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Critically Ill Exam 3 > CKD and Mineral and Bone Disorders > Flashcards

CKD and Mineral and Bone Disorders Flashcards

1
Q

when does the parathyroid produce PTH?

A

in response to low serum calcium levels

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2
Q

what are 3 ways that PTH can increase calcium levels?

A
  1. stimulate osteoclasts to release more calcium from bone
  2. decrease secretion of calcium by the kidney
  3. activating vitamin D
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3
Q

what does calcitriol increase?

A

calcium

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4
Q

how can calcitriol increase calcium? 2

A
  1. increase absorption in the GI tract
  2. increase calcium reabsorption in the distal tubules of the kidney
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5
Q

what can nephron loss cause an increase in? 2

A
  1. plasma phosphate
  2. increased calcium and phosphate binding
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6
Q

what are 2 things that nephron loss can decrease?

A
  1. vitamin D activation in the kidneys
  2. plasma calcium
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7
Q

what can renal osteodystrophy cause an incraese in?

A

aluminum

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8
Q

what are 5 symptoms of secondary hyperparathyroidism?

A
  1. decreased range of motion
  2. gritty sensation in the eyes
  3. calcium deposits
  4. redness
  5. inflammation
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9
Q

what is the corrected serum calcium range?

A

8.4-9.5

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10
Q

what is the normal serum phosphorous range?

A

3.5-5.5

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11
Q

what is the range for PTH levels?

A

300-500

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12
Q

what should you treat first for renal osteodystrophy?

A

phosphate

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13
Q

what are 4 non-pharm treatments for renal osteodystrophy?

A
  1. dietary restriction of phosphorous
  2. hemodialysis or peritoneal dialysis
  3. restriction of aluminum exposure
  4. removal of the parathyroid glands (last resort)
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14
Q

what is the range to restrict phosphorous to?

A

800-1000 mg/day

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15
Q

what is hemodialysis and peritoneal dialysis insufficient for?

A

hyperphosphatemia

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16
Q

if PTH levels are at ______ the removal of parathyroid glands can be considered?

A

> 800

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17
Q

what is a pharmacologic treatment that can be used to treat hyperphosphatemia?

A

phosphate binders

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18
Q

what are the 5 types of phosphate binders that can be used to treat hyperphosphatemia?

A
  1. aluminum-based
  2. calcium-based
  3. aluminum/calcium free
  4. iron based
  5. magnesium based
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19
Q

what type of phosphate binder cannot be used chronically?

A

aluminum based phosphate binders

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20
Q

how long can aluminum phosphate binders be used?

A

4 weeks max

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21
Q

what are the 3 symptoms that show aluminum toxicity?

A
  1. neurotoxicity
  2. bone disease
  3. anemia
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22
Q

when are the aluminum based phosphate binders used?

A

when phosphate levels are >7 and pt doesn’t respond to other binders

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23
Q

what are 4 things you should monitor for aluminum based phosphate binders?

A
  1. PTH
  2. calcium
  3. phosphate
  4. serum aluminum concentrations
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24
Q

what are the 2 types of calcium based phosphate binders?

A
  1. calcium carbonate
  2. calcium acetate
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25
Q

what can the ca2+ phosphate binders aid in?

A

metabolic acidosis

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26
Q

which of the 2 calcium based phosphate binders is more potent?

A

calcium acetate

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27
Q

what patients should calcium based phosphate binders not be used in? 3

A
  1. elevate serum calcium
  2. arterial calcifications
  3. adynamic bone disease
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28
Q

you should not exceed how much elemental calcium per day from the calcium based phosphate binders?

A

1500mg

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29
Q

what are 5 side effects of the aluminum based phosphate binders?

A
  1. constipation
  2. nausea
  3. poor taste
  4. dialysis dementia
  5. osteomalacia
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30
Q

what are 3 side effects of the calcium based phosphate binders?

A
  1. constipation
  2. nausea
  3. hypercalcemia
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31
Q

what are 3 things you should monitor when taking calcium based phosphate binders?

A
  1. calcium
  2. phosphate
  3. PTH
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32
Q

what are 4 common interactions seen with calcium based phosphate binders?

A
  1. quinolones
  2. tetracyclines
  3. oral bisphosphonates
  4. thyroid products
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33
Q

when should you monitor calcium levels closely when patients are on calcium based phosphate binders?

A

vitamin d supplementation

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34
Q

when can you use phosphate binders? 2

A
  1. when serum phosphate cannot be controlled through diet
  2. patients receiving dialysis
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35
Q

what are 2 aluminum/calcium free phosphate binders?

A
  1. sevelamer
  2. lanthanum carbonate
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36
Q

what phosphate binder has cholesterol benefits?

A

sevelamer

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37
Q

what are contraindications of sevelamer?

A

bowel obstruction

38
Q

what are 5 things that should be monitored for sevelamer?

A
  1. calcium
  2. phosphate
  3. HCO3
  4. Cl
  5. PTH
39
Q

what are 4 common drug interactions with sevelamer?

