Good pharmacists..⚕📚👨‍⚕

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Handbook of Nephrology and Hypertension ALGrawany 7E 2023 .pdf

❇️
Management of resistant HTN: Progress to next step if blood pressure remains uncontrolled
1⃣
Step 1
♻️
Exclude causes of HTN:
secondary causes, white-coat effect, medication nonadherence
♻️
Maximize lifestyle interventions: low-sodium diet (<2400 mg/day), at least 6 hours/night of
uninterrupted sleep, weight loss, exercise)
♻️
Optimize three-drug regimen of CCB, RAS inhibitor, and diuretic (appropriately dosed for
renal function) at maximally tolerated doses.
2⃣
Step 2: Substitute optimally dosed thiazide diuretic (chlorthalidone or indapamide) for previous diuretic
3⃣
Step 3: Add mineralocorticoid (aldosterone) receptor antagonist: spironolactone or eplerenone
4⃣
Step 4:
🔴
If heart rate ≥70 beats/min, add β-blocker
🔴
If β-blocker is contraindicated, add central α1-agonist (clonidine or guanfacine)
5⃣
Step 5: Add hydralazine and titrate to maximal dose (use concomitantly with a β-blocker and diuretic)
6⃣
Step 6: Substitute minoxidil for hydralazine and titrate
7⃣
Step 7: Refer to HTN specialist or ongoing clinical trial
#BASEL
#ACCP
-ASHP - Cardiology 2023

⏺
Initial loop diuretics dosing in patients hospitalized with HF and congestion :
1⃣
For patient’s on long term 2.5× their outpatient dose on a mg per mg basis ,demonstrated safety and efficacy
2⃣
for patients not receiving long term 40-80mg IV BID of furosemide or the equivalent .
لتوضيح رقم واحد..
لو كان بيأخذ 40mg orally BIDمرتين باليوم بتكون
الجرعة 100mg IV BID
الهدف لمنع post dosing or post diurteic Na retention
او ما تمسى أيضا
braking phenomenon
#Basel
https://t.me/pharma_Note

❇️
In CKD the tubular secretory capacity for a diuretics is lowered offern in parallel with the reduction in GFR ,thus higher blood levels are required to effect tubular delivery sufficient to prompt a diuresis
وهذا توضيح للسؤال التالي..
لماذا نزيد جرعه المدر كلما قل معدل الترشيح الكلوي بخلاف العادة الي ننقص فيها جرعة الدواء عندما يقل معدل الترشيح الكلوي.
#Basel

❇️
To administer Aminoglycoside antibiotics, for total dosing
✅
For patient’s having weight is 1-1.2 times their ideal body weight, ideal body
weight is used.
✅
For patients whose weighs more than 1.2 times ideal body weight, use adjusted
body weight is used

❇️
Fosinopril is the only phosphinate-containing ACE inhibitor
❇️
In contrast to other ACE inhibitors, fosinopril is eliminated from
the body via both renal and hepatic pathways, which make it a safer choice in patients
with impaired kidney function.

⚫
The definition of nephrotoxicity for vancomycin :
☑️
Generally defined as minimum of 2 to 3 consecutive documented increases in serum creatinine levels:
1️⃣
Increase of 0.5mg/ml for patients with scr WNL or
2️⃣
Increase greater than 20%from baseline (especially for patients with abnormal baseline creatinine)
#Basel
IDSA