miscellaneous Flashcards
To lower PTH
For normal - high Ca
Use: Cinacalcet (Sensipar) PO or Etelcalcitide (Parsabiv) IV
To lower PTH
For normal - low Ca
Use activated Vit D & its analogs
Calcitriol (Rocaltrol) - endogenous
OR
Analogs that have less increase in Ca and PO4:
Paricalcitol (Zemplar)
Doxercalciferol (Hectorol)
Phosphate binders for normal - high Ca (noncalcium based)
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
Calcium based Phosphate binders for low Ca
Calcium acetate less Ca, more $$$
Calcium Carbonate (more Ca in here) and cheaper
Add on Phosphate binder for dialysis patients or for people who cant tolerate other phosphate binders
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
Drug classes that slow CKD progression
ACEi/ARB
SGLT2i for GFR > 20
Finerenone for GFR > 25 and K < 5
GLP1 IF DIABETIC (not for nondiabetics)
Goal of using ACE/ARB for albuminuria
30-35% albuminuria reduction
Finerenone starting doses
20mg if eGFR above 45
10mg if GFR < 45
Oral iron Therapy
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%
IV iron
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
Metformin, SGLT2i, and GLP1 is used for what type of diabetes ONLY?
T2DM
Moderate / high intensity statin for T1DM and T2DM
When should you use Ezetimibe 10mg or PCSK9i like alirocumab 75mg or evolocumab 140mg
For ASCVD > 10% and high lipids
Diabetes w CKD what nonpharm
diet, exercise, smoking cessation, ideal body weight (weight loss)
HTN w CKD what nonpharm
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
What medications should you use in all patients with diabetes and CKD?
Metformin (For T2DM only)
SGLT2 (for T2DM only)
RAAS inhibitor (ACE/ARB or direct renin inhibitor)
Statin
A1C target for diabetes with CKD stages 1-3
A1C target of 7%.
As CKD progresses to 4-5, A1C target is less strict
CKD progression risk factors- modifiable
Diabetes, HTN, proteinuria, hyperlipidemia, tobacco use (these we address w drugs)
Systemic inflammation
Environmental exposures (heavy metals)
Nonmodifiable CKD progression risk factors
older age (after 30years old esp)
Black or native american
Genetics
what stages of CKD can you use statins?
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.
Which SGLT2i can u use with ACEi/ARB for CKD at the same time regardless of diabetes/nondiabetes?
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)
Goals of therapy
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
