1
Q
Aluminum hydroxide
A
AlternaGel, Amphojel
2
Q
Calcium acetate
A
PhosLo, Phoslyra
3
Q
Calcium carbonate
A
Tums
4
Q
Lanthanum carbonate
A
Fosrenol
5
Q
Sevelamer carbonate
A
Renvela
6
Q
Sevelamer hydrochloride
A
Renagel
7
Q
Calcitriol
A
Rocaltrol, Calcijex
8
Q
Doxercalciferol
A
Hectorol
9
Q
Paricalcitrol
A
Zemplar
10
Q
Cinacalcet
A
Sensipar
11
Q
Fludrocortisone
A
Florinef
12
Q
Sodium polystyrene sulfonate
A
Kayexelate
13
Q
Sodium citrate/Citric acid
A
Bicitra, Cytra-2, Oracit, Shohl’s solution
14
Q
What are the Aluminum-based phosphate binder?
A
- Aluminum hydroxide (AlternaGel, Amphojel)
15
Q
Calcium based phosphate binders = First line therapy for hyperphoshatemia of CKD
A
- Calcium acetate (PhosLo, Phoslyra)
2. Calcium Carbonate (Tums)
16
Q
What are the Aluminum free/Calcium free phosphate binders?
A
- Lanthanum carbonate (Fosrenol)
2. Sevelamer carbonate (Renvela)
17
Q
How to take phosphate binder?
A
Take with food TID
18
Q
How to take Fosrenol?
A
Must Chew thoroughly to reduce the risk of serious adverse GI events
19
Q
What is the advantage of sevelamer carbonate over sevelamer hydrochloride?
A
*Carbonate maintaing bicarbonate concentrations is good because these patient tend to be acidotic so Bicarb will neutralize the acidosis
20
Q
Which phosphate binders can lower total cholesterol and LDL by 15 - 30%?
A
Sevelamer (Renvela, Renagel)
21
Q
What is the contraindication for fosrenol?
A
Patient with bowel obstruction, ileus, and fecal impaction
22
Q
What are two form of Vitamin D ?
A
- D3 = cholecalciferol synthesized in skin
2. D2 = ergocalciferol produced from diet
23
Q
Vitamin D analogs used to treat secondary hyperparathyroidism
A
- Calcitriol ( Rocaltrol, Calcijex)
- Doxercalciferol (Hectorol)
- Paricalcitol (Zemplar)
24
Q
Calcimimetic used to treat secondary hyperparathyroidism
A
Cinacalcet ( Sensipar) = Doesn’t affect calcium level
25
What type of EKG changes occurs with hyperkalemia?
1. flattened P wave
| 2. Elevated T wave
26
Treatment of metabolic acidosis of CKD
Bicarb in the form of
1. Sodium bicarbonate (tab, granules, powder)
2. Sodium Citrate/Citric acid (Oracit, Shohl's solution)
27
What are the drugs that *should not be used in severe renal impairment*?
1. Avanafil
2. Bisphosphonates
3. Chlorpropamide
4.Dabigatran
5. Duloxetine
6. NSAIDs
7. Glyburide
8. Lithium
9. Nitrofurantoin
10. Potasisum sparing diurectics
11. Tadalafil
12 Tenofovir
28
What is the duration limitation associated with aluminum based phosphate binders?
Limited duration to *4 weeks*
29
What are the complications associated with CKD?
1. *Anemia*
2. Bone abnormalities [ initially due to elevation of phosphorus, to compensate for *hyperphosphatemia* = increases release of PTH = overtime lead to *secondary hyperparathyroidism*]
3. hyperkalemia
30
What are some drugs that *increases potassium levels *?
1. *Potassium sparing diuretics*
2. *ACEIs/ARBs*
3. NSAIDs
4. Cyclosporin/tacrolimus
5. Heparin
6. canaglifozin
7. Bactrim
8. supplements
9. drospairenone OC (Yaz)
31
What can be given to stabilize the cardiac tissue due to low potassium ?
*IV calcium*
32
What are the options to lower potassium levels?
1. remove sources of potassium intake
2. enhance potassium uptake by the cells [ via *Insulin + glucose*=stimulate insulin secretion/prevent hypoglycemia]
3. if pt has metabolic acidosis = Sodium bicarb
4. nbeulized abluterol
5. increase renal excretion w/ furosemide or fludrocortisone (Florinef)
6. Cation exchange resin (Kayexolate /SPS)
7. Emergeny dialysis
33
what are the most common causes of CKD
DM and HTN
34
what are complications that can arise due to CKD
anemia, bone and mineral metabolism, acid-base and electrolyte disturbances
35
what are the two types of dialysis
Hemodialysis and peritoneal dialysis
36
what are the factors that affect drug removal during dialysis
molecular size,
protein binding (highly protein bound drugs will generally not be removed),
plasma clearance (will not remove highly hepatic drugs),
volume of distribution (drugs with a large Vd will not be effectively removed), and the
dialysis membrane
37
what are some things that can be used to gauge the severity of kidney damage
SCr, albumin in the urine, BUN
38
what must you take into account when using SCr to estimate kidney function
degree of muscle mass and metabolism in the patient
39
what are some other things that affect the BUN
level of hydration, protein consumption BUN increases with renal impairment
40
what is used as a marker of renal function in various estimating equations
serum creatinine
41
what measures the amount of nitrogen that comes from the waste product urea
BUN
42
what is mainly reabsorbed at the descending limb of the loop of henle
water
43
what is primarily reabsorbed at the ascending limb of the loop of henle
Na, Cl
44
what effect do loop diuretics have on calcium
they increase calcium absorption and long-term use of thiazide diuretics have a protective effect on bone
45
where do loop diuretics act
inhibit Na/K pumps of ASCENDING limb of loop of henle
46
where do TZD act
inhibit Na-Cl pump in distal tubule
47
the collecting duct is primarily affected by
aldosterone and ADH
48
what is the primary effect of aldosterone
increase Na, water retention and to lower K+
49
what are drugs that are aldosterone antagonist (name the generic)
spironolactone, eplerenone, amiloride These block the effects of aldosterone and can cause an increase in serum potassium.
