Drugs in Renal Patient

Question 1

NSAID in renal

Answer 1

Never in failure as cause constriction

Avoid if high risk of AKI

Question 2

What are DAMN drugs to always stop if risk of AKI

Answer 2

Diuretic
ACEI
Metformin
NSAID

Question 3

Hydrocodone / morphine in renal

Answer 3

Avoid in AKI as renal excretion so accumulate leading to increased toxicity

Question 4

If can’t avoid what should you do

Answer 4

Reduce dose

Reduce dose frequency

Question 5

Pregabalin / gabapenitn

Answer 5

Reduce dose

Question 6

What does phenytoin use do

Answer 6

Cause acute interstitial nephritis

Question 7

What should you do in AKI / CKD

Answer 7

Correct for uraemia and low albumin

Question 8

What are opiates with minimal renal excretion

Answer 8

Oxycodone
Tramadol
Fentanyl

Question 9

Paracetamol

Answer 9

Fine in renal failure

Question 10

What should you do with BP medications in AKI

Answer 10

Assess indication

Consider stopping as likely hypovolaemic

Question 11

ACEI in renal

Answer 11

Renal protective as decreases protein

Nephrotoxic as dilates kidney leading to decreased eGFR

Question 12

What should you do with ACEI

Answer 12

Stop in AKI

Keep on long term

Question 13

Thiaizde diuretic

Answer 13

No use if eGFR <30 as won’t reach distal tubule

Question 14

What can it cause and what should you do

Answer 14

Acute interstitial nephritis

Withhold if volume deplette

Question 15

Loop diuretic

Answer 15

Stop if hypovolaemic

Use if stable hyperkalaemia to increase excretion but careful if hypovolaemc

Question 16

K sparing

Answer 16

Stop in AKI

Cause volume depletion and hyperkalaemia

Question 17

CCB / a blocker / BB

Answer 17

Exacerbate hypo-perfusion

Withhold or reduce dose

Question 18

What does acyclovir cause and what should you do

Answer 18

Interstitial nephritis
Increase in renal failure
Reduce dose
Increase fluid

Question 19

Aminoglycoside e.g. gentamicin

Answer 19

Tubular and ototoxicity
Should ovoid
Reduce dose and frequency if can’t

Question 20

What does vancomycin cause

Answer 20

Acute interstitial nephritis

Renal and ototoxicity

Question 21

How it is excreted

Answer 21

Not really renal so can be useful

Question 22

Carpapenem’s

Answer 22

Reduce freq as will accumulate

Question 23

Trimethoprim / co-trimox

Answer 23

Cause hyperkalaemia esp with ACEI / spirnolacton

Avoid or reduce dose

Question 24

What is risk of hypoglycaemia drugs in AKI

Answer 24

Accumulate if renal exerted so may increase risk of hypoglycaemia
Avoid long acting preparation

Question 25

Metformin

Answer 25

Not if eGFR <30

Cause lactic acidosis

Question 26

Glicazide

Answer 26

May still have residual insulin which will build up

So decrease dose

Question 27

Insulin

Answer 27

Need less as renal excreted

Question 28

Anti-coagulation

Answer 28

Review need
Calculate HASBLED
Use creatinine clearance to work out if will increase
Consider with-holding if renal cleared

Question 29

Aspirin

Answer 29

Usually fine at 75mg but assess indication

Question 30

Simvastatin

Answer 30

Can cause rhabdomyolysis leading to AKI

Question 31

Digoxin

Answer 31

Hyperkalaemia
May accumulate in AKI
Interacts with amiadaone to increase level

Question 32

What should you do

Answer 32

Reduce dose and monitor drug and K levels

Question 33

What are signs of toxicity

Answer 33

Yellow glow
N+V
Dizzy
Brady 
Visual disturbance
Confusion
Arrhythmia
Reverse tick on ECG