Pharmacotherapy of CKD Flashcards
1
Q
To treat Anaemia
A
- Kidneys are unable to synthesise enough erythropoietin for RBCs
- Treatment:
1. Erthyrhopoiesis - Stimulating Agents (ESA)
2. Iron supplement if iron levels are low
3. Blood Transfusion to patients resistant to ESA
2
Q
Erthyrhopoiesis - Stimulating Agents (ESA)
A
- Epoetin Alpha
1. Administered by S/C 3 times a week until therapeutic response is obtained (Usually 2-6 weeks)
2. IV at the same time with dialysis
3. Life-threatening side effects
4. Stroke and myocardial infarction if Hb levels are too high - Nursing Implication: Do not shake the vial as it may deactivate the drug
3
Q
To treat Hyperphosphatemia
A
- Kidneys are unable to adequately excrete phosphate
- Treatment:
1. Dietary restriction of Phosphate (Oily fish and Dairy Products)
2. Phosphate binders such as calcium carbonate, calcium acetate lanthanum carbonate, sucroferric oxyhydroxide / sevelamer
4
Q
To treat Hypervolemia
A
- Pathogenesis: Kidneys are unavailable to excrete sufficient sodium and water, leading to water retention
- Treatment
1. Dietary Restriction of Sodium
2. Diuretics (Loop diuretics in Acute Condition, Thiazides in Mild Condition)
5
Q
To treat Hyperkalemia
A
- Kidneys are unable to adequately excrete potassium
- Treatment
1. Dietary Restriction of Potassium
2. Sodium polystyrene sultanate (Kayexalate) -> PO/Rectally, Not absorbed, exchanges Na+ for K+ as it travels through the intestine
6
Q
To treat Hypocalcemia
A
- Usually corrected by reversing the hyperphosphatemia
- Additional calcium supplements may be necessary
7
Q
Vitamin D Supplements
A
- The kidneys plays an important role in transforming inactive Vit D to active Vit D (Calitriol)
- CKD -> Decrese Active Vit D
- Vit D: Hypercalcemia, Increase CVS Risk, Vascular Clarification
8
Q
To treat Metabolic Acidosis
A
- Kidneys are unable to adequately excrete metabolic acids
- Treatment: Sodium bicarbonate or Sodium citrate
9
Q
MOA of Diuretics
A
- Block Na+ reabsorption in the nephron and send more Na+ in the urine
- Water travels with Na+
- The volume of Urination increases (Diuresis)
10
Q
Side effects of Diuretics
A
- Fluid and Electrolyte Disturbances — Dehydration, Orthostatic Hypotension, Potassium and Sodium Imbalances
11
Q
Classification of Diuretics
A
- 3 Major Groups (Loop Diuretics, Thiazides Diuretics, Potassium sparing Diuretics)
- One Miscellaneous Group (Osmotic Diuretics, Carbonic Anhydrase Inhibitors)
12
Q
Loop Diuretics
A
- MOA: To block reabsorption of sodium and chloride in the loop of Henle
- Primary Use: To reduce oedema associated with heart, hepatic cirrhosis, or renal failure
- Adverse Effects: Hypovolemia, Orthostatic Hypotension and Syncope, Electrolyte Imbalance (Hypokalemia), Ototoxicity
- Prototype: Furosemide
13
Q
Furosemide Drug Interactions
A
- F + Aminoglycoside: Ototoxity cause by Furosemide and Aminoglycoside
- F + Digoxin: Furosemide causes hypokalemia, and that leads to increased digoxin toxicity
- F + Antihypertensives: Increased risk of hypotension
14
Q
Thiazide Diuretics
A
- MOA: To block reabsorption and increase potassium and water excretion in the distal tubules
- Primary Use: To treat mild to moderate hypertension (Also indicated to reduce oedema associated with Heart, Hepatic, and Renal Failure). Not effective in patients with severe renal failure
- Prototype Drug: Hydrochlorothiazide
15
Q
Potassium Sparing Diuretics
A
- Advantage: Diuresis without affecting blood potassium levels
- MOA: Either by blocking sodium or by blocking aldosterone, the hormone that controls renal reabsorption of sodium and potassium
- Prototype: Spironolactone
- Contraindications: Patients with Anuria, Significant impairment of renal function or hyperkalemia