A
  1. quinolones
  2. mycophenolate
  3. tacrolimus
  4. thyroid products
40
Q

what must patients do when taking lanthanum carbonate?

A

chew tablet thoroughly to prevent GI SE

41
Q

what is a warning seen when taking lanthanum carbonate?

A

GI perforation

42
Q

what are 3 things that should be monitored with lanthanum carbonate?

A
  1. calcium
  2. phosphate
  3. PTH
43
Q

what are 3 common drug interactions seen with lanthanum carbonate?

A
  1. quinolones
  2. thyroid products
  3. anatacids
44
Q

what are 2 iron based phosphate binders?

A
  1. ferric citrate
  2. sucroferric oxyhydroxide
45
Q

how should patients take sucroferric oxyhydroxide?

A

chew and then swallow

46
Q

how should patients take ferric citrate?

A

do not crush or chew to avoid teeth discoloration

47
Q

what is there a high risk of when taking ferric citrate?

A

increased iron absorption

48
Q

absorption of iron is ___ with sucroferric oxyhydroxide

A

minimal

49
Q

what are 5 things that should be monitored for with sucroferric oxyhydroxide?

A
  1. iron
  2. ferritin
  3. TSAT
  4. phosphate
  5. PTH
50
Q

what are 3 common interactions with the iron based phosphate binders?

A
  1. quinolones
  2. thyroid products
  3. doxycycline
51
Q

what agents should NOT be used with the iron phosphate binders?

A

thyroid products

52
Q

when can magnesium based phosphate binders be utilized?

A

to decrease the amount of calcium containing binders required to manage phosphate

53
Q

why is the use of magnesium based phosphate binders limited?

A

GI effects (diarrhea)

54
Q

when is vitamin D therapy utilized?

A

after hyperphosphatemia is controlled

55
Q

what is used to treat elevated PTH levels?

A

vitamin D therapy

56
Q

what do exogenous vitamin D compounds mimic?

A

the activity of calcitriol

57
Q

what are the 2 vit D precursors that can be used?

A
  1. ergocalciferol
  2. cholecalciferol
58
Q

what are the vitamin D precursors effective in?

A

patients with stage 3 CKD

59
Q

when cant you use the vit D precursors?

A

in patients with CKD stages 4-5

60
Q

what is teh most active form of vit D?

A

calcitriol

61
Q

what 2 things can calcitriol and calcifediol cause?

A
  1. hypercalcemia
  2. hyperphosphatemia
62
Q

what are the 2 active vit D analogs?

A
  1. calcitriol
  2. calcifediol
63
Q

what are the 2 vitamin D analogs?

A
  1. paricalcitol
  2. doxercalciferol
64
Q

what do the vit d analogs have a decreased effect on?

A

intestinal absorption of calcium and phosphate

65
Q

what are 2 contraindications of vitamin D analogs?

A
  1. hypercalcemia
  2. vitamin d toxicity
66
Q

what are 4 things that should be monitored with the vit d analogs?

A
  1. calcium
  2. phosphate
  3. PTH
  4. 25-hydroxyvitamin D (calcifediol only) goal: 30 and 100 ng/ml
67
Q

what do calcimimetics increase the sensitivity of?

A

the parathyroid gland to serum calcium levels

68
Q

what do calcimimetocs decrease?

A

serum calcium and phosphorous levels

69
Q

what patients are calcimimetics great for?

A

patients with:
1. elevated PTH levels
2. Elevated calcium and phosphate levels

70
Q

what are 2 calcimimetics that can be used?

A
  1. cinacalcet
  2. etelcalcetide
71
Q

what is a contraindication for calcimimetics?

A

hypocalcemia

72
Q

what is a warning for the use of calcimimetics?

A

pt with seizure history

73
Q

what 3 things should be monitored when using calcimimetics?

A
  1. calcium
  2. phosphate
  3. PTH
74
Q

what type of phosphate binders should you use first when treating hyperphosphatemia?

A

aluminum/calcium free agents

75
Q

CALCIUM CARBONATE

A

TUMS

76
Q

CALCIUM ACETATE

A

PHOS-LO

77
Q

SEVELAMER HCL

A

RENAGEL

78
Q

SEVELAMER CARBONATE

A

RENVELA

79
Q

LANTAHNUM

A

FOSRENOL

80
Q

SUCROFERRIC OXYHYDROXIDE

A

VELPHORO

81
Q

FERRIC CITRATE

A

AURYXIA

82
Q

ERGOCALCIFEROL

A

VITAMIN D2

83
Q

CHOLECALCIFEROL

A

VITAMIN D3

84
Q

CALCITRIOL

A

CALCIJEX, ROCALTROL

85
Q

CALCIDFEDIOL

A

RAYALDEE

86
Q

PARICALCITOL

A

ZEMPLAR

87
Q

DOXERCALCIFEROL

A

HECTOROL

88
Q

CINACALCET

A

SENISPAR

89
Q

ETELCALCETIDE

A

PARSABIV

90
Q
A

Critically Ill Exam 3 (9 decks)

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