Pharmacist Discusses Medications for Kidney Disease

Pharmacist Discusses Medications for Kidney Disease

November 3, 2019 0 By William Morgan


hi my name is Linda Awdishu and I’m a
pharmacist at UC San Diego chronic
kidney disease clinic in this module you
are going to learn about medications
used in kidney disease I hope you find
the information you need to make an
informed choice about what medicines to
take to maintain your kidney health one
of the most important things you can do
for your kidney function and health is
to control your blood pressure
ask your kidney doctor about what your
target blood pressure should be this
blood pressure goal is individual and
set depending on a number of factors
your level of kidney disease if there’s
any protein in your urine and your age
check your blood pressure at home and
bring in your records to your next
doctor’s appointment studies have shown
that blood pressure measured at the
doctor’s office might not be reflective
of your blood pressure at home your
kidney doctor will review your home
readings as well as the office readings
there are several different types of
medications that are used to lower high
blood pressure
these include ACE inhibitors angiotensin
receptor blockers loop or thiazide
diuretics and calcium channel blockers
if you forget to take your blood
pressure medicine don’t double up on
your dose the next day as this can
affect your kidney function oh and if
you run out of certain blood pressure
medicines due to refill problems be
careful because your blood pressure can
go up make sure to refill your
prescriptions a few days before you run
out of the medication
ACE inhibitors and angiotensin receptor
blockers are medications that reduce or
block a powerful blood pressure hormone
ACE inhibitor drug names usually end in
pril PRIL for example lisinopril or
ramipril angiotensin receptor blockers
usually end in artan ARTAN
like losartan or valsartan these
medicines are beneficial because not
only do they lower blood pressure but
they also reduce protein in the urine
these medications have been shown to
slow the progression of chronic kidney
disease here’s a tip that you might not
be aware of take these medicines in the
evening as they may work better to lower
your blood pressure these medications
are usually very well tolerated but they
can raise your blood potassium level and
they can affect your kidney function to
minimize this risk check with your
doctor if you need to cut back on foods
that are high in potassium while taking
this medication also if you are sick and
not able to drink enough fluids
your doctor may temporarily stop the
medication until you’re feeling better
and able to drink more this will help to
prevent an injury to your kidney
diuretics are medications commonly
referred to as water pills medications
in this class include
hydrochlorothiazide chlorothalidone
furosemide and bumetanide diuretics work
by removing excess salt and water from
your body for this reason it’s very
important to reduce the amount of sodium
in your diet so these medications can
work effectively diuretics are one of
the first medicines we use to control
your blood pressure but they do have
some side effects you might find that
you have to use the restroom more often
so make sure to take your diuretics in
the morning so that you’re not awake all
night from having to use that restroom
and if you have to take a second dose
take it later in the afternoon again so
that it doesn’t keep you up all night
large doses of diuretics might affect
your sodium or potassium concentrations
your doctor will monitor your blood work
for these side effects some diuretics
can increase your sensitivity to the Sun
make sure to wear sunblock and avoid sun
exposure during the peak
time of day between 10 a.m. and 2 p.m.
