Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PHRM 825 > PHRM 825: CKD and ESRD > Flashcards

PHRM 825: CKD and ESRD Flashcards

1
Q

What percent of people in ESRD are on dialysis/get a kidney transplant and which is better?

A

~70% dialysis
~30% transplant
Transplant is ALWAYS better than dialysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

3 major causes of CKD

A

1) Diabetes
2) HTN
3) Glomerulonephritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How does KDIGO define CKD?

A

Abnormalities of kidney structure, present for >3 months with implications for health

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What things does KDIGO use to classify the stages of CKD?

A

Cause, GFR, and albuminuria category

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the definition of AKI?

A

Change to kidney function over a short period of time (couple of weeks max)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What stage of CKD do we start to worry about patients?

A

Stage 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

A 20 year old without ESRD will live an additional __ years

A

47-60

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

A 60 year old without ESRD will live an additional ___ years

A

16-23

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

A 20 year old with ESRD will live an additional ___ years

A

17-21

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

A 60 year old with ERSD will live an additional ____ years

A

4-5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What formula is the most commonly used to estimate Creatinine clearance?

A

Cockroft and Gault

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

3 qualities of the Cockroft and Gault formula for estimation of CrCl

A
  • Accurate for patients with stable kidney function (assuming SCr is stable)
  • Good predictor of GFR and easy to use
  • Tends to overestimate renal function in moderate to severe kidney impairment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What formula is the most accurate measure of GFR?

A

MDRD (includes adjustments for race and gender)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the Cockroft and Gault equation for creatinine clearance?

A

Men: CrCl = (140-age)IBW/(SCr72)
Women: [(140-age)IBW/(SCr72)]*0.85

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are 7 complications associated with CKD and ESRD patients?

A
  • Uremia
  • Fluid retention
  • Electrolyte imbalance
  • Mineral and Bone Disorder (CKD-MBD)
  • Anemia
  • Acid-base disorders
  • Nutrition
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Definition of uremia

A

Cluster of symptoms which is associated with ESRD from any cause. Symptoms are due to the accumulation of waste molecules in the blood that are normally removed by the kidneys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is measured to assess signs and symptoms of uremia?

A

BUN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are 2 results of fluid retention?

A

Edema and increase in blood pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Should you restrict fluids for a patient with fluid retention?

A

Not generally necessary if Na+ intake is controlled, however large amounts of free water should be avoided

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

In what cases will diuretics not work?

A

When the kidneys are not working

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

____ diuretics are ineffective when CrCl < 30 mL/min

A

thiazide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

____ diuretics will work when CrCl < 30 mL/min

A

loop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What diuretic can be used for patients that have a sulfa allergy to loop diuretics and what is the risk of this diuretic?

A

Ethacrinic acid; odotoxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What 3 things can cause the parathyroid gland to increase production of iPTH?

A
  • Hyperphosphatemia
  • Decreased vitamin D activation
  • Hypocalcemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How does iPTH result in fractures?

A

In causes reabsorption of Ca+2 from bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the difference between phosphate and phosphorus?

A

Phosphate –> Dietary intake

Phosphorus –> portion of phosphate measured in blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What medications can treat hyperphosphatemia?

A

Phosphate binders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is an important counseling point for phosphate binders?

A

Always take with food

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How do phosphate binders work?

A

They bind dietary phosphate that is ingested in the food and the chelate is eliminated in the feces

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are 2 calcium containing phosphate binders?

A
  • Calcium carbonate (Tums)

- Calcium acetate (PhosLo)

31
Q

What is the max dose of elemental Ca and what can happen if it is exceeded?

A

1500 mg/day; soft-tissue calcification

32
Q

Side effects of calcium carbonate/acetate

A

Constipation

33
Q

Why is calcium acetate better than calcium carbonate?

A
  • Binds twice as much phosphate compared to calcium carbonate
  • May produce fewer hypercalcemic events when compared to calcium carbonate
34
Q

What are 6 non-calcium containing phosphate binders?

A
  • Sevelamer carbonate (Renvela)
  • Lanthanum carbonate (Fosrenol)
  • Sucroferric oxyhydroxide (Velphoro)
  • Auryzxia (ferric citrate)
  • Aluminum hydroxide (Amphojel)
  • Magnesium Carbonate (Mag-carb)
35
Q

How should you dose non-calcium containing phosphate binders?

A

Take the total daily dose and divide it by the number of meals

36
Q

When should dietary phosphorus intake be restricted to 800-1000 mg per day?

A
  • Phos > 4.6 mg/dL (CKD stage 3 and 4)
  • Phos > 5.5 mg/dL (CKD stage 5)
  • PTH > target range for stage 3, 4, or 5
37
Q

What does SHPT stand for?

