Renal Disease

Question 1

List ten drugs that cause kidney disease

Answer 1

1. Aminoglycosides
2. amphotericin B
3. cisplatin
4. cyclosporine
5. loop diuretics
6. NSAIDs
7. polymyxins
8. radiographic contrast dye
9. tacrolimus
10. vancomycin

Question 2

List five key classes of ABX that require dose adjustment in CKD

Answer 2

1. aminoglycosides (increase dosing interval)
2. beta lactam antibiotics (except ceftriaxone, oxacillin, dicloxacillin, nafcillin
3. fluconazole
4. quinolones (except moxifloxacin)
5. vancomycin

Question 3

List two key CV drugs that require dose adjustment in CKD

Answer 3

1. LMWHs (enoxaparin)

2. Rivaroxaban

Question 4

List two key GI drugs that require dose adjustment in CKD

Answer 4

1. H2RAs (famotidine, ranitidine)

2. Metoclopramide

Question 5

List seven other anti-infectives that require dose adjustment in CKD (hint: anti-tuberculosis, antivirals, others)

Answer 5

1. amphotericin B
2. anti-tuberculosis medications (ethambutol, pyrazinamide)
3. antivirals (acyclovir, valacyclovir, ganciclovir, valganciclovir, oseltamivir)
4. aztreonam
5. NRTIs, including tenofovir
6. polymyxins
7. Bactrim

Question 6

List four other CV drugs that require dose adjustment in CKD (antiarrhythmics, DOAC, lipid)

Answer 6

1. antiarrhythmics (digoxin, disopyramide, dofetilide, procainamide, sotalol)
2. apixaban
3. dabigatran
4. statins (except: atorvastatin, fluvastatin, lovastatin)

Question 7

List five pain/gout drugs that require dose adjustment in CKD

Answer 7

1. allopurinol
2. colchicine
3. gabapentin, pregabalin
4. morphine and codeine
5. tramadol ER

Question 8

List three other drugs that require dose adjustment in CKD (hint: immuno, epilepsy)

Answer 8

1. Cyclosporine
2. tacrolimus
3. Topiramate

Question 9

List 1 drug contraindicated in patients with CrCl <60

Answer 9

1. Nitrofurantoin

Question 10

List two drugs contraindicated in patients with CrCl <50

Answer 10

1. Tenofovir disoproxil fumarate (e.g. Stribild, Complera, Atripla, Symfi, Symfi Lo)
2. Voriconazole IV (due to the vehicle)

Question 11

List four drugs contraindicated in patients with CrCl <30

Answer 11

1. Tenofovir alafenamide containing products (Genvoya, Biktarvy, Descovy, Odefsey, Symtuza)
2. NSAIDs
3. Dabigatran (DVT/PE)
4. Rivaroxaban (DVT/PE)
5. Avanafil
6. Bisphosphonates
7. Duloxetine
8. Fondaparinux
9. Potassium-sparing diuretics
10. Tadalafil
11. Tramadol ER

Question 12

List two drugs/drug classes contraindicated in GFR <30

Answer 12

1. SGLT2 inhibitors (canagliflozin, dapagliflozin, empagliflozin)
2. Metformin

Question 13

List five other drugs which may be contraindicated in CKD but whose recommendations are not that straight forward

Answer 13

1. Meperidine
2. Dofetilide (<20 CrCl)
3. Edoxaban (<15)
4. Glyburide
5. Sotalol

Question 14

List 8 drugs + others that raise potassium levels

Answer 14

1. Ace inhibitors
2. Aldosterone receptor antagonists
3. Aliskiren
4. ARBs
5. Canagliflozin
6. Drospirenone-containing COCs
7. Sulfamethoxazole/Trimethoprim
8. Transplant drugs (cyclosporine, everolimus, tacrolimus)
9. Other (glycopyrrolate, heparin [chronic use], NSAIDs, potassium-containing IV fluids [including parenteral nutrition], potassium supplements, pentamidine)