Drug Prescribing In Renal Failure Pdf Free 14

A range of drug classes are candidates for deprescription in CKD. NSAIDs are priority for deprescribing in CKD because of potential adverse effects such as worsening of CKD, fluid retention, hyperkalemia, BP, and AKI (52,77,82). NSAIDs, including cyclooxygenase-2 inhibitors should be avoided in hypertension, CHF, and CKD of all causes (52). Other candidate drug classes for deprescribing in CKD include proton pump inhibitors, for which growing evidence indicates potential kidney and nonkidney-related harm with prolonged usage (83).

Brand name drugs have patents that expire after a number of years. When these patents expire, other manufacturers are free to develop generic versions of these drugs. To keep Medicare costs low, CMS encourages Part D plan members to take the less expensive generic drugs. In fact, the pharmacy may substitute a generic drug for a brand name drug at the point of sale because these formulary changes fall into the category of maintenance changes, which do not require advance notice to the beneficiary. There is no transition policy that guarantees a member the right to continue to receive the brand name drug for the rest of the year when a generic becomes available.

drug prescribing in renal failure pdf free 14

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Patients on anti-tuberculosis treatment may develop acute kidney injury (AKI), but little is known about the renal outcome and prognostic factors, especially in an aging population. This study aimed to calculate the incidence of AKI due to anti-TB drugs and analyze the outcomes and predictors of renal recovery.

Patients were excluded if they: 1) had shock or urinary tract infection; 2) were under potentially nephrotoxic drugs other than rifampin at the onset of AKI; 3) had other conditions possibly resulting in AKI, such as hypercalcemia and nephrotic syndrome; 4) had end-stage renal disease and was under renal replacement therapy; and 5) had non-tuberculous mycobacteria infection.

More than 50% of the AKI events occurred within two months of anti-TB treatment, indicating that an acute phase reaction may be contributory. The findings also suggest that patients with CKD and hypoalbuminemia maybe more vulnerable to severe and permanent renal damage. After AKI develops, more physicians decide to discontinue pyrazinamide, rather than rifampin, implying that they do not know which of the first-line anti-TB drugs is the most common offending drug for AKI. Continuous medical education on the correct regimen modification is necessary to prevent further renal damage in TB patients with AKI.

The present study has some limitations. First, there is no strong evidence to confirm rifampin as the cause of AKI due to the lack of pathology results. Only seven patients had a second AKI episode after re-challenge rifampin. However, this may not be a serious problem because possible causes other than anti-TB medication have been excluded and AKI due to first-line anti-TB drugs other than rifampin is rarely reported [5, 6]. Second, in this retrospective study, there is no standard protocol of laboratory follow-up for every TB patient during anti-TB treatment. Follow-up depends on the primary care physicians. Patients who did not have any symptoms or signs suggestive for AKI usually had no follow-up data on renal function. Therefore, risk factors of AKI during anti-TB treatment were not identified. Furthermore, asymptomatic patients with AKI may be missed, resulting in lower incidence and recovery rates of AKI. Third, although some characteristics of the study subjects are similar as those of the general TB population in Taiwan, the results here may not be applicable to all TB patients because this is a retrospective study conducted in a medical center.

Anti-tuberculosis drug-induced acute kidney injury is not rare in an aging population. It usually develops within two months of treatment and resolves within three months after onset. Although about 27% of patients with AKI will have permanent renal impairment, those who present with fever, rash, and GI disturbance at the onset of AKI have better renal recovery. Of the 73% of patients who had recovery of renal function, 87% successfully continued rifampicin or had rifampicin re-introduced.

Special care is required in prescribing and monitoring pharmacologic therapies in older adults. Metformin is the first-line agent for older adults with type 2 diabetes, although it can cause gastrointestinal side effects and a reduction in appetite that can be problematic for some older adults. See Figure 9.3 for general recommendations regarding glucose-lowering treatment for adults with type 2 diabetes and Table 9.2 for patient- and drug-specific factors to consider when selecting glucose-lowering agents. 2ff7e9595c