1What is the first line treatment for CKD?
ACEI and ARBs
2Stages 1 of CKD?
eGFR is equal to or greater than 90
3Stage 2 of CKD?
eGFR is 60-89
7Stage 5 of CKD?
less than 15
8What is the purpose of the treatment for CKD?
renal protection and slow progression
9What should you monitor with CKD treatment?
proteinurea
serum creatinine
potassium
10Anemia is a common complication of CKD, what should be used to treat the anemia?
erythropoietic-stimulating agents
iron supplementation
11What is the MOA for calcium salts?
combines with dietary phosphorus to form insoluble calcium phosphate which is excrete in feces
12Which calcium salt is used for treatment of hyperphosphatemia in end stage renal disease?
calcium acetate
13What are the AE of calcium acetate?
arrhythmias
hypomagenesium
hypotension
nausea
pruritus
weakness
14What are some cautions wit hcalcium acetate?
constipation
monitor calcium levels
15What is a CI with calcium carbonate?
ceftriaxone
16What are the AE of calcium carbonate?
anorexia
milk alkali syndrome
hypercalcemia
constipation
flatulence
nausea
vomitting
flatulence
17What are the vitamin D supplements?
calcitriol
paricalcitrol
doxercalciferol
18What is the first line treatment for CKD?
ACEI and ARBs
19What are the indications for calcitriol?
secondary hyperparathyroidism
hypocalcemia
20What is the MOA for paricalcitrol?
synthetic vitamin D analog that binds and activates vitamin D receptors in the kidneys, parathyroid glands, intestines and bone
21What is the indication for paricalcitrol?
prevention and treatment of secondary hyperparathyroidism associated with CKD stages 3-4 and stage 5 patients on hemodialysis and peritoneal dialysis
22What does paricalcitol do?
reduces PTH levels
improves calcium and phsophorus homeostasis
stimulates bone mineralization
23What is the AE of paricalcitol?
nausea
24When is lanthanum carbonate indicated?
CKD patients with high phosphorus levels with stage 5 kidney disease
25When are phosphate binders CI?
IV potassium/sodium phosphate
26What is the MOA of lanthanum carbonate?
it dissociates into ions in the upper GI tract and bind directly to dietary phosphate which creates an insoluble lanthanum phosphate complex inhibiting phosphorus absorption
27What are the common AE of phosphate binders?
n/v/d
hypertension
28What are the AE specific to lanthanum carbonate?
abdominal pain
constipation
dialysis graft occlusion
h/a
29What are the warnings associated with all phosphate binders?
bowel obstruction
30What are the warnings associated with lanthanum carbonate?
ileus
fecal impaction
Caution in patients with:
Chron's disease
ulcerative collitis
PUD
31What is the MOA of sevelamer?
binds directly to dietary phosphate in the intestine and inhibits its absorption
32What is the indication of sevelamer?
in patients with CKD stage 5 on hemodialysis with high phosphate levels
33What are the AE of sevelamer?
dyspepsia
nasopharyngitis
bronchitis
limp pain
pruritus
arthralgia
dyspnea
34When should you be cautious using sevelamer?
GI motility disorders
GI surgery
dysphagia
35When patients are on hemodialysis should you use calcium asperate or sevelamer to treat high phosphorus levels?
sevelamer- causes less hopsitalizations from hypercalcemic episodes
36Which parental iron therapy is best for decreasing the risk of anaphylaxis?
iron sucrose
37What are the AE of both hematopoietic growth factors?
HTN
n/v/d
thrombembolism
h/a
38What are the AEs specific to epoetin alfa?
tachycardia
cough
pruritus
rash
arthralgias
39What are the AEs specific to darbepoetin?
infectious disease
hypotension
spasm
peripheral edema
abdominal pain
40What are the box warnings associated with hematopoetic growth factors?
CKD patients at greater risk for dealth, serious cardiovascular reactions and stroke
cancer- shortened overal survival or increased risk of tumor progression
increased risk of DVTs
41What cancers do you work about progression with hematopoietic treatment?
head, neck, breast, lymphoid, NSCLC, cervical
42What is the MOA of Darbepoetin?
it is an erythropoesis stimulating protein closely related to erythropoietin so its action is similar to that of endogenous erythropoietin
interacts with stem cells the increase RBC production
43Which heamtopoietic growth factor has a longer half life and only needs to be administered weekly or biweekly?
darbepoetin
44What are the oral iron therapies?
ferrous sulfate
ferrous fumarate
ferrous gluconate
45What are the AE of oral iron therapies?
