5/8/2017. Clinical Pharmacy Specialist Division of Kidney Disease and Hypertension

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1 Clinical Pharmacy Specialist Division of Kidney Disease and Hypertension Clinical Assistant Professor Adjunct Clinical Associate Professor Pharmacy Practice 1

2 Accessed 9/1/15. 2

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5 GFR categories (ml/min/1.73 m 2 ) GFR categories (ml/min/1.73 m 2 ) 5/8/2017 Albuminuria categories G1 Normal to high 90 G2 Mildly decreased <30 mg/g <3 mg/mmol mg/g 3-30 mg/mmol >300 mg/g >30 mg/mmol G3a Mildly to moderately decreased G3b Moderately to severely decreased G4 Severely decreased G5 Kidney failure < 15 Table 1.1 Percentage of NHANES ( ) participants, in the various CKD (egfr and albuminuria) risk categories (KDIGO 2012) a) Percentage in each category ( ) <30 mg/g <3 mg/mmol Albuminuria categories mg/g >300 mg/g >30 mg/mmol 3-30 mg/mmol G1 Normal to high G2 Mildly decreased G3a Mildly to moderately decreased G3b Moderately to severely decreased G4 Severely decreased G5 Kidney failure < 15 <

6 Accessed 9/1/2015 PK Parameter Absorption Distribution Metabolism Elimination Alteration Believed to be reduced Reduced plasma protein binding Increased accumulation of active metabolites Decrease in nonrenal clearance Increased accumulation Increased toxicity 6

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8 Top 50 Prescription Drugs Filled in U.S. Q Atorvastatin 18. Amoxicillin 35. Lisinopril/HCTZ 2. Levothyroxine 19. Prednisone 36. Citalopram 3. Lisinopril 20. Sertraline 37. Losartan 4. Omeprazole 21. Tamsulosin 38. Atenolol 5. Metformin 22. Fluticasone nasal 39. Cialis 6. Amlodipine 23. Pravastatin 40. Duloxetine 7. Simvastatin 24. Tramadol 41. Fluoxetine 8. Hydrocodone/APAP 25. Montelukast 42. Fenofibrate 9. Metoprolol ER 26. Escitalopram 43. Crestor 10. Losartan 27. Carvedilol 44. Venlafaxine 11. Azithromycin 28. Alprazolam 45. Ventolin 12. Zolpidem 29. Warfarin 46. Amphetamine/Dextroamphetamine 13. Hydrochlorothiazide 30. Meloxicam 47. Cyclobenzaprine 14. Furosemide 31. Clopidogrel 48. Trazodone 15. Metoprolol 32. Amoxicillin/Potassium Clavulanate ER 49. Methylprednisolone 16. Pantoprazole 33. Allopurinol 50. Potassium Chloride 17. Gabapentin 34. Bupropion 8

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11 Diuretic + ACEI/ARB + NSAID = Risk for AKI 11

12 Prerenal Intrinsic Diuretics ACEI/ARB NSAIDS Cyclosporine Tacrolimus Radiocontrast dye Antibiotics (aminoglycosides) HIV-meds /Antivirals Immunosuppressants Proton Pump Inhibitors Cocaine Postrenal Indinavir Acyclovir Sulfonamides Source: Acute Kidney Injury, Pharmacotherapy: A Pathophysiologic Approach, 10e Citation: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey L. Pharmacotherapy: A Pathophysiologic Approach, 10e; 2017 Available at: Accessed: May 01, 2017 Copyright 2017 McGraw-Hill Education. All rights reserved 12

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14 Source: Chronic Kidney Disease Medication Therapy Management Data Set, Medication Therapy Management: A Comprehensive Approach Citation: Angaran DM, Whalen K. Medication Therapy Management: A Comprehensive Approach; 2015 Available at: Accessed: May 01, 2017 Copyright 2017 McGraw-Hill Education. All rights reserved 14

15 Source: Chronic Kidney Disease Medication Therapy Management Data Set, Medication Therapy Management: A Comprehensive Approach Citation: Angaran DM, Whalen K. Medication Therapy Management: A Comprehensive Approach; 2015 Available at: Accessed: May 01, 2017 Copyright 2017 McGraw-Hill Education. All rights reserved Source: Chronic Kidney Disease Medication Therapy Management Data Set, Medication Therapy Management: A Comprehensive Approach Citation: Angaran DM, Whalen K. Medication Therapy Management: A Comprehensive Approach; 2015 Available at: Accessed: May 01, 2017 Copyright 2017 McGraw-Hill Education. All rights reserved 15

16 Assessment Plan The patient was prescribed lanthanum carbonate 1000 mg TID with meals 3 months ago and reports nonadherence due to taste. Patient has consistent hyperphosphatemia. The patient was prescribed sitagliptin 100 mg daily. Current creatinine clearance is approximately 25 ml/min. The patient has been taking furosemide 80 mg daily on nondialysis days. However, she is now anuric. 16

17 Assessment Plan The patient's hemoglobin has risen to 12 g/dl. She is currently treated with epoetin alfa 8,000 units 3 times a week. The patient has a urinary albumin to creatinine ratio of 200 mg/g). His blood pressure is 140/90 mm Hg; potassium is 4.2 meq/l. 17

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