Venofer

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Who gets it?

Patients with iron deficiency anemia associated with chronic renal failure. Also for iron deficient patients undergoing chronic hemodialysis or peritoneal dialysis who are concurrently receiving erythropoietin.

Pharmacologic classification?

Iron Supplements

Pharmacokinetics?

Absorbed at a constant rate by the reticuloendothelial system following IV. 60% absorption after 3 days, 90% over 1-3 weeks, and the rest absorbed over months following IM injection. Sucrose eliminated in urine, and the iron is mostly stored and used on demand. Half-life is 6 hr.

How often is it taken?

As needed, varies from patient to patient

Where is it taken?

In a healthcare facility, since it is mostly given IV

Why is it taken?

Resolution of iron deficiency anemia associated with chronic renal failure.

How is it given?

IV, dose dependent on specific patients’ needs. Patients should not take with oral iron supplements. BP should be monitored as well as signs of anaphylaxis.

 

 

 

Renal GU Drug Review!

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Group: Alyson Del Poso, Alex Bultman

Name: Bactrim

Who?

  • UTI, Acute otitis media, chronic bronchitis, shigellosis, pneumonia, traveler’s diarrhea

What? Bactrim is a combo drug of 400mg sulfamethoxazole and 80mg trimethoprim.

  • Classification: anti-bacterial sulfonamide
  • both drugs inhibit bacteria’s ability to utilize folic acid

 

When?

  • once daily

Where?

  • acute AND chronic home med.

 

Why?

  • inhibit bacteria’s growth by inhibiting the ability to utilize folic acid for growing
  • bacteriacidal

How?

  • PO – mild infections 6-12mg/kg/day
  • PO – for UTI 160mg trimethoprim/800 sulfamethoxazole
  • IV – 6-12mg/kg/day
  • Safety: watch for sulfa allergy, monitor bowel function, monitor for s/s of Stevens Johnson Syndrome, CBC levels, urinalysis

Renal/GU Drug Review: Lopressor/Metoprolol

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Who?
People experiencing high blood pressure. For prevention of MI. Reduction of angina.

What?
Beta Blocker: blocks stimulation of beta-1 adrenergic receptors. This decreases heart rate and blood pressure.

When?
Daily. In a single dose or two divided doses.

Where?
Both hospital (acute) and home settings (chronic).

Why?
Helps control HTN. May delay progression of kidney failure.

How?
Dose: 100-450 mg.
Route: PO or IV.
Safety: bradycardia, hypotension, fatigue and weakness. Due to these side effects fall risk would be a concern.
Do not administer if preadministration pulse is <50.

-Rosa and Leslie

Renal GU Drug Review: Epogen!

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Who uses it? patients with anemia associated with CKD, patients undergoing chemotherapy

What? stimulates the production of RBCs by the kidneys

Class? anti-anemic, erythropoiesis stimulating agents (ESA)

When? three times a week

why (reason)? stimulates erythropoiesis (RBC production)

how it is administered?subQ, IV; adults 50-100units/kg three times weekly; don’t dose more than 4 times a week

side note: very expensive drug

Vitamin D

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  • Who??
    • Chronic kidney patient’s receive Vitamin D
  • What??
    • Class: vitamin
    • Pharmokinetics: Vitamin D is absorbed well both IV and orally, and converted to its active form by the liver.
  • When??
    • orally the medication is given during dialysis
    • IV administration is at the end of a hemodialysis period
  • Where??
    • can be given where every dialysis occurs
  • Why??
    • Chronic kidney patient’s receive Vitamin to help if they are nutritionally deficient in phosphorous and calcium. This is accomplished by absorption of calcium and decreasing parathyroid hormone concentrations.
  • How??
    • Orally dialysis patients receive 10 mcg three times a week, not exceeding 20 mcg three times a week.
    • Intravenously patients receive 4 mcg three times a week with a maximum dose of 6 mcg three times weekly.

Lasix

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Group members: Jen Zuniga L. & Brenda Valencia

Drug: furosemide [Lasix]

Furosemide [Lasix] PO

Furosemide [Lasix] PO

Who?  – Fluid overload/edema due to HF, hepatic impairment or renal disease; hypertension

What? – It is a loop diuretic. Inhibits the reabsorption of sodium and chloride from the loop of Henley and distal renal tubule. Increases renal excretion of water, Na, Cl, Mg, K, and Ca. It is effective even in impaired renal function.

When? (frequency) – Edema PO (Adults) 20-80 mg/day as a single dose is given initially, may repeat in 6-8 hr; may increase dose by 20-40 mg every 6-8 hr until desired response. Hypertension PO (Adults) 40 mg twice daily initially (when added to regimen, decrease dose of other antihypertensive by 50%); adjust further dosing based on response.

Where? (Chronic home med – Acute care – both?) – Both

Why? (Reason – Action) – Edema due to HF, hepatic impairment or renal disease; hypertension

How? (Dose, Route, Safety) – PO (20-80 mg/day), IM (20-40 mg), IV (20-40 mg). SAFETY: monitor electrolytes (potassium!); change positions slowly to minimize the risk for orthostatic hypotension; dehydration; report any hearing loss or tinnitus; report rashes, itching (Stevens-Johnson syndrome).

