Pharm Renal Dz

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Pharm Renal Dz
2011-05-15 10:23:17
kidney pharm

for upcoming pharm final
Show Answers:

  1. What is goal HgB concentration in kidney pts?
  2. When do you create a fistula for kidney pts?
    Cr >4, GFR <20
  3. When do you refer to a nephrologist? (labs)
    Cr >3.0, GFR <30
  4. When do you use the adjusted ideal body weight formula?
    Pts >130% of IBW
  5. Who has the most benefit from ACE-Is and ARBs in tx HTN?
    Pts with proteinuria >3g/24
  6. What do you monitor when using CCBs in tx HTN?
    Bradycardia, edema (caution in HF pts)
  7. When do you lower HTN goals?
    When protein excretion >1g/24h
  8. What do you restrict Na intake to?
  9. What are lipid goals?
    • LDL <100
    • Non-HDL <130
  10. Which two statins don't have to be adjusted for renal function?
    Pravastatin and Atorvastatin
  11. When you are tx anemia, how often do you check Hb?
    q1-2 weeks after new dose, then q4w when stable
  12. When do you increase ESA doses?
    If Hb increases <1g in 4w
  13. When do you decrease ESA dose?
    If Hb increases >3g in 4 weeks or Hb >12 g/dl
  14. How often do you monitor iron therapy?
    qMo during intial ESA therapy, q3mo in stable therapy
  15. What daily dose of iron is recommended?
  16. What are FePO's DI?
    • Levothyroxine, fluoros, antacids
    • Take iron on empty stomach always
  17. When do you initiate FeIV?
    When TSAT and ferritin <goals
  18. What is basic FeIV dosing?
    100 mg of iron dextran/sucrose or 125 gluconate at each dialysis for 10 or 8 doses (respectively); if no increase, give a second course
  19. What is basic FeIV dosing for TSAT and ferritin above goal, low Hb?
    1 g Fe over 8-10 weeks
  20. What is maintenance IV dosing?
    25-125 mg weekly
  21. When do you hold maintenance dosing?
    TSAT>50%, ferritin 800 mg/mL
  22. Which IV Fe product requires a test dose and why??
    Iron dextran (25mgx1 dose) due to associaton with anaphylactic reaction
  23. Why do you avoid rapid infusion with FeIV?
    hypotension, GI effects, HA, flushing
  24. Which drugs decrease serum phosphorus levels?
    Phosphate binders
  25. Which drugs supplement/replace active Vit D?
    Vit D analogues
  26. Which drugs directly antagonize PTH?
  27. What are our phosphorous goals for CKD and ESRD?
    • CKD: 2.7-4.6 mg/dL
    • ESRD: 3.5-5.5 mg?dl
  28. What are nl Ca ranges in CKD and ESRD?
    • CKD: 8.5-10.5
    • ESRD: 8.4-9.5
  29. What is dietary phosphorous restriction?
    800-1000mg/day when serum phosphorous or PTH are elevated
  30. How do you counsel a pt on phosphate binders?
    They must be taken with food, and take 1 tablet with large snacks
  31. Why are aluminum containing phosphate binders used and what must you be cautious about?
    They are more portent than calcium containing binders, but aluminum can accumulate in renal dysfunction
  32. What are aluminum ADRs?
    • Osteomalacia
    • Musculoskeletal pain
    • Anemia
    • Neurological effects
  33. When do you consider aluminum binders? How do you dose?
    When serum phos >7 mg/dL; use for < 4 weeks and one course only
  34. When do you avoid calcium binders?
    When Caxphos product >55
  35. What is dietary calcium restriction while on calicum binders?
    <200 mg/day
  36. Calcium carbonate contains what % of elemental Ca?
  37. What is PhosLo?
    • Calcium acetate with 25% Ca
    • Less pH dependent with less constipation but more GI complaints
  38. What is Sevelamer?
    Either a hydrochloride salt ( Renagel) or carbonate salt (Renvela)
  39. What are Sevelamer's effects?
    • Not absorbed into circulation
    • Binds fat-soluble vitamins and folic acid
    • Lowers serum cholesterol by 15%
    • Lowers LDL by 40%
    • Increases HDL by 20%
  40. What is Sevelamer's dosing?
    • 800 mg PO with meals for phosphorous <7.5 mg
    • 1200-1600 mg for >7.5
  41. What are Sevelarmer's CI?
    • Bowel obstruction
    • chewing or crushing (it expands)
  42. What are Sevelamer's DI?
    • Antiarrhythmics
    • Antiepileptics
    • Fluoros
    • Administer 1 h before or 3h after
  43. What is Lanthanum?
    a chewable tablet that binds phos at all pH levels
  44. What do you need to know about prescribing Lanthanum?
    • It may interfere with AXR
    • Can accumulate in liver, lung, kidney
    • GI side effects are common and can cause orthostatic HOTN
  45. What are Lanthanum's CI?
    • PUD
    • Ulcerative colitis
    • Crohns
    • Bowel obstruction
  46. What are Lanthanum's drug interactions?
    • Antiepilpetics
    • Antiarrhythmatics
  47. When do you initiate Vit D therapy?
    When PTH is not controlled by management of hyperphosphatemia
  48. When do you initiate ergocalciferol supplementation?
    When 25(OH)D<30
  49. What are ADRs of ergocalciferol?
    HYPERCALCEMIA: HA, N/V, confusion, bone pain, arrhythmias
  50. When do you initiate Vit D tx?
    When serum (OH)D >30 and PTH is above target
  51. What is the best way to administer Vit D tx?
    Intermittent IV is better than PO
  52. What do you need to caution with in doxercalciferol?
    Hepatic impairment
  53. When do you consider paricalcitol or doxercalciferol?
    pts with increased Ca or phos
  54. What is cinacalcet's MOA?
    enhances sensitivity of ca-sensing receptors on parathyroid gland to extracellular Ca, supporessing PTH release
  55. What is Cinacalcet's place in therapy?
    ESRD pts with increased PTH limited by hypercalcemia
  56. What are the warnings and ADRs with cinacalcet?
    • Warnings: adynamic bone dz if PTH <100 pg/ml, avoid in severe hepatic or CV dz
    • ADRs: hypocalcemia, NVD, dizziness, hypotension
  57. How do you tx chronic metabolic acidosis?
    • citric acid/sodium citrate (alkalinizing agent)
    • sodium bicarb (neutralizes H ions)
  58. What drugs are used in dialysis?
    • Anticoag (Heparin, citrate)
    • Abx (administered post-dialysis)
    • Epoetin, Fe, VitD
  59. What are urine level classifications?
    • Anuria: <50
    • Oligura 50-450
    • Nonoliguric >450
  60. How do you tx ATN?
    • Remove agent
    • Avoid fluid overload: consider diuretic
    • Monitor electrolyte
  61. What drugs cause AIN?
    • PCNs
    • Sulfonamides
    • Furosemide
    • NSAIDs
    • Rifampin
    • Allopurinol