1 / 25

Common Medications used in the ESRD Population

Common Medications used in the ESRD Population. Mary Kay Carone NP. Current medications in ESRD. Medication Review is a challenge!. Very sick patients. M ultiple meds Multiple providers. Frequent hospitalizations. frequent changes in medications (or just confusion!).

kennan-bradley
Télécharger la présentation

Common Medications used in the ESRD Population

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Common Medications used in the ESRD Population Mary Kay Carone NP

  2. Current medications in ESRD Medication Review is a challenge! Very sick patients • Multiple meds • Multiple providers Frequent hospitalizations • frequent changes in medications (or just confusion!) Generic vs. brand names vs. multiple meds in same class • Class redundancy and confusion!

  3. Current medications in ESRD Wait! There is more… • Changes in patient insurance coverage • The ‘donut hole’ or other financial barrier to obtaining medications (given ‘samples’ by MD) • But… • If you know the meds – the med review will be easier and more accurate • better care for our patients

  4. Current Medications in ESRD • Approach meds based on body system and ‘class’ drug is in • Review medications after a hospitalization to avoid redundancy • Contact NH or rehab if in a facility So here are the meds!

  5. Cardiac Medications ACE Inhibitor Class

  6. Cardiac Medications *means….. ARBs

  7. Cardiac Medications *means….. ** means…. Alpha blockers Combined Alpha and Beta Blockers

  8. Cardiac Medications *Needs to be given 2x a day Beta Blockers

  9. Cardiac Medications Calcium Channel Blockers (nonhydropyridines) Calcium Channel Blockers (dihydropyridines)

  10. Cardiac Medications *Given 2x a day. Significant removal during HD is “likely” Central Alpha Agonists

  11. Cardiac Medications *Given up to 4 x day. Used for HTN and CHF. Not dialyzed out – but short ½ life **Given for severe HTN, no adjustment for GFR, danger of pericardial effusion with prolonged use, can exacerbate angina Direct Vasodilators/Nitrates

  12. Cardiac Medications Antiarrhythmics *Means… ** Means… Other Diuretics

  13. Table 86Preferred Antihypertensive Agents for CVD1 *Only some BB (Carvedilol, metoprolol) ** Non dihydroperidineCCBs 1. National Kidney Foundation - C 2005 Select Guidelines from the KDOQI Hypertension  and Antihypertensive Agents in Chronic  Kidney Disease

  14. Statins

  15. Antiplatelets *means….. **means….

  16. Diabetes *means….. PO Meds

  17. Diabetes Injectable Insulins

  18. GI Medications *H2blockers – Pepcid and Zantac (Zantac given bid) ** Used for DM pts with gastroparesis, stimulates upper GI motility, taken with meals and at hs PPIs / H2 blockers Other

  19. Antidepressants Other SSRIs

  20. Sleep / Pain *Means…

  21. Sleep / Pain All pain meds cause: • CONSTIPATION! (Need to check for stool softener or laxative – don’t wait for a problem!) • Some nausea (take with food! Monitor bowel function) • Some hypotension (bring dose to HD – take mid tx • Some dry mouth (watch fluid gains) • Some dizziness (safety!!)

  22. Case Study • 65 y.o. male, recently discharged from the hospital, s/p MI, after which he had angioplasty and stent placement. He has a history of HTN, Type 2 DM and high cholesterol. • He is on the dialysis machine 1 hr., BP at start of tx was 100/60, now 90/50, HR 52. His fasting BG this morning was 55, he denies symptoms of hypoglycemia.

  23. Case Study Medications prior to admit Medications on discharge ASA 325 mg 1 x day Plavix 75 mg 1 x day Coreg 25 mg 2 x day Esomeprazole 40 mg 1 xday Cozaar 50 mg 1 x day Lantus 15 units 1 x day at night • Topral XL 25 mg 1 x day • Prilosec 40 mg 1 x day • Imdur 30 mg 1 x day • Lantus 20 units 1 x day at night • Prandin 3 mg, 3 x day, with meals

  24. 1) Given this pt’s BP and BG – what medications should be clarified first? 2)Are all of his discharge medications appropriate, from what you know of his hospital course? 3)Assuming the discharge medications are accurate, what medications from his ‘pre hospital’ list, should be questioned?

  25. Thank you!

More Related