Vancomycin

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Who gets it or what disease process? C. diff and endocarditis prophylaxis. Patients with renal impairment should use caution.

What class, pharmacokinetics, how does it work? Anti-infective. Binds to bacterial cell wall, resulting in cell death. Active against gram-positive pathogens.

When (frequency)? Until signs and symptoms of infection is resolved. Depends on organism and site of infection.

Where (chronic home and acute care or both)? Acute care, in hospitals. Most commonly seen in patients with C. diff.

Why (reason – action)? Treatment of infection and endocarditis prophylaxis.

How (dose, route, safety): IV, PO and IT. Dosage depends on the type of bacterium and seriousness of infection. Safety: trough concentration should not exceed 10 mcg/mL for mild-moderate and 15-20 mcg/mL for severe infections.

Treatment of potentially life threatening infections commonly seen in patients with Clostridium difficile. Also useful in staphylococcal infections such as endocarditis, meningitis, osteomyelitis, pneumonia, septicemia, soft-tissue infections in patients who have allergies to penicillin or its derivatives or when sensitivity testing demonstrates resistance to methicillin

 

 

Simvastatin (Zocor)

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What? Simvastatin is a lipid lowering agent, a reductase inhibitor (statin).  It inhibits HMG-CoA reductase, which is responsible for catalyzing an early step in the synthesis of cholesterol.

Who? This drug is used for patients with hypercholesterolemia and dislipidemia.  It is also indicated for patients with history or risk of MI, prevention of coronary revascularization, stroke, and cardiovascular mortality in patients with coronary heart disease.

Why? It inhibits the synthesis of cholesterol, which lowers the total, LDL, and triglycerides.  It also slightly increases HDL.  Lastly, it slows the progression of coronary atherosclerosis, resulting in a decrease of coronary heart disease related events.

When? Administer PO, once daily, only in the evening before natural cholesterol synthesis occurs during the night.

Where? Treatment usually continues for life.  Treatment occurs on outpatient and inpatient basis.

How? Dosage ranges from 5-40 mg/day.  Onset is within days and peaks within 2-4 weeks.  Only PO.  Do NOT double up or skip doses.  Inform provider immediately of muscle pain or weakness, especially when combined with fever or malaise.  Wear sunscreen and protective clothing.  Notify provider if pregnancy occurs.

Research by: Layne Gallimore, Rachel Alan, Barbie Christianson

Source: Skyscape: Davis’ Drug Guide

 

Renal GU Drug Review! Prinivil

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Lisinopril (Prinivil )

Who?:

  • Patients with hypertension
  • Patients with heart failure
  • Patients with acute MI

What?:

  • Ace Inhibitors
  • Inhibits angiotensin converting enzyme from converting angiotensin I to angiotensin II. It also prevents the degradation of bradykinin and other vasodilatory prostaglandins. Also increases plasma renin levels and decreases aldosterone levels. Net result is systemic vasodilation.

When?:

  • Once daily

Where?:

  • Chronic home med

Why?:

  • Management of patients with hypertension (high blood pressure); for those who had an MI; or to manage heart failure.
  • Vasodilator

How?:

  • Hypertension: Adults (PO)= 10mg once daily, can be increased to 20-40 mg/day
  • Renal: Adults (PO)= Initiate at 2.5-5mg daily; may be slowly titrated up to 40 mg/day.
  • Heart failure: Adults (PO)= 5 mg once daily, may be titrated every 2 weeks up to 40 mg/day. Initiate at 2.5 mg once daily for patients with hyponatremia.
  • MI: Adults (PO)= 5 mg once daily for 2 days, then 10 mg daily.
  • Safety: Avoid salt substitutes; hypotension; hyperkalemia risk; notify health care professional if rash, mouth sores, sore throat, fever, swelling of hands or feet, irregular heart beat, chest pain, dry cough, hoarseness.; fetal harm; angioedema (facial swelling and dyspnea).

Phoslo

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Phoslo (Calcium Acetate)

By Linda Schoch and Riley Friedl

Who: People who suffer from end stage renal disease get this drug

What: This drug is classified as a mineral and electrolyte replacement supplement, it works by binding to phosphate in the body, with forms a insoluble calcium phosphate complex this helps to facilitate excretion. Pharmacokinetics: absorbed through GI and it requires vit D to be used in the body, it spreads through body and can be found in breast milk and placenta, it is excreted in the feces (largest %) and the rest through the urine.

When: Dosing is 1334 mg with/before each meal

Where: This drug is given in the hospital and patients can also take it at home as well as long as they are monitoring for symptoms of hypercalcemia.

Why: this drug controls hyperphosphatemia due to the fact that ESRD patients tend to have high levels of P

How: it is given PO, with or before meals, and it is important to monitor the serum Ca and P levels, if the patient is on digoxin then monitor for s/s of toxicity. The most common side effects include: constipation, arrhythmia, bradycardia, nausea, vomiting, and renal calci.