Drugs in Renal Patient Flashcards
NSAID in renal
Never in failure as cause constriction
Avoid if high risk of AKI
What are DAMN drugs to always stop if risk of AKI
Diuretic
ACEI
Metformin
NSAID
Hydrocodone / morphine in renal
Avoid in AKI as renal excretion so accumulate leading to increased toxicity
If can’t avoid what should you do
Reduce dose
Reduce dose frequency
Pregabalin / gabapenitn
Reduce dose
What does phenytoin use do
Cause acute interstitial nephritis
What should you do in AKI / CKD
Correct for uraemia and low albumin
What are opiates with minimal renal excretion
Oxycodone
Tramadol
Fentanyl
Paracetamol
Fine in renal failure
What should you do with BP medications in AKI
Assess indication
Consider stopping as likely hypovolaemic
ACEI in renal
Renal protective as decreases protein
Nephrotoxic as dilates kidney leading to decreased eGFR
What should you do with ACEI
Stop in AKI
Keep on long term
Thiaizde diuretic
No use if eGFR <30 as won’t reach distal tubule
What can it cause and what should you do
Acute interstitial nephritis
Withhold if volume deplette
Loop diuretic
Stop if hypovolaemic
Use if stable hyperkalaemia to increase excretion but careful if hypovolaemc
K sparing
Stop in AKI
Cause volume depletion and hyperkalaemia
CCB / a blocker / BB
Exacerbate hypo-perfusion
Withhold or reduce dose
What does acyclovir cause and what should you do
Interstitial nephritis
Increase in renal failure
Reduce dose
Increase fluid
Aminoglycoside e.g. gentamicin
Tubular and ototoxicity
Should ovoid
Reduce dose and frequency if can’t
What does vancomycin cause
Acute interstitial nephritis
Renal and ototoxicity
How it is excreted
Not really renal so can be useful
Carpapenem’s
Reduce freq as will accumulate
Trimethoprim / co-trimox
Cause hyperkalaemia esp with ACEI / spirnolacton
Avoid or reduce dose
What is risk of hypoglycaemia drugs in AKI
Accumulate if renal exerted so may increase risk of hypoglycaemia
Avoid long acting preparation
Metformin
Not if eGFR <30
Cause lactic acidosis
Glicazide
May still have residual insulin which will build up
So decrease dose
Insulin
Need less as renal excreted
Anti-coagulation
Review need
Calculate HASBLED
Use creatinine clearance to work out if will increase
Consider with-holding if renal cleared
Aspirin
Usually fine at 75mg but assess indication
Simvastatin
Can cause rhabdomyolysis leading to AKI
Digoxin
Hyperkalaemia
May accumulate in AKI
Interacts with amiadaone to increase level
What should you do
Reduce dose and monitor drug and K levels
What are signs of toxicity
Yellow glow N+V Dizzy Brady Visual disturbance Confusion Arrhythmia Reverse tick on ECG
