PowerPoint Presentation...5/8/2017 8 Top 50 Prescription Drugs Filled in U.S. Q1 2016 1....
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5/8/2017 1 Adjunct Clinical Associate Professor Pharmacy Practice Clinical Assistant Professor Clinical Pharmacy Specialist Division of Kidney Disease and Hypertension
Transcript of PowerPoint Presentation...5/8/2017 8 Top 50 Prescription Drugs Filled in U.S. Q1 2016 1....
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Adjunct Clinical Associate Professor Pharmacy Practice
Clinical Assistant ProfessorClinical Pharmacy Specialist Division of Kidney Disease and Hypertension
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http://ed.ted.com/lessons/how-do-your-kidneys-work-emma-Bryce. Accessed 9/1/15.
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http://www.pathophys.org/ckd/
http://www.pathophys.org/ckd/
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Albuminuria categories
<30 mg/g
<3 mg/mmol
30-300
mg/g
3-30
mg/mmol
>300
mg/g
>30
mg/mmol
GFR
cat
ego
rie
s (m
l/m
in/1
.73
m2 ) G1 Normal to high ≥ 90
G2 Mildly decreased 60-89
G3aMildly to moderately
decreased45-59
G3bModerately to
severely decreased30-44
G4 Severely decreased 15-29
G5 Kidney failure < 15
Table 1.1 Percentage of NHANES (1999-2014)
participants, in the various CKD (eGFR and
albuminuria) risk categories (KDIGO 2012)
a) Percentage in each category (2011-2014)
Albuminuria categories
<30 mg/g
<3 mg/mmol
30-300
mg/g
3-30
mg/mmol
>300
mg/g
>30
mg/mmol
GFR
cat
ego
rie
s (m
l/m
in/1
.73
m2 ) G1 Normal to high ≥ 90 54.7 4.3 0.4
G2 Mildly decreased 60-89 30.4 2.6 0.3
G3aMildly to moderately
decreased45-59 3.9 0.9 0.2
G3bModerately to
severely decreased30-44 1.0 0.5 0.2
G4 Severely decreased 15-29 0.1 0.1 0.2
G5 Kidney failure < 15 <0.001 0.001 0.01
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http://significantdruginteractions.weebly.com/basic-concepts-of-drug-interactions.html. Accessed 9/1/2015
PK Parameter Alteration
Absorption Believed to be reduced
Distribution Reduced plasma protein binding
Metabolism Increased accumulation of active metabolitesDecrease in nonrenal clearance
Elimination Increased accumulationIncreased toxicity
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Top 50 Prescription Drugs Filled in U.S. Q1 2016
1. 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
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Diuretic + ACEI/ARB + NSAID = Risk for AKI
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• Prerenal
• Intrinsic
• Postrenal
DiureticsACEI/ARBNSAIDS
CyclosporineTacrolimus
Radiocontrast dyeAntibiotics (aminoglycosides)
HIV-meds /AntiviralsImmunosuppressants
Proton Pump InhibitorsCocaine
IndinavirAcyclovir
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: http://accesspharmacy.mhmedical.com/content.aspx?sectionid=134127206&bookid=1861&Resultclick=2 Accessed: May 01, 2017
Copyright © 2017 McGraw-Hill Education. All rights reserved
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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:
http://accesspharmacy.mhmedical.com/content.aspx?bookid=1079§ionid=61424690&jumpsectionID=61424708 Accessed: May 01,
2017
Copyright © 2017 McGraw-Hill Education. All rights reserved
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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:
http://accesspharmacy.mhmedical.com/content.aspx?bookid=1079§ionid=61424690&jumpsectionID=61424708 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:
http://accesspharmacy.mhmedical.com/content.aspx?bookid=1079§ionid=61424690&jumpsectionID=61424708 Accessed: May 01,
2017
Copyright © 2017 McGraw-Hill Education. All rights reserved
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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.
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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.
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