Renal Disease Flashcards
Drugs that cause Kidney Disease 10
- Ags
- Ampho B
- Cisplatin
- Cyclosporine
- Loop Diuretics
- NSAIDs
- Polymxyins
- Radiographic contrast dye
- Tacrolimus
- Vancomycin
Select drugs that need decreased dose or increased dosing interval 4 groups
- Antiinfectives
- AGs, increase dosing interval mostly
- Beta-lactams
- FLuconazole
- Quinolones (except moxifloxacin)
- Vanco
- CV drugs
- LMWH
- Rivaroxaban for A fib
- GI drugs
- Ranitidine famotidine
- Metoclopramide
- Others
- Bisphosphanates
- Lithium
- 1.
Drugs that are contraindicated in CKD with cut off < 60
Nitrofurantoin (macrobid, macrodantin)
Drugs that are contraindicated in CKD with cut off < 50
2
- Tenofovir diso (stribild, complera, atripla, symfi, symfi lo)
- Voriconazole IV due to vehicle
Drugs that are contraindicated in CKD with cut off < 30 4
- Tenofovir alfenamide (Genvoya, biktarvy, descovy, odefesey, symtuza)
- NSAIDs
- Dabigatran
- Rivaroxaban
COntraindiacted GFR < 30
- SGLT2 inhibitors
- Canagliflozin, dapagliflozin, empagliflozin
- Metformin
Other meperidine
Both ____ and ____ cause increase release of?
Both high PO4 and low Ca cause increase PTH release
Key drugs that raise potassium levels 8
- ACE
- ARB
- Aldosterone receptor antagonists
- Aliskeren
- Canagliflozin
- Droperinone containt COCs
- Bactrim
- Transplant meds (cyclosporin, everlimus, tacrolimus)
Steps for treating severe hyperkalemia
- Stabalize the heart with calcium gluconate
- Move it
- Regular insulin
- Dextrose
- Sodium bicarb if metabolic acidosis is present
- Albuterol
- REmove it:
- Furosemide
- Sodium polystyrene sulfonate: binds K in GI tract rectal has much faster onset (use in emergency)
- Patiromer: not for acute emergency, binds in GI tract
- Sdium zerconium not for acute
- Hemodiaylsis: takes hours to set up
Phosphate binders
Aluminum Hydroxide Suspension
- Aluminum based: effecetive but bone toxicity limits use, dialysis dementia
What should you do if you miss a dose of phosphate binder?
SKip and resume normal dosing because it is used to block the absorption of dietary phosphate
How is hyperphosphatemia treated in CKD patients?
First dietary restrictions and then phosphate binders are likely required
If you miss a phosphate binder dose you should skip it
What are the 3 types of phosphate binders?
- Aluminum based
- Calcium-based
- aluminum free, calcium free agents
Aluminum based phosphate binders
How long is treatment limited and why?
Potent but rarely used to due to aluminum accumulations which can cause nervous system and bone toxicities
Treatment is limited to 4 wks
SIDE effects: dialysis dementia
Calcium based phosphate binders
First line:
SIde effects: Hypercalemia
Monitor Ca
Hypercalemia can be even more problematic when Vitamin D is used
Tums, PhosLo
Aluminum free calcium free binders, less side effects more expensive
3 types brand and generic
Iron absoprtion occurs with ferric citrate and IV iron may need to be reduced
Sucroferric (velphoro), Ferric citrate (Auryxia)
Lanthanum (foserenol)
Lanthanum
WHat should you tell your parents?
Chew all the way to reduce GI adverse effects
Al free Ca free
SEs: N/V/D/constipation
Sevelamer Brand name?
Where is it absorbed?
What other added benefits does it have?
Renvela
- Carbonate better than hydrocholoride in maintaining bicarb
- Not systemiccally aborbed phosphate binder also reduces cholesterol and LDL by 15-30%
- SEs: N/V/D > 20% very common
- Reduce dietary absorption of vitamins DEK and folic acid
Phosphate binder drug interactions
Separate administration of levothyroxine and antibiotics that chelate (quinolones, tetracyclines)
CKD first treat hyperphosphatemia then treat _____ with?
Which one is synthesized in the skin?
Which is produced by plants?
What is reserved for later stages?
What is the main calcimimetic? Only used for?
elevations in PTH are treated with Vitamin D
- Vit D def occurs when the kidney is unable to hydroxylate Vit D into the active form 1,5-dihydroxy Vit D
- Vit D3 cholecalciferol which is synthesized in the skin after exposure to ultraviolet light
- Vit D2: ergocalciferol produced from plant sterols PRIMARY DIETARY Source
- Active form of vitamin D3 Calcitriol (used in later stages CKD or ESRD)
- Cincacalcet (Sensipar): Calcimimetic mimics the action of calcium on the parathyroid gland which further reduces PTH (ONLY USED FOR PATIENTS ON Dialysis
Vitamin D analogs: 4
Key side effect?
What should be monitored?
- Calcitriol (Rocaltrol) active form of Vit D3
- Calcifediol (rayaldee) ER
- Doxercalciferol (Hectorol)
- Paricalcitol (Zemplar)
SIDE effects hypercalemia
Monitor Ca
Vitamine D3: Cholecalciferol
Vitamin D2: Ergocalciferol
Elevations in PTH are treatment primarily with Vit D
Calcimimetics
Brand Name
Contraindications and SEs
Cincacalcet (Sensipar)
Contraindications: Hypocalemia
Etelcalcetide (Parsabiv): warning for hypocalemia, muscle spasms, paresthesia (burning sensation on skin)
How is anemia caused in CKD?
lack of erythropoeitin which is produced by the kidneys, which causes the stimulation of the production of RBCs
What can limit the need for blood transfusions in CKD anemia
ESA
Erythropoeisis Stimulating Agents
- Epoetin Alfa (procrit,epogen) and longer lasting darbepoetin (Aranesp)
- Risks: elevated blood pressure, should only be used inf Hgb <10g/dL
- Then should be held if hgb exceeds 11
- Only works if there is enough Iron so look at iron levels
Sodium polystyrene
SPS, kayexalate
Bind to other drugs watch DIs
Patiromer (Veltassa)
Hypomagnesia
Binds to many drugs separate by 3 hours
Not for emergency use neither is sodium zirconium
How should all phosphate binders be given?
With meals
Lanthanum should be chewed thoroughly to reduce risk of severe GI adverse effects
What medications are not for emergency use in CKD patients with severe hyperkalemia? 3
Oral Sodium polystyrene sulfonate
Patiromer
Sodium zirconium cyclosilicate
WHat is used when a patient has metobolic acidosis asscociated with their CKD?
Sodium bicarbonate
