Lect 3

Question 1

as kidney function declines there is ___

Answer 1

• hyperphosphatemia
• inhibition of renal activation of Vit D
• stim of PTH secretion
• Ca levels are maintained by bone resorption
• elevated Ca x P product can cause soft tissue calcification

Question 2

as kidney function declines there is ___

Answer 2

• hyperphosphatemia
• inhibition of renal activation of Vit D
• stim of PTH secretion
• Ca levels are maintained by bone resorption
• elevated Ca x P product can cause soft tissue calcification

Question 3

hypocalcemia

Answer 3

serum Ca less than 8.5 mg/dL

Question 4

Ca x P product

Answer 4

less than 55 mg2/dL2

Question 5

PTH ranges for Stage 4 and 5 CKD

Answer 5

above the normal range to prevent over suppression of PTH

Question 6

hypocalcemia

Answer 6

serum Ca

Question 7

Ca x P product

Question 8

PTH ranges for Stage 4 and 5 CKD

Answer 8

above the normal range to prevent over suppression of PTH

Question 9

PTH ranges for Stage 4 and 5 CKD

Answer 9

above the normal range to prevent over suppression of PTH

Question 10

what is first line non-pharm intervention for CKD pts?

Answer 10

dietary phosphate restriction

800-1000 mg/day

Question 11

parathyroidectomy

Answer 11

for pts with SEVERE CKD-MBD and nonresponsive to pharm therapy (PTH is higher than 800 picograms/mL)

Question 12

MOA of phosphate binding agents

Answer 12

bind dietary phos in the GI tract and form an insoluble product that can be excreted in feces
lowers phos absorption

Question 13

ex of phos binding agents

Answer 13

elemental Ca= lanthanum-, aluminum-, and magnesium-containing compounds
nonelemental= sevelamer carbonate
many times these are taken TID with a meal

Question 14

calcium carbonate

Answer 14

TUMS

more soluble in acidic environments, thus given before meals

Question 15

calcium acetate

Answer 15

PhosLo

binds 2X phosphorus as calcium carbonate

Question 16

what phos binding agents are first line for control of both serum phos and Ca conc?

Answer 16

oral calcium compounds

Question 17

what phos binding agent is approved for ESRD pts?

Answer 17

lanthanum carbonate

Question 18

aluminum salts

Answer 18

restriction is limited to 4-week therapy

Potential for producing anemia

Question 19

Mg containing antacid

Answer 19

use is limited in CKD pts due to GI side effects and potential for Mg accumulation

Question 20

ADR’s of phosphate binding agents

Answer 20

• ALL are limited by GI side effects (constipation, diarrhea, N/V, abd pain)
• hypercalcemia
• CNS tox & worsened anemia= aluminum binders
• hyperMgemia and hyperKemia= Mg binders

Question 21

Vit D therapy MOA

Answer 21

activated Vit D (calcitriol) suppresses PTH secretion by stim absorption of Ca by intestinal cells, proximal tubular cells, and through direct activity on parathyroid gland

Question 22

examples of Vit D agents

Answer 22

• ergocalciferol (Vit D2) and cholecalciferol (Vit D3)= must be converted to active form by the kidney since they are Vit D precursors
• calcitriol (1,25 D3)= most active form
• paricalcitol or doxecalciferol= analogs

Question 23

what Vit D agents are used in pts with severe kidney disease?

Answer 23

calcitriol or one of the analogs (since the rest need the kidney to convert them to active form)

Question 24

which Vit D drug can be used either by oral or IV routes?

Answer 24

calcitriol

Question 25

calcimimetics MOA

Answer 25

acts on the Ca-sensing receptor on the surface of the chief cells of the parathyroid gland to mimic the effect of extracellular ionized Ca and increase the sensitivity of the Ca sensing receptor
DOES NOT increase intestinal Ca/ phos absorption

Question 26

example of calcimimetic

Answer 26

cinacalcet hydrochloride (Senispar)= tx for secondary hyperparathyroidism in ESRD pts and tx of hyperCaemia in pts w/ parathyroid carcinoma

Question 27

efficacy of calcimimetics

Answer 27

signficantly decreased PTH and Ca x P product

Question 28

ADR’s of calcimimetics

Answer 28

N/V

Question 29

ADR’s of calcimimetics

Answer 29

N/V

Question 30

PK of cinacalcet

Answer 30

Cmax reached in 2-6 hours

large vol of distribution and mostly protein bound so negligible removal by dialysis