Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

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

A
  1. Phos
  2. PTH
  3. Ca
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

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

A

PTH: >/=500

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How should high PTH be managed at first?

A

early treatments maintain serum phos levels within normal ranges

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the 3 mainly used types of phosphate binders?

A
  1. Aluminum based
  2. Calcium based
  3. Sevelamer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

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

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When should Aluminum based phos binders be used?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are SEs of Aluminum based Phos binders?

A

constipation
poor taste
nausea
dialysis dementia
osteomalacia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the monitoring parameters for Phos binders?

A
  1. Ca
  2. PTH
  3. Phos
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Is Ca carbonate or Ca Acetate more potent?

A

Ca Acetate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What pts are Ca based Phos binders CI in?

A
  1. elevated serum Ca
  2. arterial calcification
  3. dynamic bone disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are SEs with Ca based phos binders?

A
  1. nausea
  2. constipation
  3. hypercalcemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are SEs with Selvelamer?

A
  1. N/V/D
  2. constipation
  3. dyspepsia
  4. abdominal pain
  5. flatulence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are CI to using Selvelamer?

A

bowel obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What drugs interact with Selvelamer and should be administered separatly?

A
  1. quinolones
  2. mycophenolate
  3. tacrolimus
  4. thyroid products
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What other agents are used to decrease serum phos?

A
  1. lanthanum carbonate
  2. iron-based binders
  3. magnesium based binders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
What are warnings with ferric citrate iron based binder?
1. do not chew/crush may discolor teeth mouth 2. increased iron absorption; keep away from children
26
What are SEs with iron based binders?
1. diarrhea 2. constipation 3. black stool due to iron
27
What products should NOT be taken with iron based phos binders?
thyroid products
28
What products can be used to decrease the amount of Ca based binders to manage phos?
Mg based binders
29
How does Vit D therapy treat MBD-CKD?
1. increase Ca absorption from GI tract 2. decreases PTH synthesis and secretion (active/analogs)
30
What forms of Vit D are effective in patients with stage 3 CKD? Why?
1. Ergocalciferol (D2), Cholecalciferol (D3) 2. required activation via 1alpha-hydroxylase in kidneys; stages 4 and 5 can no longer convert
31
What forms of Vit D are used in patients with stage 4 and 5 CKD?
1. Active Vit D (Calcitriol, Calcifediol) 2. Vit D analogs (Paricalcitol, Doxercalciferol)
32
What are CIs to using active vit D or vit D analogs?
1. hypercalcemia 2. Vit D toxicity
33
What are SEs of active vit D or vit D analogs?
1. N/V/D 2. hypercalcemia 3. hyperphosphatemia 4 digitalis toxicity potentiated by hypercalcemia
34
How do calcimimetics decrease PTH, Ca, and Phos?
1. increase sensitivity of parathyroid gland to serum Ca levels 2. decrease in serum Ca and Phos
35
What agents are Calcimimetics?
1. Cinacalcet SENISPAR 2. Etelcalcetide PARSABIV
36
What are CIs to using calcimimetics?
1. hypocalcemia 2. caution in seizure history
37
What are warnings with Etelcalcetide PARSABIV?
1. hypocalcemia 2. worsening HF 3. GI bleeding 4. decreased bone turnover 5. muscle spasm
38
What are SEs with calcimimetics?
1. hypocalcemia 2. N/V/D 3. paresthesias 4. fatigue 5. constipation 6. bone fracture 7. weakness/myalgia/limb pain
39
How should binders be administered to control phos?
added one onto the other until goal phos reached
40
Calcium carbonate
TUMS
41
Calcium acetate
PHOS-LO
42
Sevelamer HCl
RENAGEL
43
Sevelamer carbonate
RENVELA
44
Lanthanum
FOSRENOL
45
Sucroferric oxyhydroxide
VELPHORO
46
Ferric citrate
AURYXIA
47
Ergocalciferol
Vit D2
48
Cholecalciferol
Vit D3
49
Calcitriol
CALCIJEX (IV) ROCALTROL (PO,soln)
50
Calcidfediol
RAYALDEE
51
Paricalcitol
ZEMPLAR
52
Doxecalciferol
HECTOROL
53
Cinacalcet
SENSIPAR
54
Etelcalcetide
PARSABIV (IV)

Critically Ill (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions