hypophosphatemia
  3. Milk-alkali syndrome: HA, nausea, weakness, irritability, renal impairment, alkalosis
22
Q

List a Resin binder

A

Sevelamer Hydrochloride

23
Q

Sevelamer Hydrochloride MOA

A

Binds phosphate in intestinal lumen to limit absorption

24
Q

Sevelamer Hydrochloride clinical indications

A
  1. Tx of hyperphosphatemia in CKD pt’s

2. Patients @ risk of extra-skeletal calcification

25
Q

What does Sevelamer Hydrochloride lower?

26
Q

Sevelamer Hydrochloride ADE’s

A
  1. Metabolic acidosis
  2. N/V/D
  3. Dyspepsia
27
Q

What is unique about the Lanthanum Carbonate half life?

A

Half life in bones= 2-3.6 years

Potential for accumulation of lanthanum

28
Q

Lanthanum Carbonate ADE’s

A
  1. N/V
  2. Abdominal pain
  3. Constipation
  4. Dyspepsia
  5. Bowel obstruction
  6. Fecal impaction
29
Q

Aluminum Hydroxide MOA

A

Binds phosphate in GI tract to prevent absorption

30
Q

Why isn’t Aluminum Hydroxide a first line agent?

A

Risk of aluminum toxicity

31
Q

Who do we use Aluminum Hydroxide in?

A

Short-term (4 weeks) in patients w/ hyperphosphatemia that are not responding to other binders

32
Q

Aluminum Hydroxide ADE’s

A
  1. Constipation
  2. Fecal impaction
  3. Hypomagnesemia
  4. Hypophosphatemia
33
Q

List the Vitamin D analogs used for ESRD

A

IV or PO:

  1. Doxercalciferol
  2. Paricalcitol
    * Already activated
34
Q

What would we use in a patient with hypocalcemia and chronic renal dialysis?

A

Calcitriol=active form of Vitamin D

35
Q

List Vitamin D agents and dosing

A
  1. Ergocalciferol D2: daily doses, active metabolite D3

2. Cholecalciferol D3: higher doses, weekly or monthly

36
Q

Indications for Ergocalciferol D2 and Cholecalciferol D3

A
  1. Hypophosphatemia

2. Hypoparathyroidism

37
Q

Ergocalciferol D2 and Cholecalciferol D3 (Vitamin D agents) ADE’s

A

Hypercalcemia

38
Q

What vaccines is recommended annually for CKD patients?

39
Q

What vaccines are indicated in GFR <30?

A
  1. Pneumococcal vaccine

2. Hepatitis B vaccine

40
Q

Epoetin alfa dosing

41
Q

Darbopoetin alfa dosing

42
Q

Methoxy PEG-epoetin beta dosing

A

Every 2 weeks

Once HgB stabilizes, double the dose and administer monthly

43
Q

List the Phosphate binders that lower LDL

A

Resnin Binders

  1. Sevelamer Carbonate
  2. Sevelamer Hydrochloride

Pharmacology- Exam #4 (6 decks)

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