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Medication management in AKI

List six of the most common classes of medications that are nephrotoxic?
(These three make up the "triple whammy")
Aminoglycosides (eg gentamycin)
List some very commonly used medications that are renally excreted and risky in renal impairment
Antibiotics - penicillins, vancomycin, trimethoprim
Neuropathic agents
Hypoglycaemic agents
What do ACE inhibitors do to the renal arterioles?
Constrict the efferent arteriole
Ron has AKI, this is his drug chart. What would you change?
Perindopril 5mg
Atorvastatin 40
Aspirin 100mg
Metformin 1g bd
Digoxin 125 microg daily
Diltiazem CR 240mg daily
Meloxicam PRN
Withhold perindopril (consider another antihypertensive like a CCB)
Withhold metformin (consider temporary insulin)
Dose reduce digoxin (and monitor levels)
Cease meloxicam
Lakshmi has AKI (eGFR=20), this is her drug chart. What would you change?
Enoxaparin 40mg daily
Atorvastatin 40mg nocte
Atenolol 50mg bd
Frusemide 40mg po bd
Paracetamol SR 1330 tds
Levetiracetam 1g bd
Clopidogrel 75mg daily
Aspirin 100mg daily
Morphine 2mg s/cut PRN
Enoxaparin 20mg daily (and monitor anti-Xa)
Atenolol 25mg daily (and monitor HR)
Frusemide - increase or reduce as per fluid status
Levetiracetam - reduce to 250-500mg bd
Oxycodone 5mg q4H PRN - or could consider fentanyl