prescribing in renal impairment Flashcards
what is CKD?
chronic kidney disease
- decline in kidney function - gradual and irreversible
- asymptomatic usually
what to monitor and do with meds in someone with CKD?
monitor renal function
suspend nephrotoxic drugs
FBC and bone profile
what is AKI?
acute kidney injury
rapid and reversible decline in kidney function
what serum creatinine levels indicate AKI?
increase > 26micromol/L in 48 hrs
>50% in 7 days
management of AKI?
pre-renal cause - IVT (fluid) resuscitation
post-renal cause - relieve obstruction
medications to withhold in AKI? (DAMN C)
Diuretics
ACEi/ARBs
Metformin
NSAIDs
Contrast media (CT scan)
complications of AKI?
hyperkalaemia
fluid overload
metabolic acidosis
uraemia
problem with hyperkalaemia and how to help?
increased risk of ventricular fibrillation
- protect heart
- get K+ into cells
effect of renal impairment on absorption?
may be reduced
effected by gastric pH
effect of renal impairment on distribution?
increased free drug - less protein binding
Vd altered by hydration state
effect of renal impairment on metabolism?
slower in CKD
effect of renal impairment on elimination?
filtration reabsorption reduced
accumulation of drugs - toxicity
3 strategies of prescribing in renal impairment?
increase dosing intervals
decrease dose
review drug choice
