01 October 2015

Pharmacist Discusses Medications for Kidney Disease

In this video, pharmacist Linda Awdishu, PharmD MAS at UC San Diego Health (http://health.ucsd.edu/nephrology) discusses medications used to lower high ...

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