Mineral bone disease in CKD

Question 1

how to treat mineral bone disease

three steps

Answer 1

treat with phosphate binder

2. treat with vitamin D
3. treat with calcimimetic

both steps 2 and 3 will help fix the hyperparathyroidism

Question 2

foods high in phosphorous

Answer 2

meats, processed foods, soft drinks, dehydrated milks,, desert, instant cappuccino hard cheeses (cheddar, parmesan), nuts, yolk

Question 3

steps to picking phosphate binder

Answer 3

1. correct the serum calcium with equation
   corrected calcium= measured calcium+0.8(4-albumin)

2.if hypocalcimeic. use calcium based binder such as calcium acetate (phoslo) which is first line. or calcium carbonate

if normal calcium or high calcium, use non calcium based binders like sevelamer carbonate (renvela) which is first line, ferric citrate (auryxia), lanthanum carbonate (Fosrenol)

Question 4

step 2: increase vitamin D

indication

with what

Answer 4

when calcium is low

endogenous: calcitrol (rocaltrol)

Paricalcitol (Zemplar)

Doxercalciferol (hectoral)

Question 5

goals of therapy for secondary hyperparathyroidism

Answer 5

correct calcium: 8.5-10.2
correct phosphorous 2.7 -4.6 or 3.5-5
iPTH: <2-9 X the upper limit of normal assay

Question 6

Phosphate binder

examples:

calcium based:

Class:

Indication:

Mechanism of Action:

Effects of mechanism of Action:

Adverse Effects: calcium based:

Absolute Contraindications:–
Pregnancy: —

Warning/ Precautions: –

Drug-Drug Interactions (DDIs):

Monitoring Parameters: TAKE WITH FOOD

Answer 6

Phosphate binder

examples:non calcium ferric citrate (aurixia) Sevelemar, lanthanum, or sucroferic oxyhydroxides

calcium based: calcium acetate (Phoslo), calcium carbonate

Class: phosphate binder

Indication: reduce phosphate in hyperparathyroidism in cod

Mechanism of Action: binders limit phosphate absorption in GI tract by binding with dietary phosphate

Effects of mechanism of Action: decrease phosphate absorption

Adverse Effects: calcium based: STONES, BONES, AND ABDOMINAL GROANS, clciphylaxis, abdominal calcification (highest if calciumXphosphate is>55
Absolute Contraindications:–
Pregnancy: —

Warning/ Precautions: –

Drug-Drug Interactions (DDIs): fluoroquinones, levothyroxine, iron, seperate administration by 2 hours

Monitoring Parameters: TAKE WITH FOOD
2. if high calcium, used non calcium based binders like sevalemer, ferrous citrate (auryxia), lanthanum carbonate

Question 7

step3: calcium mimetic:
indication

examples

Answer 7

if calcium level is normal to high

cinalcet )sensipar

etelcalcitide (Parsabiv)