Drugs nmgh 3 feb 2016 presentation
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1. The document discusses the appropriate use of medications in patients with kidney disease, covering topics like pharmacokinetics, pharmacodynamics, drug interactions, and specific drug classes. 2. It highlights challenges with using renally-inappropriate medications and presents studies on optimizing treatment of conditions like diabetes, hypertension, hyperkalemia, and mineral bone disease in chronic kidney disease. 3. The presentation also addresses special considerations for drug prescribing and use in dialysis patients.
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Drugs nmgh 3 feb 2016 presentation
- 1. Drugs and Kidney:Drugs and Kidney: The Art and ResponsibilityThe Art and Responsibility Hussein Sheashaa, MD, FACP Professor of Nephrology, Urology and Nephrology Center and Director of Medical E-Learning Unit, Mansoura University, and Executive Director of ESNT- Virtual Academy: http://lms.mans.edu.eg/esnt/ Mansoura NGH; Feb 3rd , 2016
- 3. Introduction Use of renally inappropriate medication Pharmaco (kinetics, dynamics, genomics) Special drugs and situations Closure Outline
- 4. Introduction
- 6. Introduction: Cost and cost Clin J Am Soc Nephrol 10: 1822–1830, October 2015.
- 8. J Am Geriatr Soc 2015 in press Inappropriate Medications
- 9. J Am Geriatr Soc 2015 in press Inappropriate Medications
- 10. J Am Geriatr Soc 2015 in press Inappropriate Medications
- 12. Bioavailability: Furosemide dosing oral/IV Gancyclovir Drug absorption Iron Iron and thyroxin Pharmacokinetics: Bioavailability in CKD
- 13. Distribution: Free and total Digoxin example Pharmacokinetics: Distribution in CKD
- 14. Cytochrome system: Enzyme inducers and inhibitors Pharmacokinetics: Metabolism
- 16. Nephrol Dial Transplant (July 2014) 29: 1284–1300 Pharmacokinetics: Oral Antidiabetics
- 21. Clin J Am Soc Nephrol 10: 1287–1290, July 7th , 2015. Pharmacodynamics: Glomerular Disease
- 23. Pharmacogenomics
- 24. J Am Med Inform Assoc 2014;21:e93–e99. Preemptive Pharmacogenomics
- 25. TPMT Nat Rev Drug Discov 2005; 4:639.
- 26. CLINICAL PHARMACOLOGY & THERAPEUTICS | VOLUME 98 NUMBER 1 | JULY 2015 Pharmacogenetics: Tacrolimus Scenario
- 27. Erasmus MC, Rotterdam, The Netherlands American Journal of Transplantation, 2016; Accepted article Tacrolimus Scenario: RCT, 240 Patients
- 28. DiabetesDiabetes
- 29. Glycemic ControlGlycemic Control Nephrol Dial Transplant (May 2015) 30: ii1–ii142
- 31. J Am Soc Nephrol 26: 1248–1260, June 2015 Hypertension: Drug Interactions
- 32. Weir, et al. J Am Soc Nephrol 26: 987–996, 2015. Hypertension: BB Dialysability
- 33. IronIron
- 34. JAMA. 17 November 2015;314(19):2062-2068 Pharmacodynamics: Iron Induced Anaphylaxis
- 35. Am J Kidney Dis. 2016, in press Iron
- 36. Nephrol Dial Transplant (December 2015) 30: 2019–2026 CRUISE Continuous Replacement Using Iron Soluble Equivalents: Phase 3, RCT, n 599, 48 w
- 37. PPIPPI
- 39. PPI and CDI
- 40. Am J Kidney Dis. 2015;66(5):775-782 PPI and Hypomagnesemia
- 41. International Journal of Cardiology (2016), in press PPI, Hypomagnesemia and AF
- 42. Bone 81 (2015) 675–682 PPI and Osteoporosis
- 43. PPI and Pediatrics SBBO CDI, Salmonella, Campylob. URTI CAP, HAP, VAP Celiac Fundic gastric polyp Rebound acidhypersecretion Ca Malabsorption and BMD VC, B12 Mg CVS Interstitial Nephritis Microbiome
- 45. Hyperkalemia: New Treatment N Engl J Med 2015;372:222-31.
- 46. CKD-MBDCKD-MBD
- 47. COMBINE Study J Am Soc Nephrol 26: 2328–2339,October 2015 The CKD Optimal Management With BInders and NicotinamidE study
- 48. StatinsStatins
- 49. Expert Opin. Drug Saf. (June 2015) 14(6):935-955 Statins IntoleranceStatins Intolerance
- 50. Nephrol Dial Transplant (May 2015) 30: ii1–ii142 DKD: Use of Statins
- 51. CMAJ, February 17, 2015, 187(3) Clarithromycin and StatinClarithromycin and Statin
- 52. Drug Prescription inDrug Prescription in DialysisDialysis
- 53. Am J Kidney Dis. 2015;66(1):125-132 Drugs in Dialysis
- 54. JAMA Nov 2015
Editor's Notes
- IMPORTANCE All intravenous (IV) iron products are associated with anaphylaxis, but the comparative safety of each product has not been well established. OBJECTIVE To compare the risk of anaphylaxis among marketed IV iron products. DESIGN, SETTING, AND PARTICIPANTS Retrospective new user cohort study of IV iron recipients (n = 688 183) enrolled in the US fee-for-service Medicare program from January 2003 to December 2013. Analyses involving ferumoxytol were limited to the period January 2010 to December 2013. EXPOSURES Administrations of IV iron dextran, gluconate, sucrose, or ferumoxytol as reported in outpatient Medicare claims data. MAIN OUTCOMES AND MEASURES Anaphylaxiswas identified using a prespecified and validated algorithm defined with standard diagnosis and procedure codes and applied to both inpatient and outpatient Medicare claims. The absolute and relative risks of anaphylaxis were estimated, adjusting for imbalances among treatment groups. RESULTS A total of 274 anaphylaxis cases were identified at first exposure, with an additional 170 incident anaphylaxis cases identified during subsequent IV iron administrations. The risk for anaphylaxis at first exposure was 68 per 100 000 persons for iron dextran (95%CI, 57.8-78.7 per 100 000) and 24 per 100 000 persons for all nondextran IV iron products combined (iron sucrose, gluconate, and ferumoxytol) (95%CI, 20.0-29.5 per 100 000) , with an adjusted odds ratio (OR) of 2.6 (95%CI, 2.0-3.3; P < .001). At first exposure, when compared with iron sucrose, the adjusted OR of anaphylaxis for iron dextran was 3.6 (95%CI, 2.4-5.4); for iron gluconate, 2.0 (95%CI 1.2, 3.5); and for ferumoxytol, 2.2 (95%CI, 1.1-4.3). The estimated cumulative anaphylaxis risk following total iron repletion of 1000mg administered within a 12-week period was highest with iron dextran (82 per 100 000 persons, 95%CI, 70.5- 93.1) and lowest with iron sucrose (21 per 100 000 persons, 95%CI, 15.3- 26.4). CONCLUSIONS AND RELEVANCE Among patients in the US Medicare nondialysis population with first exposure to IV iron, the risk of anaphylaxis was highest for iron dextran and lowest for iron sucrose.
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