[PHARMA] CKD Flashcards
stage 1 CKD
kidney damage w/ normal or increased GFR
<90
stage 5 CKD
kidney failure GFR <15 or dialysis indicated
aim of TTT
Delay the progression
Treat manifestations
prevent ARF
delaying the progression of CKD includes (6)
managing:
1-underlying cause
2-BP
3-Glycemic control
4-Proteinuria
5-Dyslipidemia
6-Subclinical hypothyroidism
Stage 1 CKD can be diagnosed by
US
CT
Proteinuria
preventing ARF includes
1-avoid dehydration
2-nephrotoxins
3-UTI
nephrotoxins include (6)
1-aminoglycosides
2-NSAIDs
3-IV contrast media
4- Amphotericin B
5-Cyclosporine
6-Tacrolimus
Discontinue ACEIs/ARBs
target BP
<140/90
which bp is more important to control
Systolic BP
if BP target is not reached then add
loop diuretics ± Non DHP CCBs, BBs, Vasodilators
administering anti-HTN TTT at bedtime leads to
decreased CVS risks
blood pressure control
ACEIs/ARBs, loop diuretics
if BP target not reached: loop diuretics ± , Non DHP CCBs, BBs, Vasodilators
BP control strategy
-ACEIs/ARBs
-measure Creatinine & K+ baseline levels before TTT
-monitor serum Creatinine, K+
-if BP target not reached: loop diuretics ± Non DHP CCBs, BBs, Vasodilators
discontinuing ACEIs/ARBs results in
return of renal function to baseline levels
glycemic control (7)
1-insulin
2-oral metformin
3-DPP4 inhibitors
4-Glipzide
5-Gliclazide
6-Repaglinide
7-Thiazoldindione
oral metformin elimination
renal
thiazoldindione eliminiation
hepatic
risk of using thiazoldindione
salt & water retention–> EDEMA
thiazoldindione CI in
CHF
why must oral metformin be avoided/ adjust its dose
renally eliminated–>risk of lactic acidosis
proteinuria control (3)
ACEIs/ARBs
Non DHP CCBs
Mineralocorticoid anatgonists
if creatinine levels >30% of baseline w/ ACEIS, ARBs
DISCONTINUE
all patients w/ proteinuria regardless of BP should receive
ACEIs/ARBs
risk of using mineralocorticoid antagonists
Hyperkalemia
DOC in diabetic patients w/ proteinuria
Non DHP CCBs
Non DHP CCBs mechanism of action in proteinuria control
decrease protein excretion in diabetic patients related to reductions in BP
CVS risks management
Statin + Ezetimibe
edema management
1-avoid dehydration
2-Loop diuretics
3-Thiazide diuretics
A.DOC in treating edema?
B. Why?
Loop diuretics
effective even w/ low GFR
why are thiazide diuretics not the DOC in edema treatment
ineffective when used alone in GFR<30
diuretic therapy prevents
volume overload
anemia mechanism
↑hepcidin= ↓iron availability
↓Erythropoietin
↓RBCs lifespan 70-80d
concomitant blood loss w/ dialysis
anemia management
1-ESA: epoetin α, darbepoetin
2-iron supplements
3-Folic acid & Vit B12
A. iron supplements preferred route of administration?
B. Why?
parenteral
oral route absorption can be impaired dt gastric mucosal edema
ESA adverse effects
HTN
seizures
target Hb levels
11-12g/dL
Hb levels >13 g/dL can effect
renal functions
renal osteodystrophy management (4)
1-Active Vit D: calcitrol, alfacalcidol, paricalcitol
2- Phosphate binders + restrict dietary Phosphate
3-Cinacalcet
4-Parathyroidectomy
Cinacalcet lowers PTH by
↑receptor sensitivity to extracellular Ca++
↓PTH
dialysis indications (8)
1-severe metabolic acidosis
2-Hyperkalemia
3-intractable volume overload
5-pericarditis, encephalopathy (uremia signs)
6-peripheral neuropathy
7-intractable GIT symptoms
8-asymptomatic adults w/ GFR 5-9
drug therapy w/ dialysis (7)
1-erythropoietin
2-iron supplements
3-Phosphorous binders
4-active Vit D
5-Folic acid + B12
6- Vit E
7- antihistamines
