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Therapeutics > CKD & HTN > Flashcards

CKD & HTN Flashcards

1
Q

4 most common causes of CKD

A
  1. diabetes
  2. HTN
  3. glomerulonephritis
  4. polycystic kidney disease
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2
Q

diabetes/A1C goal in CKD management

A

A1C < 7%
healthy weight
moderate intensity exercise

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3
Q

cardiovascular goals in CKD management

A

BP <120/80 mmHg
lipid management

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4
Q

renal goals in CKD management

A

slow eGFR decline, reduce albuminuria 30-50%

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5
Q

goal of ACE/ARB therapy in CKD and when to start

A

SBP <120 mmHg and 30-50% albuminuria reduction
start right away unless CI

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6
Q

contraindications of ACE/ARB

A

pregnancy, bilateral renal artery stenosis, history of ACE/ARB angioedema

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7
Q

side effects of ACE/ARB

A

hypotension/orthostasis/dizziness, cough, hyperkalemia

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8
Q

monitoring eGFR decline for ACE/ARB therapy

A

declines 30-50%, reduce dose
declines >50%, hold therapy

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9
Q

monitoring K rise for ACE/ARB therapy

A

K >5, dietary restrictions
K >6, start a loop +/- SPS or patiromer

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10
Q

goal of SGLT2 therapy in CKD and when to initiate

A

A1C <7% and reduce proteinuria
start right away regardless of DM

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11
Q

goal of finerenone and when to start in CKD

A

goal SBP <120 mmHg
used in those with T2DM with persistent albuminuria when other therapies are not enough.

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12
Q

what must eGFR and K be in order to start finerenone

A

eGFR > 25
K <5.5

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13
Q

when can a GLP1RA be used for CKD

A

in T2DM after SGLT2 has already been initiated

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14
Q

HGB levels in anemia

A

males <13 g/dL
females <12 g/dL

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15
Q

target HGB during anemia therapy

A

10-11 g/dL
(lower than normal)

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16
Q

target serum ferritin during anemia therapy

A

> 500 ng/mL (KDIGO)
(higher than normal)

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17
Q

target TSAT during anemia therapy

A

> 30% (KDIGO)

18
Q

when to initiate ESAs in non-dialysis CKD, and what is the target

A

start when HGB < 10 g/dL, target <10g/dL

19
Q

when to initiate ESAs in ESRD, and what is the target

A

start when HGB <10g/dL, target 10-11 g/dL.

20
Q

when to reduced ESA dose by 25%

A

if HGB approaches 12g/dL after 4 weeks or if it increases >1g/dL in 2 weeks or less

21
Q

when to increase ESA dose by 25%

A

if HGB is below target after 4 weeks

22
Q

side effects of ESAs

A

hypertension, hypercoaguability (thrombosis risk), hypersensitivity, PRBCA, headache, fatigue, edema, progression of malignancy

23
Q

target elemental iron for oral treatment

A

200 mg elemental iron/day in divided doses

24
Q

side effects of oral iron

A

GI upset (nausea, cramping, constipation), dark stool, many DDIs

25
Q

side effects of IV iron

A

dyspnea/wheezing, itching, myalgias, hypotension, flushing, edema, chest pain, cardiac arrest, injection site reaction, anaphylactic reactions, infection

26
Q

corrected calcium =

A

measured calcium + 0.8 (4 - albumin)

27
Q

consequences of MBD of CKD

A

CV disease, bone disease, calciphylaxis

28
Q

target calcium in MBD treatment

A

8.5-10.2 mg/dL
avoid hypercalcemia

29
Q

target phosphorous in MBD treatment

A

2.7-4.6 mg/dL

30
Q

target iPTH in MBD treatment

A

<2-9x the upper limit of normal
~150-600 pg/mL

31
Q

phosphate binders to use when calcium is normal-high

A

sevelamer carbonate
lanthanum carbonate ferric citrate
sucroferric oxyhydroxide
aluminum hydroxide

32
Q

phosphate binders to use when calcium is low

A

calcium carbonate
calcium acetate

33
Q

activated vitamin D products used to lower iPTH when calcium is normal-low

A

calcitriol
paricalcitol
doxercalciferol

34
Q

calcimimetics to used to lower iPTH when calcium is normal-high

A

cincalcet
etecalcetide

35
Q

side effects of sevelamer

A

GI upset, diarrhea

36
Q

side effects of lanthanum carbonate

A

GI upset, possible lanthanum accumulation

37
Q

ferric citrate for MBD side effects

A

GI, diarrhea, iron overload, stool discoloration

38
Q

sucroferric oxyhydroxide for MBD side effects

A

GI, diarrhea

39
Q

aluminum hydroxide side effects

A

Al toxicity- GI upset, CNS toxicity, microcytic anemia

40
Q

side effects of calcium carbonate and acetate

A

abdominal discomfort, nephrolithiasis, calciphylaxis
stones, bones, abdominal groans

41
Q

cinacalcet side effects

A

GI/NV, hypocalcemia, QTc prolongation, ventricular arrythmias

42
Q

etecalcetide side effects

A

less GI but still NV, QTc prolongation, hypocalcemia

Therapeutics (29 decks)

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