50
what is the normal range for SCr
0.6 - 1.2 mg/dL
51
when is the Cockcroft-Gault equation not preferabele
in young children, ESRD, when renal status is rapidly changing
52
CrCL of what indicates dialysis
< 15
53
when making an adjustment to a drug regimen based on CrCl what are your options
changing the dose (decreasing) or changing the dosing interval (extending)
54
if a patient has poor renal clearance and they are on a aminoglycoside and quinolone what should you do
change the dosing interval since they have concentration dependent killing properties
55
if a patient has poor renal clearance and they are on a Beta lactam what should you do
change the dose since they have time dependent killing properties
56
if a patient has CKD and proteinuria what medication should they be on regardless of whether they also have DM
ACE-I or ARB they decrease proteinuria
57
what are the main benefits of ACE-I/ARBs in CKD pt
preserve renal function, decrease proteinuria, and provide cardiovascular protection
58
what may you see once you begin a CKD pt on an ACE-I or ARB
a 30% increase in their SCr (d/c if > 30% increase)
59
what electrolyte is effected by ACE-I/ARBs and how
potassium, they increase serum K
60
how long should a CKD patient be monitored when starting an ACE-I or ARB and what are you monitoring
monitor SCr and K for 1-2 weeks after initiation of therapy
61
why do CKD patients become anemic
kidney produces EPO which declines as kidney function declines
62
what are some foods high in phosphorous
dairy products, dark colored sodas, chocolate, nuts
63
what type of phosphate binders are 1st line
calcium based such as calcium acetate and carbonate (PhosLo)
64
what are the aluminum based phosphate binders
Alternagel. Should only be used short term to decrease phosphorous
65
how do you initially treat hyperphosphatemia
dietary restrictions
66
why must phosphate binders be taken with food
they only bind the phosphate coming from your diet. don't take it after you eat, there is no point.
67
what are the SE of using an aluminum based phosphate binder
constipation, osteomalacia, poor taste, intoxication (neurotoxicity)
68
why are aluminum based phosphate binders not used much
accumulation b/c its renally cleared and potential for osteomalacia and aluminum intoxication
69
what are the calcium based phosphate binders Brand (Generic)
PhosLo, Phoslyria (calcium acetate)
| Tums (calcium carbonate- although calcium acetate binds more phosphorus than Tums)
70
what are the SE of using a calcium based phosphate binder
constipation, hypercalcemia, nasea
71
what are the aluminum and calcium free phosphate binders Brand (Generic)
```
sevelamir (Renvela, Renagel),
lanthinum carbonate (Fosrenol)
```
72
elevation in PTH is primarily treated with
Vitamin D
73
what form of Vit D is given to CKD patients
Calcitrol
74
what is the effect of active Vit D3
increase calcium absorption from the gut, increase serum calcium concentrations, and inhibits PTH secretion
75
how do calcimimetics works
increase sensitivity of calcium sensing receptor on PT gland therefore decreasing Ca, PTH, PO4 and preventing progression of bone disease
76
calcimimetics are used to treat what condition
secondary hyperparathyroidism
77
what is an example of a calcimimetic Brand (generic)
Sensipar (Cinacalcet)
78
what is the normal range of potassium
3.5 - 5 meq/L
79
what is the most abundant intracellular cation
potassium
80
what is the most abundant extracellular cation
sodium
81
what are some things that increase K+ excretion
diuretics (strongly loops, weakly TZD), aldosterone agonist, bicarbonate
82
what effect does insulin have on potassium
causes it to shift inside the cells
83
what is the most common cause of hyperkalemia
decrease renal excretion due to renal failure
84
why are diabetics at a higher risk of having hyperkalemia
insulin deficiency
85
what are some SSx a patient may experience when hyperkalemic
muscle weakness, bradycardia, fatal arrhythmias, paresthesias may occur
86
why is calcium given to patients with hyperkalemia
to stabilize cardiac tissues therefore help prevent arrhythmias
87
what can be given to enhance K+ uptake by cells
glucose + insulin
88
why is glucose given along with insulin when treating hyperkalemia
to prevent hypoglycemia
89
a patient is suffering from hypoaldosteronism and is now hyperkalemic what can you give them
fludrocortisone (Florinef)
90
what cation exchange resin can be used to treat hyperkalemia
Kayexelate (SPS) can reduce K+ by 2 mEq/L
91
what dosage forms does Kayexelate come in and what precaution must be taken with one of them
rectal (preferred in emergencies) and oral, don't give sorbitol when giving orally due to risk of GI necrosis
92
what are common side effects of kayexelate
decrease appetite, constipation, nausea, vomiting
93
serum bicarbonates levels of what indicate starting treatment of metabolic acidosis
< 22 mEq/L
94
what effect does sevelamer have on cholesterol
decreases ldl and cholesterol
95
Which beta-lactam antibiotics are not adjusted for renal issues
Nafcillin
Oxacillin
Dicoloxacillin
Renal disease
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