calcium channel blockers are very
effective medicines for controlling
blood pressure some calcium channel
blockers commonly used include diltiazem
amlodipine and nifedipine some of
the medicines work different than others
and have different types of side effects
for example
diltiazem slows the heart rate and
reduces blood pressure
diltiazem can interact with many
medications for example diltiazem can
interact with cholesterol-lowering
medications called statins it can
increase the amount of statins in your
body side effects of diltiazem
includes slowing the heart rate fatigue
and a headache other calcium channel
blockers like amlodipine and nifedipine
open up the blood vessels to lower blood
pressure nifedipine might actually
work a bit better if it’s taken in the
evening and you need to take it on an
empty stomach for best absorption so
watch out for those bedtime snacks side
effects of nifedipine and amlodipine
include headache swelling and an
increase in your heart rate so it’s
different from diltiazem amlodipine can
increase the amount of cholesterol
medicines in your body
one particular medication to look out
for is simvastatin it actually requires
an adjustment in the dosage when you
take it with amlodipine if you are
taking both simvastatin and amlodipine
together talk to your doctor to see if
the dose is right for you diabetes is
the leading cause of chronic kidney
disease
there are many medicines that are used
to treat diabetes that also require a
dosage adjustment or actually have to be
changed to a different medication
diabetes medicines such as glyburide or
metformin may not be recommended in
advanced kidney disease such as stage 4
or stage 5 patients with kidney disease
are at
higher risk for a low blood sugar
insulin can stay in your body a lot
longer and continue to lower your blood
sugar in advanced kidney disease we
actually have to lower the insulin dose
and if you experience a low blood sugar
avoid using orange juice to correct the
blood sugar orange juice is high in
potassium and might raise your potassium
levels here’s a tip try apple juice or
glucose tablets instead the hemoglobin
a1c test is a measure of your blood
sugar control over the past three months
this test is routinely measured by your
doctor to check on your blood sugar
control
however this test may not be as accurate
if you have anemia so monitor your blood
sugars at home and bring in your
records to your doctor’s appointment
we’ll use all of that information to
help make better decisions about your
diabetes care now let’s talk about
cholesterol-lowering medications
medications that end in statin lower
your cholesterol
some examples are simvastatin
atorvastatin or rosuvastatin most
statins need to be taken in the evening
the reason for this is that the enzyme
that makes cholesterol in your body is
at its highest activity while you sleep
however atorvastatin and rosuvastatin
can be taken any time of the day
because these are long-acting
medications statins have a lot of drug
interactions so always consult your
pharmacist or your doctor they can cause
muscle weakness cramping or pain notify
your doctor if you experience this
side-effect and stop taking the
medication until you can see your
provider patients with kidney disease
often have to restrict their diet for
phosphorus-containing foods when dietary
changes just aren’t enough we prescribed
medications to lower phosphorous which
are called phosphorus binders examples
of phosphorus binders are calcium
carbonate
or tums calcium acetate or Phoslo
sevelamer carbonate or Renvela
lanthanum carbonate or Fosrenol these
medications help to trap phosphorus in
the food that you eat and help you to
eliminate it so it doesn’t raise your
blood levels so it’s super important
that you take these medicines at the
start of eating your meal
do not take phosphorus binders at the
same time as other medicines as they may
interfere with your body’s absorption of
the medication phosphorus binders are
usually well tolerated but they can
cause stomach upset or some bloating
erythropoietin or EPO is a hormone
produced by the kidney whose job is to
make red blood cells if your kidney
function declines your body will make
less EPO you might be prescribed EPO
in the form of Procrit or Epogen
or Aranesp for anemia these medications
are given as an injection in the fat
tissue the dose and how often you
receive the medicine depends on your
kidney function and your hemoglobin
result EPO may initially cause body
aches pain at the injection site but
these side-effects go away with
continued treatment EPO however can
raise your blood pressure and most
importantly if you have an active cancer
this might not be the right drug for you
in order for IPO to work well patients
need to take an iron supplement iron can
be prescribed by mouth or orally or it
can be injected into your vein oral iron
should be taken on an empty stomach for
best absorption in your body side
effects of oral iron include dark
colored stools so don’t be afraid when
you see that for the first time
constipation and nausea here’s a tip try
taking it at bedtime so you don’t feel
nauseous during the daytime intravenous
iron is used when your body is not
absorbing enough oral iron into
Venis iron is given as at an infusion
center side-effects of intravenous iron
