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SG - Pharm 4 > CKD > Flashcards

CKD Flashcards

1
Q

CKD is classified based on what 3 things?

A
  • Cause of kidney disease
  • assessment of GFR
  • extent of proteinuria
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2
Q

What are frequent complications of advanced CKD?

A
  • altered Na and water balance
  • hyperkalemia
  • metabolic acidosis
  • anemia
  • CKD related mineral and bone disorder (CKD-MBD)
  • cardiovascular disease
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3
Q

What is the 1st, 2nd, and 3rd leading causes of CKD leading to ESRD?

A
  1. DM
  2. HTN
  3. Glomerulonephritis
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4
Q

Besides the top 3 (DM, HTN, and glomerulonephritis), what other 4 diseases cause CKD?

A
  • Polycystic Kidney Disease
  • Wegener’s granulomatosis
  • Vascular Diseases
  • HIV nephropathy
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5
Q

1st line therapy for CKD caused by DM?

A

ACEI or ARB

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6
Q

Tx for CKD caused by DM:

  • ACEI or ARB
    • Dose is usually increased until what 3 things happen?
A
  • Albuminuria is reduced by 30-50% (1st goal!)
  • Significant drop in eGFR
  • Hyperkalemia
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7
Q

Therapy for CKD caused by HTN?

A

ACEI and ARB

(effect on renal hemodynamic and reduction of BP)

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8
Q

Deficiency in the production of endogenous erythropoietin by the kidney (iron deficiency as a contributing factor)

A

Anemia

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9
Q

2 ways to manage anemia

A
  • erythropoietic stimulating agents (ESAs) (epoetin alfa, darbepoetin alfa)
  • Regular iron supplementation (oral or IV administration)
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10
Q

What are the “administartion limits” of treating anemia? (2)

A
  • Higher risk of cardiovascular events
  • When hemoglobin is targeted to greater than 11 g/dL
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11
Q

At which stage of CKD should you send to nephrology based on the GFR?

A

Stage 2 CKD (mildly decreased) = 60-89

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12
Q

At what stage of CKD do you need adjust dose?

A

Stage 3 CKD, GFR of 50-60

(most common GFR is at 30)

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13
Q

What stage of CKD is ESRD?

A

Stage 5

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14
Q

KDIGO recommendations for initiation of Erythropoiesis Stimulating Agents and Iron in Anemia of CKD

  • If Hb is <___ g/dL, consider the ____ of Hb prior to initiating ESA.
  • DO NOT initiate if Hb is ___g/dL or greater
A
  • 10 / rate of fall
  • 10
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15
Q
  • Do not use ESAs to intentionally increase Hb above ___ g/dL
  • Do not use ESAs to maintain Hb above ___g/dL
A
  • 13
  • 11.5
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16
Q

Initiate Iron therapy when TSat is ___% or less and ferritin is ___ or less

A
  • 30
  • 500
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17
Q

Use ESAs to avoid drop in Hb to <9 by starting an ESA when Hb is between ___ and ___ g/dL

A

9 and 10

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18
Q

What are the 3 Erythropoiesis-Stimulating Agents in CKD?

A
  • Epoetin alfa
  • Darbepoetin alfa
  • Methoxy PEG-epoetin beta
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19
Q

Which ESA?

  • Adults: 50-100 units 3x/week
A

Epoetin alfa

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20
Q

Which ESA?

  • Once every 4 weeks
A

Darbepoetin alfa

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21
Q

Which ESA?

  • Every 2 weeks, once Hb stabilizes, double the dose and administer monthly
A

Methoxy PEG-epoetin beta

22
Q

MOA of which drug?

  • Induces erythropoiesis by stimulating the division of differentiation of committed erythroid progenitor cells
  • Induces release of reticulocytes from the bone marrow into the blood stream
A

Erythropoetin Stimulating Agents (ESA)

23
Q

2 clinical indications for ESAs

A
  • Anemia due to myelosuppression
  • Anemia due to CKD
24
Q

ESA half lives

  • Are half lives longer in IV or SQ?
A

SQ

25
Q

3 Adverse Effects of ESAs

A
  • Boxed warning: increased CV and CKD events w/ Hb >11 g/dL
  • Cancer
  • Increase risk of DVT
26
Q

What is the Hb goal / change for management of anemia in adults?

A

1-2g/dL in 4 weeks

27
Q

What are the 6 abnormalities in Chronic Kidney Disease-Mineral & Bone Disorder?

A
  • Parathyroid hormone (PTH)
  • Calcium, phosphorus
  • The calcium-phosphorus product
  • Vit D
    Bone turnover
  • Soft tissue calcifications
28
Q

What effect does PTH have in regards to CKD-MBD?

A
  • Serum Ca increased**
  • Serum Phosphate decreased**

(Net effect on serum levels)

29
Q

What effect does Vit D have in regards to CKD-MBD?

A
  • Serum Ca increased*
  • Phosphate increased*

(net effect on serum levels)

30
Q

What effect does FGF23 have in regards to CKD-MBD?

A
  • Decreased serum phosphate*

(Net effect on serum levels)

31
Q

4 ways to manage CKD-MBD?

