CKD Medchem

What is the role of Parathyroid glands

Senses low calcium and releases more hormone

which goes to bone and kidney

The bone will release calcium and increase calcium levels

The kidney increases calcitriol formation and decreases excretion of calcium

The calitriol goes to small intestine which increases absorption of calcium and increases serum calcium

What is the relationship between vitamin D and Calcium

Vitamin D goes to liver turns into calcidiol then to kidney to convert to calcitriol which goes to small intestine and increases calcium

What is the role of thyroid gland and calcium

Thryoid gland releases calcitonin which decreases calcium reabsorption, absorption and bone reabsorption of calcium so overall lowers blood Ca levels

What oral drugs treat Anemia bc of CKD

Ferrous Sulfate

Ferrous Gluconate

Ferrous Fumurate

What is the elemental iron in each

Ferrous Sulfate= 65 mg= 20%

Ferroys fumurate 39 mg= 12%

Ferrous Fumurate 107 mg= 33%

What is Iron Dextran

Complex of ferric hydroxde and dextran

What are the connections of IV dextran

Linear alpha 1,6 linkage

Branced a 1,3 linkage

Why is Iron Sucrose more preffered

Due to less side effects where this does not cause anaphylactic reactions

What is the MOA of Iron Sucrose

Dissociates into iron and saccharate

Transferred as complex with transferrin to targer cells and then incorporated into hemoglobin as the cells mature

What is Erythropoietins

When there is low blood oxygen the kidney produces Erythropoietin which stimulates Red Bone marrow to increase RBCs

What are the erythropoietin drugs

Epotein Alfa

Darbepoetin alfa

Where does erythropoietins originate from

Produced by recombinant DNA technology using CHO cells

How is metbolic acidosis treated

Sodium Bicarbonate

How is hyperkalemia treated

Calcium Chloride

Calcium Gluconate

What is the role calcium salts for hyperkalemia

Protect the heart from harmful effects of Potassium such as disruption of heart’s electrical system arythmias

What is Kayexalate

A polymeric cation exchange resin that binds K+ ions in exchange for Na+ ions in the distal colon

What is used to treat hyperphosphatemia

Phosphate binders= Sevalemer

Non Phosphate binders= Tenapanor

What is Savelamer

Phosphate binder

A polymer former by the reaction between allylamine and epichlorhydrin

What is the MOA of Sevlamer

Binds to phosphates in intestine and prevents them from being absorbed into the body

Is sevlamer positively or negatively charged

Positively charged

What is Tenapanor

Non binder

Reduces serum phosphorus by inhibiting NHE3

Why is Tenapanor not orally available

Large molecular weight

What is the MOA of Tenapanor

Local inihbition of sodium hydrogen exchanger NHE3 leading to less sodium absorption and reduce permeability towards the paracellular pathway

What is Hypercalcemia

Common in later stages of CKD

Can result from hyperparathyroidism or vitamin D elevation

What is Cinacalcet

Mimics high level of calcium and inhibits synthesis and secretion of PTH

Increases receptor sensitivity to extracellular Ca 2+

What is the SAR of Cinacalcet

Naphtahlene needed for binding affinity

NH forms ionic interaction with the side chain of Glutamate of CaSR

The flexible propyl linker can be converted to rigid variant without loss of CaSR bindng affinity

What treats hypocalcemia

Oral Calcium Salts

Vitamin D preparations

How does Cholecalciferol become 25-hydroxycholecalciferol

By CYP2R1 in the liver

How does 25 hydroxycholecalciferol become calcitril

Kidney CYP27B1

How does Calcitriol become inactivated

Calcitriol 24-hydroxylase cleaves c23-24 bond

How many hydroxylations does ergocalciferol go through to be active

2

What is Paricalcitriol

Active

What happens to Doxecalciferol

Undergoes 25-hydroxylation in the liver to become active ercalcitriol

If someone has severe renal disease which step is impacted

Choleciferol to 25-hydroxycholecefirol

If there is impaired vitamin D activation what impact does it have on ca and po4 levels

decrease

If patient has chronic liver disease what step is impacted

the first step

Vitamin D inactivation is catylyzed by what

CYP 24A1

What happens to Egocalciferol

Needs 25 hydroxylation in liver then 1 hydroxylation in the kidney

What are Vaptans

V2r antagonist to treat euvolemic or hypervolemic hyponatremia

What are examples of Vaptans

Conivaptan and tolvaptan

What is the structure of Conivaptan

3 regions

Tricyclic

Terrahydrobenzoimidazo azepine

What is the structure of Tolvaptan

Bicyclic

3 regions

tetrahydro benzo azepine

What is the MOA of Vaptans

Dilute urine

Increased free water clearance

raises serum NA

What are SGL2 inhibitors

Sodium glucose inhibitors orignally anti diabetic

Inhibit flucose reabsorption in the promximal renal tubule lowering blood sugar levels

Protective functions

What is Dapafliflozin

SGLT2 inhibitor

B-D glucose

metabolized by UGT1A9

What is Canagliflozin

C-glycosyl compound