a
Which is due to consistently high PTH levels? (high bone turnover)
a) Ostetitis Fibrosa Cystica
b) Adynamic bone disease
b
Which is due to oversuppressed PTH levels? (low bone turnover)
a) Ostetitis Fibrosa Cystica
b) Adynamic bone disease
vitamin d, iPTH, phsophorus, calcium
Which lab tests do we use for CKD-MBD? (4)
8.5-10.2 mg/dL
What is the normal range for Corrected Ca?
2.7-4.6 mg/dL
What is the normal range for phosphate?
14-64 pg/ml
What is the normal range for iPTH?
> 20 ng/ml
What is the normal range for 25(OH)D?
restriction of dietary phosphorus intake; < 800-1000 mg/day
What is the nonpharmalogical recommendations for CKD-MBD?
CKD + persistent hyperphosphatemia
What is the indication for Phosphate binders?
must administer with meals to be effective; titrated every 2-3 weeks until PO4 levels are normalized ; take other meds 1-2 hrs before or 3 hrs after
What is the counseling for Phosphate Binders? (3)
oral calcium binders
What is the 1st line option in patients WITHOUT hypercalcemia?
1500 mg
What is the max dose of elemental calcium per day?
200 mg
What is the elemental calcium for Calcium Carbonate?
169
What is the elemental calcium for Calcium Acetate?
resin binders
What is the first-line option for patients WITH hypercalcemia or risk of
calcifications?
ferric citrate, sevelamers
Which binders must be taken whole? (2)
d
Which must be chewed?
a) calcium carbonate
b) Sevelamer Carbonate
c) Ferric citrate
d) Sucroferric oxyhydroxide
e) Sevelamer hydrochloride
f) calcium acetate
potential for systemic/GI accumulation if taken whole
What are the potential risks associated with Lananthum?
aluminum hydroxide
What is the last line option due to toxicity?
< 4 weeks
How long can a patient use Aluminum Hydroxide?
a
Which has drug interactions with PPIs & H2 blockers?
a) calcium carbonate
b) Sevelamer Carbonate
c) Ferric citrate
d) Sucroferric oxyhydroxide
e) Sevelamer hydrochloride
f) calcium acetate
serum calcium, risk for calcifications, iron status, pill burden, cost, formulation
What are the considerations when choosing a phosphate binder? (6)
<30 ng/mL
Which patients are indicated for Vitamin D supplementation?
CKD + hemodialysis
Which patients should NOT be using Inactive vitamin D?
inactive vitamin D
Which form of vitamin D should be used in patients NOT on hemodialysis?
50,000 IU weekly x 6-12 weeks
What is the initial treatment dose? (Inactive Vitamin D)
800-2000 IU daily
What is the maintenance dose for Inactive Vitamin D?
25(OH)D, calcium, phosphorus, PTH
What monitoring must be done for patients on vitamin D supplementation? (4)
sevelamer carbonate, sevelamer hydrochloride
What are the Resin binders? (2)
ferric citrate, sucroferric oxyhydroxide
What are the iron based binders? (2)
c
Which can helpful in patients with iron deficiency?
a) calcium carbonate
b) Sevelamer Carbonate
c) Ferric citrate
d) Sucroferric oxyhydroxide
e) Sevelamer hydrochloride
f) calcium acetate
CKD stage: 3-4
What is the indication for Calcifediol?
CKD stage 4-5 + persistently high PTH + hemodialysis
What is the indication for Vitamin D analogs?
Hypercalcemia/hyperphosphatemia; nutritional vitamin D supplements
_________ is a bigger concern with Vitamin D analogs than __________.
ESRD + hemodialysis
What is the indication for Calcimimetics?
serum calcium < 8.4
When do we NOT initiate a Calcimimetic?
CYP3A4; CYP2D6
Cinacalcet is metabolized by ________ and is a potent inhibitor of ________.
vitamin D, calcium (early CKD)
Which labs will decrease? (2)
phosphorus, calcium (late CKD)
Which labs will increase? (2)