Common Medications used in the ESRD Population Mary Kay Carone NP.
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Transcript of Common Medications used in the ESRD Population Mary Kay Carone NP.
Common Medications used in the ESRD Population
Mary Kay Carone NP
Current medications in ESRD
Medication Review is a challenge!
Very sick patients Very sick patients • Multiple meds• Multiple providers• Multiple meds• Multiple providers
Frequent hospitalizations Frequent hospitalizations • frequent changes in medications (or just confusion!)
• frequent changes in medications (or just confusion!)
Generic vs. brand names vs. multiple meds in same
class
Generic vs. brand names vs. multiple meds in same
class
• Class redundancy and confusion!• Class redundancy and confusion!
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
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!
Cardiac Medications
Generic Brand Dose
Ramipril Altace 2.5 − 2.0
Enalapril Vasotec 2.5 − 40
Benazapril Lotensin 10 − 40
Lisinopril Zestril 10 − 40
ACE Inhibitor Class
Cardiac Medications
Generic Brand Dose
Valsartan Diovan 80 − 320
Losartan Cozaar 25 − 100*
Telmisartan Micardis 20 − 80
Candesartan Atacand 8 − 32
*means…..
ARBs
Cardiac Medications
Generic Brand Dose
Doxazosin Cardura 1 − 16
Terazosin Hytrin 1 − 20
*means…..** means….
Alpha blockers
Generic Brand Dose
Carvedilol Coreg 6.25 − 50*
Labetalol NormadyneTrandate
200 − 800**
Combined Alpha and Beta Blockers
Cardiac Medications
Generic Brand Dose
Atenolol Tenormin 25 − 100
Metoprolol Lopressor 50 − 100*
Telmisartan Micardis 20 − 80
Metoprolol (extended release)
Toprol XL 50 − 100
Beta Blockers
*Needs to be given 2x a day
Cardiac Medications
Generic Brand Dose
Diltiazem Cardizem CDDilacor XRTiazac
180 − 420
Diltiazem (extended release)
Cardizem LA 120 − 540
Calcium Channel Blockers (nonhydropyridines)
Calcium Channel Blockers (dihydropyridines)
Generic Brand Dose
Amlodipine Norvasc 2.5 − 10
Nifedipine (long acting) Adalat CCProcardia XL
30 − 60
Cardiac Medications
Generic Brand Dose
Clonidine Catapres 0.1 − 0.8
Clonidine patch Catapres TTS 0.1 − 0.3
Methyldopa Aldomet 250 − 1000*
Central Alpha Agonists
*Given 2x a day. Significant removal during HD is “likely”
Cardiac Medications
Generic Brand Dose
Hydralazine Apresoline 25 − 100*
Minoxidil Loniten 2.5 − 8.0**
Isosorbide montrate Imdur 30 − 240
Isosorbide dinitrate 10 − 40
Nitroglycerin spray NitrolingualNitrostat
1 − 2 sp.0.3 − 0.6
Direct Vasodilators/Nitrates
*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
Cardiac Medications
Generic Brand Dose
Amioderon
CorderonePacerone
200 − 600
Antiarrhythmics
Generic Brand Dose
Ranolazine Ranexa 500 − 1000*
Ranexa Lanoxin 0.125 − .5**
Other
Generic Brand Dose
Furosemide Lasix 40 − 120
Torsemide Demadex 20 − 200
Diuretics
*Means…** Means…
Table 86Preferred Antihypertensive Agents for CVD1
Types of CVD Thiazide orLoop Diuretics
ACE inhibitors or ARBs
Beta Blockers
Calcium Channel Blockers
Aldosterone Antagonists
Heart Failure with systolic dysfunction
X X X* X
Post MI with systolicdysfunction
X X X
Post MI X
Chronic stable angina X X
High risk CAD X X X X
Recurrent CVA prevent X X
SVT X X**
*Only some BB (Carvedilol, metoprolol)
** Non dihydroperidine CCBs
1. National Kidney Foundation - C 2005 Select Guidelines from the KDOQI Hypertension and Antihypertensive Agents in Chronic Kidney Disease
StatinsGeneric Brand Dose
Atorvastatin Lipitor 10 − 80
Rosuvastatin Crestor 5 − 40
Simvastatin Zocor 5 − 80
Lovastatin Mevacor 10 − 80
Niacin Niaspan 500 − 2000
AntiplateletsGeneric Brand Dose
Clopidogrel Plavix 75*
ASA/Dipyridamole Aggrenox 25/200**
Warfarin Coumadin Variable based on PT/INR
*means…..**means….
Diabetes
Generic Brand Dose
Sitagliptin Januvia 25 − 50
Glimepitide Amaryl 1 − 4
Pioglitazone Actos 15 − 30
Repaglinide Prandin 0.5 − 4*
Glyburide MicronaseDiabeta
5 − 20
PO Meds
*means…..
Diabetes
Generic Brand Dose
Insulin Glargine Lantus Start 10, avg. 50
Insulin Lispro Humalog bid-qid
Insulin Aspart Novolog bid-qid
Insulin NPH Novolin N qd-bid
Insulin Regular Novolin R bid-qid
Insulin Glulisine Apidra bid-qid
Insulin 70/30 Humulin 70/30 qd-bid
Injectable Insulins
GI Medications
Generic Brand Dose
Esomeprazole Nexium 20 − 40
Omeprazole Prilosec 20 − 40
Famitodine Pepcid 20 − 40
Ranitidine Zantac 150*
Generic Brand Dose
Metoclopramide Reglan 5 − 10**
Other
PPIs / H2 blockers
*H2blockers – Pepcid and Zantac (Zantac given bid)** Used for DM pts with gastroparesis, stimulates upper GI motility, taken with meals and at hs
Antidepressants
Generic Brand Dose
Sertraline Zoloft 50 − 200
Citalopram Celexa 20 − 40
Bupropion Wellbutrin 1 00 − 300
Fluoxetine Prozac 10 − 80
Paroxetine Paxil 10 − 30
Venlafaxine Effexor 37.5 − 112.5
Amitryptiline* 10 − 25
Other SSRIs
Sleep / PainGeneric Brand Dose
Zolpidem Ambien 5 − 10
Alprazolam Xanax 0.25 − 0.5*
Risperidone Risperdal 1 − 3
Morphine Sulphate MS Contin 15 − 30
Hydromorphone Dilaudid 2 − 4
Gabapentin Neurontin 100 − 300*
Oxycodone/acetaminophen
Percocet 2.5 − 10/325 − 650
*Means…
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!!)
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.
Case Study
Medications prior to admit• 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
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
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?
Thank you!