miscellaneous

Question 1

To lower PTH
For normal - high Ca

Answer 1

Use: Cinacalcet (Sensipar) PO or Etelcalcitide (Parsabiv) IV

Question 2

To lower PTH
For normal - low Ca

Answer 2

Use activated Vit D & its analogs
Calcitriol (Rocaltrol) - endogenous
OR
Analogs that have less increase in Ca and PO4:
Paricalcitol (Zemplar)
Doxercalciferol (Hectorol)

Question 3

Phosphate binders for normal - high Ca (noncalcium based)

Answer 3

1st line Sevelamer carbonate (Renvela)
Lanthanum carbonate (Fosrenol)
For iron deficiency too: Ferric citrate (Auryxia) - high pill burden
Sucroferric oxyhydroxide (Velphoro) - doesnt help with iron but less pill burden and chewable.
Sevelamer HCl (Rengel) isnt used

Question 4

Calcium based Phosphate binders for low Ca

Answer 4

Calcium acetate less Ca, more $$$
Calcium Carbonate (more Ca in here) and cheaper

Question 5

Add on Phosphate binder for dialysis patients or for people who cant tolerate other phosphate binders

Answer 5

Tenapanor (Xphozah)
CI in GI obstruction and age <6
dosed BID before morning and evening meals
AE: diarrhea
DI: Sodium polystyrene sulfonate (SPS)
separate administration by 3 hrs

Question 6

Drug classes that slow CKD progression

Answer 6

ACEi/ARB
SGLT2i for GFR > 20
Finerenone for GFR > 25 and K < 5
GLP1 IF DIABETIC (not for nondiabetics)

Question 7

Goal of using ACE/ARB for albuminuria

Answer 7

30-35% albuminuria reduction

Question 8

Finerenone starting doses

Answer 8

20mg if eGFR above 45
10mg if GFR < 45

Question 9

Oral iron Therapy

Answer 9

Ferrous sulfate 325 mg 20%
Ferrous Gluconate 525mg 20% PO
Ferric Citrate (Auryxia) - 210mg 100%
has 100% elemental iron bc new iron drug
Ferric maltol (Accrufer) 100%
Polysaccharide iron 100%

Question 10

IV iron

Answer 10

Iron Dextran - only one that requires 25mg test dose bc of high risk of infusion/anaphylactic reactions
Ferric Gluconate (Ferrlecit) IV
Iron Sucrose (Venofer)
Ferumoxytol (Feraheme)
Ferric carboxymaltose (Injectafer)
Remember, IV has 100% bioavailability

Question 11

Metformin, SGLT2i, and GLP1 is used for what type of diabetes ONLY?

Answer 11

T2DM

Question 12

Moderate / high intensity statin for T1DM and T2DM
When should you use Ezetimibe 10mg or PCSK9i like alirocumab 75mg or evolocumab 140mg

Answer 12

For ASCVD > 10% and high lipids

Question 13

Diabetes w CKD what nonpharm

Answer 13

diet, exercise, smoking cessation, ideal body weight (weight loss)

Question 14

HTN w CKD what nonpharm

Answer 14

diet (less sodium intake <2g/day), exercise 30mins 5x a week, ideal body weight to bmi of 20-25kg/m^2, limit alcohol intake to 2 or less drinks/day for male and 1 or less for females

Question 15

What medications should you use in all patients with diabetes and CKD?

Answer 15

Metformin (For T2DM only)
SGLT2 (for T2DM only)
RAAS inhibitor (ACE/ARB or direct renin inhibitor)
Statin

Question 16

A1C target for diabetes with CKD stages 1-3

Answer 16

A1C target of 7%.
As CKD progresses to 4-5, A1C target is less strict

Question 17

CKD progression risk factors- modifiable

Answer 17

Diabetes, HTN, proteinuria, hyperlipidemia, tobacco use (these we address w drugs)
Systemic inflammation
Environmental exposures (heavy metals)

Question 18

Nonmodifiable CKD progression risk factors

Answer 18

older age (after 30years old esp)
Black or native american
Genetics

Question 19

what stages of CKD can you use statins?

Answer 19

Stages 1-5 without dialysis
DONT use in dialysis patients. If they were already on it, you can leave it or take it off tho. No evidence to support taking it off needed.

Question 20

Which SGLT2i can u use with ACEi/ARB for CKD at the same time regardless of diabetes/nondiabetes?

Answer 20

empagliflozin
dapagliflozin
canagliflozin
empa dapa cana
DONT USE IN T1DM! can cause euglycemic diabetic ketoacidosis.
Additional AE of SGLT2: UTI (vaginal yeast infections, Fournier’s gangrene)

Question 21

Goals of therapy

Answer 21

Avoid hypercalcemia (normal range)
Target normal range 3.5-5.5 for phosphorus
iPTH target 150-600 pg/ml
hemoglobin 10-11g/dl
TSAT greater than 30%
Ferritin greater than 500ng/ml