GI discomfort
nausea
constipation
black discoloration of stool
46How long should oral iron therapies be administered?
3-6 months or three months after correction of anemia in order to build iron stores
47When are parenteral iron therapies indicated?
oral intolerane
nonadherance
CIs
intestinal malabsorption
pts who decline indicated blood transfusion
chronic bleeding refractory to oral tx
renal anemia together with EPO treatment
48What are the parental iron therapies?
iron dextran
iron sucrose
ferric gluconate
ferumoxytol
49What are the AE of parenteral iron therapies?
thrombophlebitis
myalgia
arthralgia
h/a
anaphylaxis
50What is ferrous sulfate used for?
building block for hemoglobin synthesis in patients with anemia of CKD who are being treated with EPO
51What are the indications for iron dextran complex?
microcytic hypochromic anemia
replenish iron stores in patients on EPO therapy
oral admin is infeasible or ineffective
52What should you monitor with parenteral iron therapies like iron dexran and iron sucrose?
anaphylaxis
53What is iron sucrose used for?
treat iron deficiency anemia in patients with dialysis and non dialysis dependent CKD
54Which parental iron therapy is best for decreasing the risk of anaphylaxis?
iron sucrose
55What is the MOA of cinacalcet?
modulation of calcium sensitive receptor in parathyroid glands which increases the sensivity of the receptor to circulating calcium causing inhibition of PTH release
56What are the indications of cinacalcet?
primary hyperparathyroidism after failed parathyroidectomy
hypercalcemia in hemodialysis patients with secondary hyperparathyroidism due to CKD
parathyroid carcinoma with hypercalcemia
57What are the AE of cinacalcet?
n/v/d
hypocalcemia
58What are the contraindications of calcimemetics?
hypocalcemia
59What is a DDI with canacalcet?
CYP2A6-strongly inhibits
60What diuretics can be used to treat CKD?
thiazide type
loop
potassium sparing
carbonic anhydrase
osmotic
61Metalazone is which type of diuretic?
thiazide type
62What should you monitor with metalazone?
serum electrolytes
uric acid
fluid balance
renal function
blood pressure
63What are some cautions with metolazone?
hypokalemia
hyponatremia
64What is an AE of metolazone?
hypokalemia
65What is the MOA of SGLT2 inhibitors?
increased glycosuria through inhibition of SGLT2 in kidney
66What are some AE of SGLT2 inhibitors?
genital yeast infections
UTIs
polyuria
dehydration
DKA
67What are the CI with SGLT2 inhibitors?
chronic kidney disease
recurrent UTIs
68All SGLT2 inhibitors decrease...
heart failure hopitalization
69Which SGLT2 inhibitor decreases CV death?
empagliflozin
70All but _____ SGLT2 inhibitor decreases nephropathy?
ertuglifozin
71What is the mOA for potassium chlordie?
principal intracellular cation of most body tissues
72What are the cautions with potassium chloride?
hyperkalemia
severe renal impairement
GI lesions
arrhythmias
73What are the AE of potassium chloride?
n/v/d
abdominal discomfort
74What should a patient be told about taking potassium chloride?
take with food
75What are some risk factors for acute renal failure?
advanced age
acute infections
preexisting chronic respiratory disease
preexisting chronic cardiovascular disease
dehydration
CKD
76Drug induced nephrotoxicity is more common in which patient population?
ICU patients
77What are some nephrotoxic substances?
NSAIDs
antifungals
some antibiotics, antivirals and antimetabolites
platinum based chemotherapeutic drugs
immunosupressants
inhalation anesthetics
contrasting agents
78What are some ways drugs causes nephrotoxicity?
GFR alteration
tubular cell toxicity
interstitial nephritis
crystal nephropathy
79What are the atbx that cause nephrotoxicity?
aminoglycosides
vancomycin
cephalosporins
colistin
sulfonamides
streptomycin
80What are some antivirals that cause nephrotoxicity?
acyclovir
foscarnet
cidofovir
81What are some antimetabolites that cause nephrotoxicity?
methotrexate
cladribine
82Acute renal failure patients are often what?
diuretic resistant
83What is one of the most important things with acute renal failure?
fluid management
84How should you manage fluid in patients with ARF?
combination diuretic therapy
continuous infusion of loop diuretic
aggressive sodium restriction
85What is the cockroft gault equation?
CrCl (mL/min)= (140-age x IBW)/(72 x SCr)
86MDRD takes into account?
patients age and race