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Collab Therapies 2 > Renal Disorders And Erythropoeisis Agents > Flashcards

Renal Disorders And Erythropoeisis Agents Flashcards

1
Q

Why does anemia occur from CKD?

A

It occurs bc the kidneys produce the hormone erythropoietin needed by the bone marrow to create RBCs

So with CKD — kidneys don’t produce enough erythropoietin = bone marrow produces less RBCs = Anemia from CKD
Will also lead to:
- iron deficiency and
- decreased folic acid

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2
Q

What is the treatment for anemia associated with CKD?

A
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3
Q

With anemia present what other supplements will the pt be needing apart from erythropoesis stimulating agents darbopoetin?

A

Will need :
- folic acid
- iron

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4
Q

What are some AE associated with darbopoetin / epoetin (Eprex)?

A
  • fever
  • muscle aches
  • bone pain
  • flushing
  • hypertension
  • injection site reactions
  • n&v
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5
Q

What is needed as a supplement with darbopoetin?
And when is darbopoetin often given?

A
  • should be taken with iron
  • often given after dialysis when pt is on dialysis
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6
Q

What are some contraindications for darbopoetin?

A
  • uncontrolled HTN
  • high hemoglobin > 130g/L for kidney disease pts
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7
Q

What is the indication for ferrous sulfate (Iron) in kidney disease?

A

To prevent or treat iron deficiency anemia

With CKD anemia — iron deficiency will follow so pts will take darbopoetin and iron together

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8
Q

What are some contraindications to taking ferrous sulfate (iron) supplements?

A
  • KDA
  • iron overload
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9
Q

What are some possible AE of ferrous sulfate (iron)?

A
  • GI upset
  • black stool
  • gastric irritation
  • n& v
  • diarrhea / constipation
  • stomach cramping
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10
Q

How should ferrous sulfate (iron) be taken?

A
  • take with food to decrease GI upset (AVOID TAKING WITH MILK OR DAIRY PRODUCTS)
  • needs to be taken with large amount of water or with glass of orange juice
  • remain upright for up to 30min after to decrease esophageal irritation
  • avoid taking with antacids and dairy products (if needed take at least 1-2hrs after iron)
  • maintain diet high in iron (dark greens, leafy vegetables, dried fruits, beans, meats, eggs)
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11
Q

What are some drug interactions with ferrous sulfate (iron)?

A
  • increased effect with :folic acid
  • decreased effect with: antacids & calcium
  • decrease absorption of : antibiotics (tetracyclines, quinolones)
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12
Q

Why is folic acid given in kidney disease ?

A

Given with CKD related anemia

Folic acid is needed to create RBCs
So with anemia, pts will also be taking folic acid supplements

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13
Q

What is the AE of folic acid?

A

Yellow discoloured urine

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14
Q

What are some drug interactions with folic acid (folate)?

A

cause folic acid deficiency with: -oral contraceptives
- corticosteroids
- sulfonamides
- antibiotic trimetoprim

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15
Q

How should folic acid (folate) be taken?

A

Should be taken with food

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16
Q

What is the Nutritional therapy with CKD?

A
  • fluid restriction : urine output + 600mls
  • protein restriction
  • calories 30-35kcal/kg
  • fat : most of caloric requirement
  • carbs: most of caloric requirement
  • potassium 2-3G
  • sodium 1-3g
  • phosphate 800-1000mg
  • calcium varies
17
Q

Mrs. W is prescribed the following diet:
- fluid restriction of 1.2L/day
- low sodium (1-2g/day)

What strategies/recommendations will you give to Mrs. W to help her adhere to this diet?
A) eat a vegetarian diet
B) take only sips of fluid at a time
C) avoid canned or prepared foods
D) avoid drinking coffee

A

C)
Very high In sodium and hard to keep track

A) is wrong bc does not change anything
B) is wrong bc if takes small sips but every 2min does not help calculate the amount can still go over
D) is wrong bc they can drink coffee just not in too large amounts (no need to completely avoid it)

18
Q

What is a kidney friendly diet?

A
  • protein: ingest lean proteins without excess fat (ex: eggs, skinless chicken) — protein is good but hard to filter by kidneys so we want it to be easier so lean proteins is better
  • fats : choose healthy fats (raw olive oil instead of fried foods)
  • sodium: use herbs to spice your food instead of salt, choose fresh or frozen vegetables instead of canned, choose low salt foods (high in sodium is hard on the kidneys so low sodium intake is necessary)
19
Q

What are some teaching tips to help limit fluid intake?

