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Renal Exam 2 > Pharmacotherapy of Renal Bone Disease > Flashcards

Pharmacotherapy of Renal Bone Disease Flashcards

1
Q

PTH + Ca

A

Increases serum Ca

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2
Q

Vit D + Ca

A

Increases serum Ca

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3
Q

Calcitonin + Ca

A

Decrease serum Ca

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4
Q

As you lose nephrons you have

A

Increased PO4 retention (inhibit Vit D, decreased Ca, stimulate PTH)
Decreased productive of Vit D3

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5
Q

Decreased production of Vit D3

A

Decrease Ca in GI tract

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6
Q

Stimulated PTH secretion =

A

Decrease reabsorption of PO4 in proximal tubule

Increased reabsorption of Ca

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7
Q

GFR less than 30

A

Loss of increase Ca reabsorption and decreased phosphate
Decreased Ca reabsorption and increased phosphate reasborption
Bone resorption maintains Ca levels
PTH levels increase

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8
Q

Secondary hyperparathyroidism ADRs

A

Altered lipid metabolism, insulin secretion, myocardial and skeletal muscle function, neurologic and immune function
Eryhtropoietic therapy resistance

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9
Q

> 495 pg/mL of hormone associated with

A

increased sudden death and morbidity and mortality

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10
Q

Corrected Ca X PO4 formula

A

(4-albumin) X 0.8 + Ca

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11
Q

Soft tissue calcification occurs when Corrected Ca is:

A

> 70 mg2/dL2

- Want to maintain below 55

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12
Q

Elevated Ca-PO4 is associated with:

A

Vascular calcification
CVD
Calciphylaxis
Death

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13
Q

Normal Ca =

A

8.5-10.5

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14
Q

Hypocalcemia

A

Less than 8.5

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15
Q

Acute hypocalcemia

A

Neuromuscular - tetany, muscle cramps, laryngeal spasm

CV - prolonged QT interval, decreased myocardial contractility

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16
Q

Chronic hypocalcemia

A

CNS- depression, anxiety, confusion

Derm - hair loss, groved and brtittle nails, exzema

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17
Q

Causes of hypocalcemia

A 
Intensive care unit pt
Elderly, malnourished pts
Sodium phosphate as a bowl prep agent
Vit D deficiency
-ectomy
Meds
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18
Q

**What meds causes hypocalcemia?

A

Bispphosphonates, calcitonin, furosemide, oral phoshporus therapy

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19
Q

Treatment for acute symptomatic hypocalcemia

A

100-300 mg elemental Ca IV over 5-10 minutes
(CaCl 1g or Cagluconate 2-3g)
Continyous infusion of 0.5-2mg/kg/hr

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20
Q

Calcium should not be infused faster than

A

60 mg per minutes or severe cardiac dysfunction and ventricular fibrillation

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21
Q

Asymptomatic hypocalcemia treatment

A

Oral 1-3g/d

Correct underlying cause (replace mg and Vit D)

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22
Q

Vit D3 dose

A

0.5-3mcg/d

23
Q

Ergocalciferol dose

A

50,000 units/d

24
Q

Hypercalcemia =

A

> 10.5

Symptoms occur usually when >13

25
Q

Acute hypercalcemia

A 
Anorexia
N/V
Constipation
Polyuria
Polydipsia
Nocturia
26
Q

Hypercalcemic crisis =

A

> 15
Acute renal insufficiency and obtundation
Can progress to worse

27
Q

Chronic hypercalcemia

A

Metastatic calcification
Nephrolithiasis
Chronic renal insufficiency

28
Q

Meds that cause of hypercalcemia

A

Vit D analogs
Ca supps
Lithium

29
Q

Hypercalcemia Treatment

A 
NS 200-300 mL/h
Furosemide 40-80 mg IV q1-4h
Hemodialysis 
Calcitonin 4 units/kg SQ or IM every 12 hrs
Zoledronate 4-8mg IV given over 5
30
Q

Bisphosphonate caution

31
Q

Causes of hypophosphatemia

A

Decrease GI absorption (PO4 binder, sucralfate)
Increased urinary excretion (hyperparathyroidism)
Refeeding syndrome

32
Q

Symptoms of hypophosphatemia

A

Arrhythmia, muscle fatigue, respiratory failure, myalgias, weakness, irritability, seizure, coma

33
Q

Severe hypophosphatemia Treatment

A

PO4 15-30 mmol IV over 3 hr

34
Q

Asymptomatic hypophosphatemia treatment

A

Oral PO4 supplementation

35
Q

Hyperphosphatemia causes

A

Renal failure

Intracellular phosphate release (tumor lysis syndrome)

36
Q

Hyperphosphatemia symptoms

A

Soft tissue calcification
N/V/D
Letahrgy and seizures
Renal osteodystrophy

37
Q

Restrict PO4 when:

A

> 4.7 or PTH elevated

38
Q

Phosphorous range

39
Q

What is the first-line treatment of hypercalcemic, low PTH, or vascular calcification?

A

Phosphate binders (Non-Ca, non-Mg, non-Al based)

40
Q

Sevelamar HCl (Renagel)

A

Lowers LDL, increases HDL

Phosphate binder

41
Q

Lanthanum carbonate (Fosrenol)

A

Chewable wafer

Phosphate binder

42
Q

Stage 3/4 treatment

A

Ca-based binder first-line

43
Q

Stage 5 treatment

A

Primary: Ca or phosphate bind or combo

44
Q

Calcium based binders should not be used in pts who

A

are hypercalcemic or have low PTH

45
Q

In pts with phosphate >7.0 mg/dL,

A

Al-based binders may be used for

46
Q

Vitamin D compounds that need to be activated:

A

Ergocalciferol (VitD2)

Cholecalcifediol (VitD3)

47
Q

Active Vit D compounds

A

Calcitriol (VitD3)

Paricalcitol, doxercalciferol

48
Q

ADRs of VitD

A

Hypercalcemia
Can aggravate hypophosphatemia
Adynamic bone disease

49
Q

After starting VitD,

A

Monitor corrected Ca and PO4

D/c Vit D if hyperCa

50
Q

Hold VitD therapy, then reduce dose by 50% if:

A

PTH decreases below target

Ca rises precipitously

51
Q

Start supplement with VitD if

A

Less than 30

52
Q

Start supplement with active VitD if

A

PTH > target range AND vitD below 30

53
Q

Stage 3-5 CKD Treatment

A

Active VitD if PTH progressively increasing and remain persistently higher than limit

54
Q

Calcimimetics

A

Inhibitor of CYP2D6
Take with meals
Alternative or adjunct to VitD

Renal Exam 2 (10 decks)

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