Pharm issues in renal failure

Question 1

Majority of drug metabolism occurs where?

Majority of clearance (CL) for most drugs are?

Answer 1

liver, kidney

Question 2

Recommended first time tx for HTN

Answer 2

thiazide diuretics
(then as GFR falls in CKD, less drug reaches site, so you need the stronger loop diuretic)

the strongest combo is using a diuretic at diff sites of nephron

Question 3

Can ACEI, ARBS, NSAIDS prevent or produce ARF?

Answer 3

cause - remember they decrease GFR

Question 4

What drugs can you give to pts with anemia complications due to CKD?

Answer 4

1. Epoetin, Darbepoeitin

2. Iron supplements or IV iron

Question 5

What drugs can you give to pts with renal osteodystrophy complications due to CKD?

Answer 5

kidney failure→ elevated serum phosphate → lowers serum calcium → stimulates PTH → increases serum reabsorption

(dont forget FG23 lowers VIT D → lowers serum calcium)

Tx:

• phosphate binding agents - calcium acetate, sevelamer
• Vit D: calcitriol

Question 6

Side effects of Vit D

Answer 6

Hypercalcemia

stim Ca+ absorption

Question 7

Things to avoid when treating hyperkalemia

Answer 7

remember that failing kidney cannot excrete sufficient K+
(very common in stage 5)
- avoid K+ sparing diuretics, ACEI, ARBS, Digoxin

Question 8

Do ACEI, ARBS, Digoxin cause hyper or hypokalemia?

Answer 8

Hyperkalemia

Question 9

Tx for hyperkalemia

Answer 9

Sodium polystyrene sulfonate (kayexalate)
Beta 2 agonist (albuterol)
Insulsin, 
GLucose
Bicarb