A
  • measure your fluids (1-2L/day)
  • drink from a small cup to help you keep track of how much you drink
  • limit sodium intake to decrease thirst
  • when you feel thirsty: chew gum, rinse mouth with water and spit it out, suck on a piece of ice/mints/auger free hard candy
20
Q

What are foods high in potassium?

A
  • avocados,
  • bananas,
  • melons,
  • oranges,
  • prunes,
  • spinach,
    -potatoes,
  • tomatoes,
  • granola
  • beans
  • brown or wild rice
21
Q

What are foods low in potassium?

A
  • apples
  • grapes
  • strawberries
  • pineapple
  • onions
  • peppers
  • lettuce
  • white breads
  • beef and chicken
  • white rice
22
Q

What are foods high in calcium and phosphate?

A
  • almonds
  • asparagus
  • apricots
  • artichokes
  • hapricot
  • blackberries
  • bok choy
  • cinnamon
  • bread (whole meal)
  • olives
  • oranges
  • soya milk
  • tofu
23
Q

Before administering epoetin Alfa to mrs. W, it is most important for you to assess which lab result?

A) blood urea nitrogen
B) WBC count
C) hemoglobin levels
D) urine specific gravity

A

C
Bc it can increase blood viscosity

24
Q

When administering erythropoesis-stimulating agents, it is important for you to co administer which one of the following?

A) vitamin D
B) iron
C) Sevelamer (renagel)
D) calcium

A

B

25
Q

When administering oral iron tablets, you must keep in mind that which substance other than water is the most appropriate to give with these tablets?

A) pudding
B) an antacid
C) milk
D) orange juice

A

D) will increase absorption

B) will decrease absorption
C) will decrease absorption and make you sick

26
Q

You are teaching MRS. W how to properly take her oral iron supplements. Which statement is correct ?

A) you need to take this medication on an empty stomach or else it won’t be absorbed
B) it is better absorbed on an empty stocach but it can cause your stomach to be upset, you can take it with food
C) take this medication with a sip of water and then lie down to avoid problems with low blood pressure
D) if you have trouble swallowing the tablet, you may crush it

A

B

27
Q

A pt with renal failure has severe anemia, and there is an order for darbopoetin Alfa. Upon assessment, which condition listed will you consider a contraindication to use of this medication?

A) uncontrolled HTN
B) diabetes mellites
C) hypothyroidism
D) angina

A

A

28
Q

When may NSAIDs be appropriate with CKD?

A) when a pt complains of pain
B) if pt becomes febrile
C) to help with peripheral neuropathy
D) never

A

D
It’s nephrotoxic so never

29
Q

What are the main differences between hemodialysis and peritoneal dialysis?

A

Hemodialysis: 3x per week at the hospital
- has a fluid restriction
- has a severe sodium restriction
- has a potassium restriction
- allows for less protein intake

Peritoneal dialysis: done daily at home
(risk for peritonitis or tube can block)
- no fluid restriction
- no potassium restriction
- high protein intake allowed
- less strict sodium restriction

So in general: less restriction with peritoneal hemodialysis

30
Q

Renal replacement therapy should be considered when:
A) hyperkalemia
B) metabolic acidosis
C) fluid overload
D) all of the above

A

D

31
Q

The most important nutrition goal for pts with CKD include?
A) limit sodium
B) increase protein
C) decrease caloric intake
D) increase fluid intake

A

A

32
Q

Iron supplementation has which common AE?

A) flatus
B) fatigue
C) heartburn
D) constipation

A

D
And a change of colour of stool to green or darker stool

33
Q

The formation of erythrocytes and the maturation of RBCs are driven by which hormone?

A) free thyroxin
B) progesterone
C) testosterone
D) erythropoietin

A

D

34
Q

What are known contraindication for the use of erythropoesis- stimulating agents in pts? Select all that apply

A) cancer of the neck
B) history of thrombosis
C) end stage renal disease
D) uncontrolled hypertension
E) hemoglobin level of 150mmol/L

A

D, E for sure

A and B is probably to use with caution as it can Increase tumor growth and risk for thrombosis

Collab Therapies 2 (28 decks)

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