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Pharmacist Discusses Medications for Kidney Disease

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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 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

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