Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharmacology > Co morbid CKD Mgt > Flashcards

Co morbid CKD Mgt Flashcards

1
Q

What is GFR categories for KDIGO?

A

1: >90%
2: 60-89%
3a: 45-59%
3b: 30-44%
4: 15-29%
5: <15%

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

What are the top three etiologies of CKD and ESRD?

A

DM
HTN
Glomerularnephritis

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

What is first line tx for urine albumin excretion >30mg/24 hours?

A

ACE/ARB

  • increase until 30-50% drop in urine albumin excretion
  • drop in eGFR
  • hyperkalemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How do you tx HTN induced CKD?

A

ACE/ARB

decreases BP and effects renal hemodynamics

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

When should you use caution for using ACE/ARB for tx of HTN? (2)

A

BP <110/70 or eGFR <30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What do you do if BP is >130/80 after adding ACE/ARB for tx of HTN?

A

increase dose or ACE or ARB or add thiazide diuretic

if BP continues to be elevated add clonidine, minoxidil, or hydralazine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Drug tx for DM and HTN?

A

ACE or ARB

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

Why does anemia develop in CKD?

A
  • reduced erythropoeitin production
  • toxin build up in blood cuts RBC lifespan from 120 to 60 days
  • folate and B12 deficiency
  • iron deficiency
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How do you tx anemia?

A

1.give erythropoeitin stimulating agents
epoeitin alfa, darbepoetin alfa
2. regular iron supplementation (IV)

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

What are the administration limits to ESA?

A
  • increased risk of cardiovascular events

- when Hg target is greater than 11g/dL

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

What is MOA of ESA?

A
  • stimulates erythroid progenitor cells in bone marrow to make RBC’s
  • kicks out reticulocytes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are ADE of ESA’s? (3)

A

-DVT, cancer, and cardiac events with Hg>11 g/dL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

T/F It is very painful to give ESA sub Q

A

True

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

When do you initiate ESA’s in ND-CKD?

A
  • when Hg <10g/dL
  • need for blood transfusion
  • rate of drop if Hgb
  • risk of ESA tx
  • DO NOT initiate if Hgb >10
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When do you initiate ESA’s in CKD 5HD and 5PD?

A

when Hgb is between 9-10g/dL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When do you start iron IV infusion for ND-CKD and 5HD and 5PD CKD?

A

when TSat <30% and ferritin < 500

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

T/F Do not use ESA to get Hb above 13.5 or to maintain Hb above 11.5g/dL

A

TRUE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is ESA dosing guidelines?

A

1-2g/dL increase of Hb in 4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What should you do if the Hb increases more than 1 g/dL in 2 weeks

A

reduce ESA dose by 25%

20
Q

What should you do if the Hb does not increases by more than 1 g/dL in 4 weeks?

A

increase ESA by 25%

21
Q

How long should you wait before checking labs after iron IV infusion?

A

1 week

22
Q

Whats is one reason for hypo responsiveness of ESA’s?

A

low iron! check iron

23
Q

How does PTH regulate Ca and Phosphorus?

A

increases Ca and decreases Phosphorus

24
Q

How does vitamin D regulate Ca and Phosphorus?

A

both increased in serum

25
Q

How does FGF23

A

decreases phosphorus

26
Q

How do you manage hyperphosphotemia in CKD?

A

restrict phosphorus in diet
phosphate binders
vitmain D therapy

27
Q

Name 2 calcium based binders?

A

Calcium acetate and calcium carbonate

28
Q

Name 2 iron based binders?

A

ferric citrate

sucroferric oxyhydroxide

29
Q

Name 1 resin binder?

A

Sevelamer hydrochloride

30
Q

Name 2 other elemental binders?

A

Lathanum carbonate

Aluminum hydroxide

31
Q

What is MOA of calcium based phosphorus binders?

A

binds phosphorus to form insoluable ca-phos complexes that are excreted in feces

32
Q

What are ADE of calcium based phosphorus binders?

A

milk-alkali syndrome: HA, nausea, renal impairment
hypercalcemia
Hypophosphatemia

33
Q

What is MOA of resin binder Sevelamer Hydrochloride?

A

binds phos within intestinal lumen to limit its absorption

34
Q

T/F Sevelamer hydrochloride lowers LDL

A

TRUE

35
Q

What are ADE of sevelamer hydrochloride?

A

dyspepsia!, N/V/D

36
Q

When and how should you take sevelamer hydrochloride?

A

with food

when at risk for extraskeletal calcium calcification

37
Q

What is MOA of lathanum carbonate binder?

A

binds dietary phosphate and forms insoluble Lathanum phosphorus complexes with a net decrease in calcium and phosphorus

38
Q

What are ADE of lanthanum carbonate? (4)

A
  • long half live in bone: accumulates in bone 2-3 yrs
  • fecal impaction!
  • ileus!
  • constipation
39
Q

What is MOA of Aluminum hydrochloride?

A

-binds phophate in GI tract to limit its absorption

40
Q

Whats is clinical indication for Aluminum hydrochloride?

A

short term use <4 weeks but used if need fast acting

41
Q

What are ADE of Aluminum hydrochloride?

A

risk of aluminum toxicity!
hypo Mg!
-constipation

42
Q

How often should you monitor Ca Phos, PTH in stage 3,4,5, and ESRD?

A

3: ca and phos 6-12 months, PTH depends on CKD progression
4:3-6 months, PTH 6-12 months
5: 1-3 months , PTH 3-6 mo
ESRD: 1-3 months, PTH 3-6 mo

43
Q

What is D2 and D3?

A

D2-ergocalciferol

D3-cholecalciferol

44
Q

What are the 3 Vitamin D analogs?

A

calcitriol
paricalcitol
doxercalciferol

45
Q

What is MOA of D2 and D3?

A

stimulates absoprtion of Ca and phos from small intestine

  • induces release of Ca from bone to blood
  • induces phosphorus resorption in kidney
46
Q

What is route of D2 and D3? What is dosage regimen?

A
  • PO
  • D2 lower dose and daily
  • D3 higer dose, rx, and weekly
47
Q

What vaccines are given when eGFR is <30?

A

pneumococcal vaccine

Hep B vaccines

Pharmacology (47 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions