Therapeutics: Complications of CKD 3

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Author:
kyleannkelsey
ID:
272476
Filename:
Therapeutics: Complications of CKD 3
Updated:
2014-04-29 23:15:03
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Therapeutics Complications CKD
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Therapeutics: Complications of CKD 3
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Therapeutics: Complications of CKD 3
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  1. What are the Non-Ca containing Phosphate binders and when should the y be initiated?
    • Initated when Ca (Al and Mg) type fails
    • Sevelamer HCl (Renagel)
    • Sevelamer carbonate (Renvela)
    • Lanthanum carbonate (Fosrenol)
  2. What SEs should you watch for with Non-Ca containing Phosphate binders?
    GI
  3. When should Non-Ca containing Phosphate binders be given?
    With meals
  4. Calcium carbonate (40% elemental Ca) (Tums, Oscal, Caltrate)should be given at what starting dose for renal osteodystrophy and MBD-CKD?
    1-2 tabs TID w/meals (no > ~ 1500 mg elemental Ca/day)
  5. Calcium acetate (25% elemental Ca) (Phoslo)should be given at what starting dose for renal osteodystrophy and MBD-CKD?
    1-2 tabs TID w/meals (no > ~ 1500 mg elemental Ca/day)
  6. Sevelamer (Renagel)should be given at what starting dose for renal osteodystrophy and MBD-CKD?
    800mg TID w/meals
  7. Lanthum carbonate (Fosrenal)should be given at what starting dose for renal osteodystrophy and MBD-CKD?
    250-500mg TID w/meals
  8. According to KDIGO, how often should you get Ca, PO4 and PTH levels in a patient with CKD-MBD who is stage 3?
    Ca, PO4 every 6-12 months; PTH based on baseline and CKD progression
  9. According to KDIGO, how often should you get Ca, PO4 and PTH levels in a patient with CKD-MBD who is stage 4?
    Ca, PO4 every 3-6 months; PTH every 6-12 months
  10. According to KDIGO, how often should you get Ca, PO4 and PTH levels in a patient with CKD-MBD who is stage 5?
    Ca, PO4 every 1-3 months; PTH every 3-6 months
  11. According to KDIGO, how often should you get Ca, PO4 and PTH levels in a patient with CKD-MBD who is stage 4-5 HD?
    Alkaline phosphatase every 12 months, more frequently in presence of elevated PTH
  12. What stages of CKD does KDIGO suggest you get Calcidiol levels read?
    3-5
  13. KDOQI recommends monitoring 25(OH)D (Calidiol) levels if what?
    iPTH is elevated
  14. When is it recommend to give Vit D precursor (ergocalciferol or cholecalciferol)?
    If 25(OH)D (Calidiol) level <30 ng/mL,
  15. Prior to starting Vit D therapy, serum ____ and _____ should be WNL to minimize risk of HYPERcalcemia.
    Ca & PO4
  16. Dosing conversion of calcitriol to paricalcitol is what?
    1:4
  17. If iPTH <150 and a patient is on Vitamin D precursor therapy, what should you do?
    Hold Vit D x 1 month
  18. What are the Acitve Vitamin D agents?
    Calcitrol (Calciiex or Rocaltrol)
  19. What are the Vitamin D analogs?
    • Paricalcitrol (Zemplar)
    • Doxercalciferol (Hecterol)
  20. How is Calcitrol (Calciiex or Rocaltrol) dosed?
    • 0.5-5 mcg IV TIW
    • 0.25-5 mcg PO, QD/QOD/TIW
  21. How is Paricalcitrol (Zemplar) dosed?
    • 1-4 mcg PO, QD or TIW
    • 2.5-15 mcg IV TIW
  22. How is Doxercalciferol (Hecterol) dosed?
    • 5-20 mcg PO, QD or TIW
    • 2-8 mcg, TIW
  23. What is the MOA of Calcimimietics?
    Act on Ca-sensing receptor on the surface of the PTH gland to mimic the effect of ionized Ca to increase sensitivity of Ca-sending receptor to decrease PTH secretion
  24. What is the Calcimimetic?
    Cinacalcet (Sensipar)
  25. What is the dose for Cinacalcet (Sensipar)?
    • 30mg PO daily
    • Titrate q2-4 weeks
    • Max of 180 mg
    • Usually give in combo with Vitamin D
  26. What are the AEs of Cinacalcet (Sensipar)?
    • N/V, hypocalcemia (avoid if Ca < 7.5 mg/dL)
    • Inhibitor of CYP2D6
  27. What are the pharmacological options for chronic metabolic acidosis in CKD?
    • Sodium bicarbonate tablets
    • Shohl’s® solution, Bicitra® solution
    • Polycitra
  28. Whu do you not want to give Polycitra to patients with severe CKD?
    Has K in it, so may cause HYPERkalemia
  29. What is a normal dose of Bicarb in a patient wit chronic metabolic acidosis and CKD?
    10-30 mEq/day PO in divided doses after meals/bedtime
  30. According to JNC-8, what is the goal BP for CKD?
    • <140/90
    • Sevelamar (Renegal) (Non-calcium phosphate binder) has what other useful activity in CKD?
    • Lowers LDL and HDL
  31. How do you treat Na and H20 imbalances n CKD?
    • Loop + or – a Thiazide (not a thiazide alone)
    • Reduce/eliminate salt from diet
  32. How do you treat Hyperkalemia in CKD?
    Low-K dialysate bath, dietary K restriction and potentially medication

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