A

Secondary hyperparathyroidism

38
Q

What is used to treat SHPT?

A
  • Vitamin D (ergocalciferol)

- Active vitamin D sterols (calcitriol, paricalcitrol, and doxercalciferol)

39
Q

What stage(s) of CKD requires the already activated form of vitamin D?

A

Stage 5 ERSD

40
Q

What vitamin D supplements require activation?

A

Ergocalciferol (calciferol) and cholecalciferol

41
Q

Why is it better to give unactivated vitamin D when possible?

A

It allows the kidneys to activate it when the body needs it

42
Q

What is cinacalcet (sensipar) and what does it do?

A

Type II calcimimetic agent; lowers the PTH concentration

43
Q

When is Cinacalcet (sensipar) contraindicated?

A

In hypocalcemia

If Ca <7.5 mg/dL do not use - wait until Ca is = or > 8 mg/dL

44
Q

What is the equation for corrected calcium?

A

Measured Ca + 0.8*(4 - serumAlb)

45
Q

What are the signs and symptoms of anemia in CKD patients?

A
  • Fatigue
  • Dizziness
  • HA
  • Decreased cognition
46
Q

Decreased MCV = _____ anemia

A

Microcytic

47
Q

Increased MCV = _____ anemia

A

Macrocytic

48
Q

Causes of microcytic anemia

A
  • Iron deficiency

- Aluminum toxicity

49
Q

Causes of macrocytic anemia

A
  • Folate deficiency

- B12 deficiency

50
Q

Normal MCV value

A

80-96 um^3

51
Q

Normal RDW value

A

11.5-14.5%

52
Q

What does MCV stand for?

A

Mean corpuscular value

53
Q

What does RDW stand for?

A

Red cell distribution width

54
Q

Anemia treatment goals

A
  • Reverse signs and symptoms of tissue oxygen deprivation and left ventricular hypertrophy
  • Increase exercise tolerance and capacity
  • Optimize survival
  • Increase quality of life
55
Q

What is the best assessment parameter for anemia and why?

A

Hemoglobin (Hb); it is more stable than hematocrit (Hct)

56
Q

What is normal hemoglobin for women?

A

~14

57
Q

What is normal hemoglobin for men?

A

~15.5

58
Q

When does KDIGO suggest iron supplementation in regards to TSAT and serum ferritin?

A

TSAT <30%

Serum ferritin <500 ng/mL

59
Q

What level is low in an absolute iron deficiency?

A

Ferritin

60
Q

What level is low in a functional iron deficiency?

A

TSAT

61
Q

What is the transport form of iron?

A

TSAT

62
Q

What is the storage form of iron?

A

Ferritin

63
Q

Side effects of oral iron

A
  • Stomach upset (hurts to absorb)
  • Best absorbed in acidic environment
  • Enteric coated –> Not absorbed as well
  • Avoid patients on meds that increase pH (proton pump inhibitor)
  • Separate from Ca by 2 hours
64
Q

When should Erythropoiesis Stimulating Agents (ESA) be used?

A

After all other correctable causes of anemia have been addressed

65
Q

ESA adverse effects?

A
  • Pure Red Cell Aplasia PRCA: antibodies develop to erythropoietin; d/c drug permanently
  • HTN: 23% of CKD patients with an increase in hemoglobin are at risk for increased cardiac arrest, seizures, stroke, exacerbation of CKD, HTN, acute myocardial infarction
66
Q

What is the #1 cause of ESA therpay failure?

A

Lack of vitamins or iron

67
Q

What metabolic disorder are ESRD patients at risk of getting?

A

Metabolic acidosis

68
Q

What are the protein requirements for someone in CKD stage 3,4 (GFR<30 ml/min)?

A

0.8 g/kg/day

69
Q

What are the protein requirements for someone in ESRD?

A

1.2 g/kg/day

70
Q

What are the energy requirements in kcal for ESRD/CKD patients < 60

A

35 kcal/kg/day

71
Q

What are the energy requirements in kcal for ESRD/CKD patients > 60

A

30-35 kcal/kg/day

72
Q

What is a common complication of CKD patients?

A

Uremic bleeding

73
Q

Signs and symptoms of uremic bleeding

A
  • Purpura
  • Ecchymoses
  • Epistaxis
  • Bleeding from hemodialysis access site
74
Q

Treatment for uremic bleeding

A
  • Red cell transfusions
  • Cryoprecipitate (fraction of blood containing factor VIII, fibrinogen, fibronectin)
  • DDAVP
  • Conjugated estrogens

PHRM 825 (36 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions