Prescribing in HI and RI Flashcards
High renal Cl and narrow therapeutic window
Vanc/gent, digoxin, lithium
Require dose reductions or extended dosing intervals
High renal Cl and wide therapeutic window
Penicillins, cephalosporins
Unlikely to be problematic except high doses of IV
Low renal Cl and narrow therapeutic window
Theophylline, carbamazepine, phenytoin
Dose and monitor in same way as patients without RI
Which categories do drug induced AKIs fall under?
Pre-renal - NSAIDs, diuretics
Intra-renal - Gent, ciclosporin
Post-renal - anticholinergics, chemo (obstruct renal tract)
Management of CKD
Detect early
Manage comorbid conditions - tight control of glucose, BP
Reno protect - ACEI/ARBs
Manage complications e.g. hyperkalaemia, anaemia, mineral/bone disorders, hyperphosphatemia
High hepatic clearance drugs
Morphine, propanolol
Increased BA/plasma concs, inc risk of AEs
Drugs that may worsen symptoms of liver disease
Constipating drugs
Medicines that cause GI ulceration
Sedating medicines
Anticoagulants, anti-platelets and other meds that can cause bleeding
Meds that affect fluid-electrolyte balance
Meds with high Na content
Meds that are nephrotoxic
Drug induced liver disease
RFs - females, genetics, obesity, diabetes, HIV, polypharmacy
Intrinsic drug reactions - predictable, dose dependent, occur rapidly e.g. paracetamol
Idiosyncratic drug reactions - not predictable or dose dependent, take longer to develop
Some examples of liver disease (drug-induced)
Acute liver failure - allopurinol, NSAIDs
FIbrosis and cirrhosis - MTX
Hepatitis - phenytoin
Steatosis - amiodarone, CCSs, TPN
Vasc disorders - oral contraceptive pill, azathioprine
Cholestasis - warfarin, azathioprine, carbimazole, oral contraception, flucloxacillin
Other possible tx for liver disease
Prevention of varices - BB to reduce portal HTN
Spontaneous bacterial peritonitis px e.g. co-trimoxazole
PPis to reduce oesophagitis
