complications of CKD- anemia, hyperkalemia, dialysis

Erythropeisis stimulating agenst (ESA) moa

work like EPO to produce more RBCs. Need adequate iron to make RBCS

ESAs

epoetin alfa (procrit, epogen, retacrit), darbepoetin alfa (aranesp)

when to use ESAs

hgb <10, d/c if it increases beyond 11g/dl.

side effects ESAs

evelated bp, thombosis

epoetin alfa

procrit, epogen, retacrit

darbapoetin alfa

aranesp

normal K

3.5-5meq/l

hyperkalemia

k >5.3 or 5.5 (we are concerned wtih anything above 5)

most abudnant intracellular cation

potassium

normal dietary intake of potassium

1meq/kg/d

renal potassium excretion is incresed by;

aldosterone, diuretics, high urine flow, and negatively charge ions in distal tubule (like bicarb)

symptoms of hyperkalemia

muscle weakness, bradycardias, fatal arrhtynmias

Key drugs that raise potassium

ACEi/ARBs

Aliskiren

Canagliflozine

Dospirenone-containing COCs

Potassium contian IV fluids

Potassium sparing diuertics (traimterene, sprionolactone)

Bactrim

Transplant drugs

Glycopyrrolate

Heparin chronic use

NSAIDs

Pentamidine

treatment of hyperkalemia (ideaology)

D/C potassium agents

1) stabilize heart cells

2) move potassium into cells

3) remove potassium from the body

hyperkalemia treatment; stabilizitng heart cells

IV calcium gluconate (or chloride) IV; takes 1-2 mintues to take affect

hyperkalemia treatment; move it

Regular insulin + dextroves IV, IV sodium bicarb, neublized albuterol

hyperkalemia treatment; remove it

Iv loop diuretics, sodium polystyrene sulfonate (po or pr), patriromer, (po) sodium ziroconum cyclosiliciate (po), hemodialysis

potassium binders

soidum polystyrene sulfonate, patiromer, sodium zirconium cyclosiliciate

soidum polystyrene sulfante

SPS, kayexalate

warnings wth SPS

electrolyte disturbances, GI necrosis, fecal impaction

SPS side effects

n/vs, contaitiopn, diahreea

patiromer

veltessa

patiromer warnings/se

can worsen gi motility, cause hypomagnesemis

constipation/n/d

patiromer counseling

delayed onset of action; store powder in ridge, stable at 3 mo at room temp

sodium zirconcium cyclsiliciate

lokelma

lokelma warnings/se

can worsen gi motiility, edema; peripheral edema

lokelma counseling

generally preferred due to fastest onset of action; store at room temp

metabolic acidosis; bicarb level

<22meq/l

what is metabolized to bicarbonate in liver

soidum citrate/citric acid solution (cytra-2, oracrit)

potassium binders are WHAT

non-absorbed cation exchanged resins

what drugs are more easily removed by dialysis

smaller molecules, small vd, low- protein bound

dialysis factors taht affect drug removal

high flux and high efficency hd filters increase more removal; higher blood flow rate increase drug removal over a given time