CKD Mineral Bone Disorder

Question 1

Corrected calcium

Answer 1

= measured calcium + 0.8 (4- albumin)

Question 2

Non Calcium based binders

Answer 2

1. Sevelamer carbonate
2. Lanthanum carbonate
3. Ferric citrate (IDA)
4. Surcofferic oxyhydroxide

Question 3

Renvela

Answer 3

Sevelamer carbonate
- useful with hypercalcemia and hx calcification 
- AEL GI upset, diarrhea
space out  1 hr before or 3 hrs after 
Decreases LDL and Increases HDL

dose based on Serum Phosphate:
o 5.5-7.5mg/dL: 800mg PO TID
o 7.5-9mg/dL: 1200-1600mg PO TID
o >9mg/dL: 1600 PO TID

Question 4

Fosrenol

Answer 4

Lanthanum carbonate - chewable

• useful with hypercalcemia and hx calcification
• initial dose: 500 mg TID

space out 1 hr before or 3 hrs after

Fosrenol 750= Renvela 1500 mg

Question 5

Auryxia

Answer 5

Ferric citrate

Question 6

Velphoro

Answer 6

Surcofferic oxyhydroxide (pill burden)

Question 7

Calcium based binders

Answer 7

1. Calcium acetate (PhosLo)

2. Calcium carbonate

Question 8

Serum calcium: Normal to high

Answer 8

Calcimimetic:

1. Cinacalcet ( Sensipar) - PO
2. Etelcalcitide (Parsabiv) - IV

Question 9

Serum calcium: Normal to low

Answer 9

Endogenous
1. Calcitriol ( Rocaltrol)

less Ca and PO4 increase:

1. Paricalcitol (Zemplar)
2. Doxercalciferol (Hectorol)

Question 10

Sensipar

Answer 10

Cinacalcet - PO
dose: 30 mg/day otherwise vomiting
Metabolized by CYP 34A

AE:
GI–N/V up to 50% of patients
Hypocalcemia –paresthesias, myalgia, cramping, tetany
QTc prolongation and ventricular arrhythmias

Drug INteractions:
Potent CYP2D6 inhibitor
->Tricyclic antidepressants-amitriptyline, nortriptyline
->Tamoxifen, Aripiprazole
CYP3A4 inhibitors -> ↑cinacalcet exposure
Ketoconazole (azole antifungals), protease inhibitors,

Question 11

Parsabiv

Answer 11

Etelcalcitide
IV
AE: GI, N/V, QT prolongation, hypocalcemia

Question 12

Corrected calcium

Answer 12

8.5 - 10.2 mg/dL

Question 13

Serum Phosphorous

Answer 13

2. 7-4.6

3. 5-5.5

Question 14

Ca x Phos products

Answer 14

< 55 mg2/dl2

Question 15

AE of Phosphate binders

Answer 15

• Abdominal discomfort
• Nephrolithiasis
  -Calciphylaxis
  Stone, bones, and abdominal groans

Question 16

Drug interactions with Calcium based Phosphate binders

Answer 16

Fluoroquinolones
Levothyroxine (Synthroid)
Iron
–>Separate administration by ~ 2 hours

Question 17

Iron based Phosphate BInders

Answer 17

1. Ferric acid ( Auryxia)

2. Sucroferric oxyhydroxide ( Velporo)

Question 18

Auryxia

Answer 18

Ferric acid
- 420 mg po tid
AE: GI, diarrhea, iron overload, stool discoloration

Question 19

Velporo

Answer 19

Sucroferric oxyhydroxide
- 500 mg PO TID
must be chewed
- AE: GI, diarrhea

good to lower pill burden

Question 20

Aluminum Based Phosphate BInders

Answer 20

Last line:

• Use short term, <7 days, if severe hyperphosphatemia; max 4 weeks
• Adverse Effects:GI upset, CNS toxicity (dialysis encephalopathy), microcytic anemia

Question 21

Ergocalciferol

Answer 21

Vit D2 50k units

Question 22

Cholecalciferol

Answer 22

Vit D3 >2k u qd

Question 23

Calcifedion

Answer 23

[Rayaldee] 30 mcg qhs ER
approved in CKD stage 3 and 4

lvl must be: Ca < 9.8 and phos <5.5

AE: Hypercalcemia and hyperphosphatemia

Question 24

Calcitrol

Answer 24

Calcijex - IV ROcaltrol - PO

active form of 1,25-OH D