NURS 165 Study Guide - Final Guide: Sevelamer, Parathyroid Gland, Cinacalcet
CKD Drugs
Class
Drug
Indication
Mechanism
Other
Side Effects
Other
Iron
Supplements
Ferrous
sulfate
Fe deficiency anemia &
prevention
Fe into Hb
lost in hair, nails,
skin, feces, etc.
teeth staining, constipation,
nausea, change in stool color
risk of toxicity
in peds.
Iron
dextram
^same, pt cannot
tolerate/ is ineffective
oral Fe
^same
lost in urine
hypotension, headache,
fever
IM injections: pain,
discoloration, tumor growth
fatal hRNXs
test dose
required
Hematopoietic
Agents
Epoetin
alfa
anemia of CKD/ chemo,
prior to surgery w/ major
blood loss
binds to erythropoietin
receptor on RBC and
stims proliferation and
differentiation, inc
release from BM
HTN, stroke, MI, HF, cardiac
arrest
Phosphate
Binders (non-
absorbable
polymer)
Sevelamer
1st line therapy for
hyperphosphatemia and
vascular calcification
(dialysis)
binds to phosphorous in
GI tract and decreases
absorption
also decreases LDL,
taken with food (to
prevent phosphate
absorption)
abdominal pain, black tarry
stool, bowel impaction,
acidosis
hives
Vitamin D
Analog
Calcitrol
2ndary hyperparathyroid
in predialysis,
hypocalcemia in dialysis
pts, hypoparathyroid
post-surg
bind to VitD receptors at
parathyroid gland, GI
tract, kidney/ sup. PTH
secretion by stim
intestinal Ca absorption,
decr. PTH secretion at
PT gland directly
raised serum Ca and
decreases PTH
secretion
Treat high
phosphorous before
headache, abdominal pain,
loss of appetite, weakness,
dry mouth, metallic taste,
muscle/ bone pain
LT: confusion, arrhythmias,
seizures
Calcimimetics
Cinacalcet
primary and 2ndary
hyperparathyroidism
ups sensitivity to Ca
sensor
approved for ESRD,
predialysis option
HTN, GI upset, hypocalcemia
pt should report: myalgias,
cramps, convulsions,
paresthesias
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Document Summary
^same, pt cannot tolerate/ is ineffective oral fe. Epoetin alfa anemia of ckd/ chemo, prior to surgery w/ major blood loss. 2ndary hyperparathyroid in predialysis, hypocalcemia in dialysis pts, hypoparathyroid post-surg. Cinacalcet primary and 2ndary hyperparathyroidism binds to erythropoietin receptor on rbc and stims proliferation and differentiation, inc release from bm binds to phosphorous in. Gi tract and decreases absorption bind to vitd receptors at parathyroid gland, gi tract, kidney/ sup. Pth secretion by stim intestinal ca absorption, decr. Pt gland directly ups sensitivity to ca sensor. Other lost in hair, nails, skin, feces, etc. lost in urine. Side effects teeth staining, constipation, nausea, change in stool color hypotension, headache, fever. Other risk of toxicity in peds. fatal hrnxs test dose required also decreases ldl, taken with food (to prevent phosphate absorption) raised serum ca and decreases pth secretion.
