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Critically Ill > CKD Mineral Bone Disorders > Flashcards

CKD Mineral Bone Disorders Flashcards

1
Q

What are the KDIGO 2017 guideline’s goals for treatment for corrected Ca, Phosphorus, and PTH?

A

Corrected Ca: <9.5 mg/dL
Phos: <5.5 mg/dL
PTH: <500

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2
Q

What order do we treat corrected Ca, Phosphorus, and PTH for MBD-CKD?

A
  1. Phos
  2. PTH
  3. Ca
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3
Q

When do the KDIGO guidelines suggest treating CKD-related bone mineral disorders?

A

PTH: >/=500

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4
Q

How does nephron loss due to CKD cause mineral and bone disorders?

A
  1. impaired phosphate excretion
  2. Ca-Phos deposits in soft tissues
  3. down-regulation of Vit D by fibroblast growth factor 23
  4. decreased absorption of Ca
  5. low plasma Ca –> PTH secretion
  6. actions of PTH lead to the majority of mineral bone disorders
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5
Q

How should high PTH be managed at first?

A

early treatments maintain serum phos levels within normal ranges

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6
Q

What are non pharm treatments for CKD-MBD and renal osteodystrophy?

A
  1. restriction of dietary phos to 800-1000 mg/day
  2. HD/ peritoneal dialysis (insufficient for hyperphosphatemia)
  3. restriction of aluminum exposure
  4. removal of parathyroid glands (last resort)
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7
Q

When are phosphate binders used to treat MDB-CKD?

A

when serum phos cannot be controlled with diet restriction in patients receiving dalysis

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8
Q

What are the 3 mainly used types of phosphate binders?

A
  1. Aluminum based
  2. Calcium based
  3. Sevelamer
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9
Q

Why should Aluminum based phos binders not be used more than 4 weeks?

A

risk of aluminum toxicity (neurotoxicity, bone disease, anemia)

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10
Q

When should Aluminum based phos binders be used?

A

Phos > 7mg/dL and pt not responding to other binders

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11
Q

What are SEs of Aluminum based Phos binders?

A

constipation
poor taste
nausea
dialysis dementia
osteomalacia

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12
Q

What are the monitoring parameters for Phos binders?

A
  1. Ca
  2. PTH
  3. Phos
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13
Q

Is Ca carbonate or Ca Acetate more potent?

A

Ca Acetate

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14
Q

What pts are Ca based Phos binders CI in?

A
  1. elevated serum Ca
  2. arterial calcification
  3. dynamic bone disease
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15
Q

What is the maximum amount of elemental Ca a pt can have of Ca binders and dietary sources?

A

Do not exceed 1500mg elemental Ca/ day from binders; 2000mg total elemental Ca including dietary souces

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16
Q

What medications need to be administered at different times due to interaction with Ca based phos binders?

A
  1. tetracyclines
  2. quinolones
  3. oral bisphosphonates
  4. thyroid products
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17
Q

What are SEs with Ca based phos binders?

A
  1. nausea
  2. constipation
  3. hypercalcemia
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18
Q

What are SEs with Selvelamer?

A
  1. N/V/D
  2. constipation
  3. dyspepsia
  4. abdominal pain
  5. flatulence
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19
Q

What are CI to using Selvelamer?

A

bowel obstruction

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20
Q

What drugs interact with Selvelamer and should be administered separatly?

A
  1. quinolones
  2. mycophenolate
  3. tacrolimus
  4. thyroid products
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21
Q

What other agents are used to decrease serum phos?

A
  1. lanthanum carbonate
  2. iron-based binders
  3. magnesium based binders
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22
Q

What are CIs to using lanthanum carbonate?

A
  1. bowel obstruction
  2. fecal impaction
  3. ileus
23
Q

What are SEs with lanthanum carbonate?

A
  1. N/V/D (must chew tablet thoroughly to reduce risk)
  2. constipation
  3. abdominal pain
    warning: GI perforation
24
Q

What drug administrations should be separated from lanthanum carbonate?

A
  1. quinolones
  2. Ca, Mg, Al-containing antacids (2h)
  3. thyroid products
25
Q

What are warnings with ferric citrate iron based binder?

A
  1. do not chew/crush may discolor teeth mouth
  2. increased iron absorption; keep away from children
26
Q

What are SEs with iron based binders?

A
  1. diarrhea
  2. constipation
  3. black stool due to iron
27
Q

What products should NOT be taken with iron based phos binders?

A

thyroid products

28
Q

What products can be used to decrease the amount of Ca based binders to manage phos?

A

Mg based binders

29
Q

How does Vit D therapy treat MBD-CKD?

A
  1. increase Ca absorption from GI tract
  2. decreases PTH synthesis and secretion (active/analogs)
30
Q

What forms of Vit D are effective in patients with stage 3 CKD? Why?

A
  1. Ergocalciferol (D2), Cholecalciferol (D3)
  2. required activation via 1alpha-hydroxylase in kidneys; stages 4 and 5 can no longer convert
31
Q

What forms of Vit D are used in patients with stage 4 and 5 CKD?

A
  1. Active Vit D (Calcitriol, Calcifediol)
  2. Vit D analogs (Paricalcitol, Doxercalciferol)
32
Q

What are CIs to using active vit D or vit D analogs?

A
  1. hypercalcemia
  2. Vit D toxicity
33
Q

What are SEs of active vit D or vit D analogs?

A
  1. N/V/D
  2. hypercalcemia
  3. hyperphosphatemia
    4 digitalis toxicity potentiated by hypercalcemia
34
Q

How do calcimimetics decrease PTH, Ca, and Phos?

A
  1. increase sensitivity of parathyroid gland to serum Ca levels
  2. decrease in serum Ca and Phos
35
Q

What agents are Calcimimetics?

A
  1. Cinacalcet SENISPAR
  2. Etelcalcetide PARSABIV
36
Q

What are CIs to using calcimimetics?

A
  1. hypocalcemia
  2. caution in seizure history
37
Q

What are warnings with Etelcalcetide PARSABIV?

A
  1. hypocalcemia
  2. worsening HF
  3. GI bleeding
  4. decreased bone turnover
  5. muscle spasm
38
Q

What are SEs with calcimimetics?

A
  1. hypocalcemia
  2. N/V/D
  3. paresthesias
  4. fatigue
  5. constipation
  6. bone fracture
  7. weakness/myalgia/limb pain
39
Q

How should binders be administered to control phos?

A

added one onto the other until goal phos reached

40
Q

Calcium carbonate

A

TUMS

41
Q

Calcium acetate

A

PHOS-LO

42
Q

Sevelamer HCl

A

RENAGEL

43
Q

Sevelamer carbonate

A

RENVELA

44
Q

Lanthanum

A

FOSRENOL

45
Q

Sucroferric oxyhydroxide

A

VELPHORO

46
Q

Ferric citrate

A

AURYXIA

47
Q

Ergocalciferol

A

Vit D2

48
Q

Cholecalciferol

A

Vit D3

49
Q

Calcitriol

A

CALCIJEX (IV)
ROCALTROL (PO,soln)

50
Q

Calcidfediol

A

RAYALDEE

51
Q

Paricalcitol

A

ZEMPLAR

52
Q

Doxecalciferol

A

HECTOROL

53
Q

Cinacalcet

A

SENSIPAR

54
Q

Etelcalcetide

A

PARSABIV (IV)

Critically Ill (20 decks)

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