Renal Products Flashcards
Elemental Iron in Ferrous sulfate 325mg:
65mg
Elemental iron in ferrous gluconate 325mg:
36mg
Elemental iron in Niferex forte 150mg:
150mg
Recommended elemental iron
~200mg elemental iron/day
What enhances iron absorption?
Ascorbic acid
Side effects of oral iron:
- abdominal cramping
- constipation
- nausea
- Others: esophagitis, esophageal ulceration
Drug interactions for oral iron:
- Acid suppressing agents
- Oral quinolones (take 4hrs before or 8hrs after iron)
- oral tetracyclines (take 1 hr before or 4-6hrs after iron)
- Ca, Al, Mg containing products
Iron dextrans BBW:
Highest level of anaphylaxis
Dosing of ferric gluconate
IV only. 125mg/dose at each dailysis session for a total of 8 sessions
Dosing of iron sucrose
IV only;
Dialysis: 100mg/dose at each dialysis session for a total of 10 sessions
Non-dialysis: 200mg/dose for a total of 5 doses in a 14 day period
Dosing of ferumoxytol
IV only;
Dialysis & non-dialysis: 510mg dose then repeat 510mg 3-8 days later
Adverse effects of IV Iron products
- allergic rxns (mostly iron dextran)
- hypotension, dizziness, syncope
- Dyspnea
- HA
- back pain
- Arthralgia
- Rash, pruritis
- Nausea
- increased risk of bacterial infection
- injection site rxn
Iron Overload
- aka hemochromatosis
- No physiologic mechanism for iron excretion
- HD patients at highest risk
- causes fatigue, joint pain, and liver failure
Iron toxicity
Overwhelm iron binding proteins leading to free iron in blood –> oxidative stress –> CV disease
Epoetin alfa doses
Dialysis & non-dialysis: 50-100 units/kg given 3x/week (IV preferred or SQ)
Darbepoetin doses
Dialysis: 0.45mcg/kg IV or SQ weekly; 0.75mcg/kg IV or SQ Q2 weeks
Non-dialysis: 0.45mcg/kg IV or SQ Q4 weeks
Adverse effects associated with ESAs
- expansion of blood volume
- Increased blood viscosity
- Reversal of hypoxic vasodilation
- HTN
- arthralgias/HA
- muscle spasms
- dizziness
- injection site rxn
- Fever
- dyspnea (darbepoetin)
Additional Epoetin BBWs
- perisurgery: due to increased risk of DVT, DVT prophylaxis is recommended.
BBW for all ESAs
- Patients w/ CKD are at higher risks for CV events when you target/achieve Hgb > 11g/dL
How long is an open, multidose vial of ESA good for if kept in the fridge?
21 days
Drug interactions with calcium acetate?
- Oral quinolones: separate administration by 1-2hrs
- oral tetracyclines: separate by 1-2hrs
Sevelamer (Renvela) drug interactions
Give ALL other medications 1hr before or 3hrs after
Sevelamer adverse effects:
- N/V/D
- dyspepsia
Lanthanum (Fosrenol) drug interactions
give other medications 2hrs before or after