A
  • Dietary phosphorus restriction
  • Phosphate-binding agents
  • Vit D supplementation
  • Calcimimetic therapy
32
Q

Give examples of foods high in phosphorus

A
  • Pumpkin seeds
  • Ground mustard seeds
  • Parmesan cheese
  • Brazil nuts
  • Cocoa powder
  • Edamame
  • Baker’s yeast
  • Bacon
  • Beef liver
  • Canned sardines
33
Q

What 2 drugs are Calcium Based Binders used to tx Hyperphosphatemia in CKD patients?

A
  • Calcium acetate (PhosLo)
  • Calcium carbonate (Tums)
34
Q

What 2 drugs are Iron-based binders used to tx Hyperphosphatemia in CKD?

A
  • Ferric citrate (Auryxia)
  • Sucroferric oxyhydroxide (Velphoro)
35
Q

What are 2 Resin binders used to tx Hyperphosphatemia in CKD pts?

A
  • Sevelamer carbonate (Renvela)
  • Sevelamer hydrochloride (Renagel)
36
Q

What are 2 “other elemental binders” used to tx hyperphosphatemia in CKD pts?

A
  • Lanthanum carbonate (Fosrenol)
  • Aluminum hydroxide (AlternaGel)
37
Q

Which drug?

  • MOA: Binds w/ dietary phosphate to form insoluble calcium phosphate: excreted in feces
  • Clinical indication: CKD hyper-phosphatemia
A

Calcium Based Phosphate-Binding Agents for tx of Hyperphosphatemia in CKD pts.

  • Calcium acetate (PhosLo)
  • Calcium carbonate (Tums)
38
Q

Adverse effects of which drug?

  • Hypercalciumia
  • Hypophosphatemia
  • Milk-alkali syndrome
A

Calcium Based Phosphate-Binding Agents for tx of Hyperphosphatemia in CKD pts.

  • Calcium acetate (PhosLo)
  • Calcium carbonate (Tums)
39
Q

These sxs are apart of which adverse effect for which drug?

  • HA
  • Nausea
  • Irritability
  • Weakness or Alkalosis
  • Hypercalciumia
  • Renal impairment
A

Milk-Alkali Syndrome

(from Calcium based Phosphate Binding agents for tx of hyperphosphatemia in CKD pts)

  • Calcium acetate (PhosLo)
  • Calcium carbonate (Tums)
40
Q

Which drug?

  • MOA: binds phosphate within intestinal lumen limiting absorption and decreasing serum phosphate concentrations
  • Clinical indications: Hyperphosphatmia tx, lowers low-density lipoprotein cholesterol, consider in pts at risk for “extraskeletal calcification”
A

Sevelamer Hydrochloride (Renagel)

(Resin Binder to tx hyperphosphatemia)

41
Q

Adverse effects of which drug?

  • Metabolic acidosis (greater in children)
  • N/V/D
  • Dyspepsia
A

Sevelamer hydrochloride (Renagel)

(Resin Binder to tx Hyperphosphatemia)

42
Q

Which drug?

  • MOA: binds dietary phosphate resulting in insoluble lanthanum phosphate complexes with net decreases in phosphate and Ca levels
  • Clinical indications: hyperphosphatemia tx, bone half life is 2 - 3.6 yrs, potential for accumulation of lanthanum
A

Lanthanum carbonate (Fosrenol)

“other elemental binder)

43
Q

Adverse Effects of which drug?

  • N/V
  • Abd pain
  • Bowel obstruction
  • Constipation
  • Dyspepsia
  • Fecal impaction
  • Ileus
A

Lanthanum carbonate (Fosrenol) to tx hyperphosphatemia

“other elemental binders”

44
Q

Which drug?

  • MOA: binds phosphate in GI tract preventing absorption of phosphate
  • Clinical indications: not a first line agent, reserve for short term use (4 weeks) in pts w/ hyperphosphatemia not responding to other binders
A

Aluminum Hydroxide (AlternaGel)

Used to tx hyperphosphatemia in CKD

“Other elemental binders”

45
Q

Which drug?

  • Risk of aluminum toxicity
  • Constipation, fecal impaction
  • Hypomagnesemia
  • Hypophosphatemia
A

Aluminum hydroxide (AlternaGel)

Used to tx hyperphosphatemia in CKD

“Other elemental binders”

46
Q

What are the 2 “nutritional Vitamin D” drugs?

A
  • Ergocalciferol (Drisdol)
  • Cholecalciferol
47
Q

What are the 3 “Vitamin D & Analogs?”

A
  • Calcitrol (Rocaltrol)
  • Doxercalciferol (Hectorol) - analogs
  • Paricalcitol (Zemplar) - analogs
48
Q

Production of Vitamin D requires what?

A

Conversion of 7-dehydrocholesterol to cholecalciferaol (vit D3) by sunlight

49
Q
  • The first hydroxylation step of Vitamin D occurs where?
  • The final conversion step of Vitamin D occurs where?
A
  • 1st: Liver, to form 25-hydroxyvitamin D3
  • Final: Kidney, to form 1,25-dihydroxyvitamin D3 or calcitriol
50
Q

Recommendations for CKD

  • Adjust med doses for kidney function
  • Seek pharmacist or medical advice before using OTC meds / nutritional supplements
  • Are herbal medicines recommended?
  • ___ is suggested for pts at risk for atherosclerotic events unless there is an increased bleeding risk
  • Avoid ______ in people w/ a GFR <60 or in those known to be at risk of phosphate nephropathy
A
  • Herbal meds NOT recommended
  • ASA
  • oral phosphate-containing bowel preparations

SG - Pharm 4 (16 decks)

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