Renal Failure Flashcards
What drugs can cause pre renal failure in patients with large or small vessel renal vascular disease? (3)
- ACE inhibitors
- diuretics
- NSAIDs
When would creatinine clearance CrCl be most useful when being used as an estimate of renal function?
MHRA (medicine and healthcare product regulation agency) advice that CrCl should be used as an estimate of renal function for:
- direct acting oral anticoagulants (DOACs)
- Drugs with a narrow therapeutic index that are mainly renal excreted
What is the recommended method for calculating drug doses in most patients with renal impairment?
eGFR (estimated glomerular filtration rate)
(In patients at both extremes of muscle mass, eGFR should be interpreted with caution)
What factors should be considered in assessment before prescribing in renal failure? (9)
- is the pt taking the drug - if so, what route
- Age and weight
- establish degree of renal failure (is it acute or chronic)
- Is renal replacement therapy being used
- what’s the indication for the drug (clinical pictures/risk versus benefit)
- Consider other medical problems (eg hepatic failure)
- What caused the renal failure- is it reversible
- look at other medication being taken - are these appropriate/safe
- Is the pt on a restricted fluid or sodium intake (this may effect the way a drug can be administered)
What factors should be considered when prescribing in renal failure? (6)
- Reduction in dosage or an increase in dosing intervals
- If eGRR is > 50 changes will rarely be necessary
- Start low - go slow (monitor carefully for clinical response and side effects)
- Continue to monitor renal function - modify or stop treatment if indicated
- Minimise the number of drugs prescribed
- Avoid modified release as they are likely to accumulate
(Refer/seek advice if unsure or complex)