include lowering of the blood pressure
and potential allergic reactions as you
have learned from this video patients
with chronic kidney disease have to take
a lot of different medicines this may
seem like a huge task but taking your
medications regularly is one of the most
important things you can do to keep your
kidneys healthy take your medicines on
time every day here’s some tips to
remember to take your medicines use a
pillbox and carry it with you when you
go out there’s lots of different kinds
of pill boxes so find one that works for
you and if you have trouble filling your
pill box will hey talk to your
pharmacist they can check your pill box
once it’s been filled or even fill it
for you yep that’s right little secret
there pick a time that fits in your
lifestyle for taking your medicine if
you have a tendency to watch TV at night
and fall asleep on the couch well maybe
that’s not the right time to schedule
your medications at bedtime try taking
your medicines first thing in the
morning when you wake up set a reminder
on your cell phone or alarm clock that
will help remind you to take your
medicines and most cell phones nowadays
have that capacity keep a list of your
medicines and check off that you took
them every day your pharmacist can
prepare a list of your medications and
also create a chart for you to track
whether you took your medication or not
lastly try to use one pharmacy for all
your prescriptions this way your
pharmacist can check for drug
interactions and also work with your
doctor if you need an alternative
medication let them get to know you and
do a better job at managing your
medicines also it’s so important to
bring all your medications to your
appointment
we call it the brown bag throw all your
pill bottles into a paper brown bag
we’ll go through your medicines with you
at your clinic visit sometimes you may
forget to tell your provider about a
medicine you are taking or you can’t
even remember the dose remember the
decisions made on your care are
dependent on the list of medicines that
we think you are taking
are there any medicines that get that
kidney patients should avoid the answer
is yes
non-steroidal anti-inflammatory drugs or
NSAIDs are taken for headaches pain
fever and sets can damage your kidney
especially in patients with kidney
disease diabetes and high blood pressure
ibuprofen also known as motrin or Advil
and naproxen also known as a leave are
NSAIDs check the label of any cough and
cold product that you take to make sure
it does not contain an NSAID you’d be
surprised how often patients don’t
realize in a multi ingredient product
that there can be an NSAID there if you
want to read more about medications and
kidney disease try these great websites
ww kidney org or go to http n-k dep
nih.gov forward slash living forward
slash medicines now let’s test your
understanding true or false
ACE inhibitors or angiotensin receptor
blockers can protect your kidneys the
answer to that one is true great job
which of the following is a side-effect
of ACE inhibitors like lisinopril or
angiotensin receptor blockers like
losartan
is it a a low sodium level B a high
potassium level C going to the restroom
more frequently or D a low heart rate
the answer is B a high potassium level
which of the following is a side effect
of calcium channel blockers like
diltiazem is it a a low sodium level be
a high potassium level see going to the
restroom more frequently or D a low
heart rate the answer to that is d a low
heart rate true or false
is it better to take diuretics or water
pills in the morning well the answer to
that is true because you don’t want to
be up all night going to the bathroom
true or false
patients with kidney disease may
experience low blood sugar more often
again the answer to that is true
remember that if you’re taking insulin
it can hang out in your body longer than
if you didn’t have kidney disease and
cause a low blood sugar true or false
medicines used to lower high cholesterol
may interact with some medications used
to lower high blood pressure the answer
to that is true remember we talked about
that combination of amlodipine
and simvastatin and that the interaction
can actually affect the cholesterol
medication when is the best time to take
your phosphorus binder like Tums or Renvela is it a first thing in the morning
on an empty stomach be at the start of
eating a meal see after you finished
eating a meal or D at bedtime the answer
to that is B at the start of eating a
meal true or false to improve how well
EPO works patients should also take iron
the answer to that is true iron is
needed to make red blood cells and help
EPO to work more effectively which of
the following over-the-counter medicines
might be harmful to your kidneys
is it a acetaminophen or Tylenol B
famotidine or pepcid C ibuprofen at or
Advil or motrin or D
docusate sodium or colace well I hope
you know the answer to this one it’s C
ibuprofen advil or motrin which are
NSAIDs true or false it is important for
your kidney health to take your
medicines every day while that’s a
no-brainer the answer is true always
take your medications on time every day
congratulations you’ve completed the
module on medications used in kidney
disease please check our website for
additional educational modules on kidney
health