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PHM 601 > CKD and Complications > Flashcards

CKD and Complications Flashcards

1
Q

What is the definition of anemia of CKD?

A

hemoglobin <13g/dL (males) or <12 (females)

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2
Q

What are the four goals of therapy for anemia of CKD?

A

increase oxygen-carrying capacity, improve quality of life, prevent/alleviate symptoms and complications of anemia, and decrease the need for blood transfusions

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3
Q

At what GFR does anemia generally begin?

A

<45 mL/min

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4
Q

The redistribution of drug from tissue stores makes TDM unreliable during what phase?

A

post-dialysis equilibrium

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5
Q

What is the most common cause of erythropoietin resistance?

A

iron deficiency

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6
Q

How often should an iron panel be done in ESRD patients?

A

every 3 months

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7
Q

What are the two goals of iron deficiency therapy?

A

Tsat > 30%, serum ferritin >500 ng/mL

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8
Q

What are side effects of oral iron therapy?

A

GI upset, dark stools, many drug interactions

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9
Q

What are side effects of IV iron therapy?

A

INFECTIONS, dyspnea/wheezing, myalgias, hypotension, flushing edema, chest pain, injection site reactions

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10
Q

What forms of oral iron therapy have the most and least percent elemental iron?

A

most = polysacccharide iron and ferric citrate, least = ferrous sulfate

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11
Q

What is the dosing regimen for most oral iron therapies? Why?

A

once daily or every other day; decreases the rise in hepcidin

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12
Q

ferric gluconate brand name, iron content and dosing?

A

Ferrlecit, 12.5, 125mg TIW x 8 doses

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13
Q

iron sucrose brand name, iron content and dosing?

A

Venofer, 20, 100mg 1-3x weekly

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14
Q

Iron dextran brand name, iron content and dosing?

A

Dexferrum, 50, 50-100mg q week x10 weeks

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15
Q

LMW iron dextran brand name, iron content and dosing?

A

InFed, 50, 50-100mg q week x 10 weeks

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16
Q

Ferumoxytol brand name, iron content and dosing?

A

Feraheme, 30, 510mg x2 3-8 days apart

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17
Q

Ferric carboxymaltose brand name, iron content and dosing?

A

Injectafer, 50, 750mg x2 7 days apart

18
Q

What are the four types of ESAs?

A

epoetin alfa, darbepoetin alfa, methoxy PEG epoetin beta, epoetin alfa-epbx

19
Q

When should initiation of ESA happen as per KDIGO and FDA?

A

KDIGO = Hb 9-10 g/dL, FDA = <10 g/dL

20
Q

What is the target Hb in ND-CKD as per KDIGO and FDA?

A

KDIGO = 11.5 MAX, FDA = 10

21
Q

What is the target Hb in ESRD as per KDIGO and FDA?

A

KDIGO = 11.5 MAX, FDA = 10-11

22
Q

What is the goal change in HGB per month?

A

1-2 g/dL

23
Q

When should dose adjustments be performed when on erythropoiesis stimulating agents?

A

every 4 weeks, by increments of 25% of ESA dose

24
Q

What are nine causes of ESA resistance?

A

iron deficiency, ACEi, hyperparathyroidism, aluminum toxicity, folate and/or B12 deficiency, infection, malignancy, trauma, inflammation

25
Q

What are adverse effects of ESA therapy?

A

HTN, hypercoaguability, hypersensitivity reactions, pure red blood cell apasia (PRBCA)

26
Q

What are the two goals of ESA therapy?

A

prevent blood transfusions, imrpove QoL

27
Q

What is the conversion for epoetin to darbepoetin?

A

200 units of epoetin = 1mcg darbepoetin

28
Q

What is the formula for corrected calcium?

A

corrected calcium = measured calcium + 0.8(4-albumin)

29
Q

What are three consequences of CKD-MBD?

A

CV disease, bone disease, calciphylaxis/CUA

30
Q

What are the first three steps, in order, for treating CKD-MBD?

A

phosphate binders, activated vitamin D, calcimimetics

31
Q

For phosphate binders, if the serum calcium is normal-high, use ____, and if low use ____?

A

non-calcium based binders, calcium based binders

32
Q

What is the first line non-calcium based binder?

A

sevelamer carbonate

33
Q

What is a chewable non-calcium based binder?

A

lanthanum carbonate

34
Q

What is a non-calcium based binder used in iron deficiency anemia?

A

ferric citrate

35
Q

What is a non-calcium based binder used to reduce pill burden?

A

sucroferric oxyhydroxide

36
Q

What are the two calcium based binders?

A

calcium acetate and calcium carbonate

37
Q

For lowering PTH, if the serum calcium is normal-high, use ____, and if low use ____?

A

calcimimetics, activated vitamin D and analogs

38
Q

Which calcimimetic is PO and which is IV?

A

PO = cinacalcet, IV = etelcalcitide

39
Q

What vitamin D therapy mimics the endogenous chemical?

A

calcitriol

40
Q

What vitamin D therapies cause less hypercalcemia?

A

paricalcitriol and doxercalciferol

PHM 601 (2 decks)

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