Drugs nmgh 3 feb 2016 presentation
Transcript of Drugs nmgh 3 feb 2016 presentation
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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
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Introduction Use of renally inappropriate medication Pharmaco (kinetics, dynamics, genomics) Special drugs and situations Closure
Outline
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Introduction
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JAMA. November 2015;314(17):1818-1831
Introduction:Drug Use
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Introduction:Cost and cost
Clin J Am Soc Nephrol 10: 1822–1830, October 2015.
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Use of Renally Inappropriate Medications
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J Am Geriatr Soc 2015 in press
Inappropriate Medications
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J Am Geriatr Soc 2015 in press
Inappropriate Medications
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J Am Geriatr Soc 2015 in press
Inappropriate Medications
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PharmacokineticsPharmacokinetics
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Bioavailability: Furosemide dosing oral/IV Gancyclovir
Drug absorption Iron
Iron and thyroxin
Pharmacokinetics:Bioavailability in CKD
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Distribution: Free and total
Digoxin example
Pharmacokinetics:Distribution in CKD
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Cytochrome system: Enzyme inducers and inhibitors
Pharmacokinetics:Metabolism
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Pharmacogenetics:Metabolism and Transport
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Nephrol Dial Transplant (July 2014) 29: 1284–1300
Pharmacokinetics: Oral Antidiabetics
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PharmacodynamicPharmacodynamic
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Pharmacodynamics: Antidiabetics
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Pharmacodynamics: Antibiotics
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ACEi /ARBS
Pharmacodynamics: Perioperative Management
OCS
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Clin J Am Soc Nephrol 10: 1287–1290, July 7th, 2015.
Pharmacodynamics: Glomerular Disease
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PharmacogenomicsPharmacogenomics
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Pharmacogenomics
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J Am Med Inform Assoc 2014;21:e93–e99.
Preemptive Pharmacogenomics
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TPMT
Nat Rev Drug Discov 2005; 4:639.
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CLINICAL PHARMACOLOGY & THERAPEUTICS | VOLUME 98 NUMBER 1 | JULY 2015
Pharmacogenetics:Tacrolimus Scenario
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Erasmus MC, Rotterdam, The Netherlands
American Journal of Transplantation, 2016; Accepted article
Tacrolimus Scenario:RCT, 240 Patients
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DiabetesDiabetes
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Glycemic Control Glycemic Control
Nephrol Dial Transplant (May 2015) 30: ii1–ii142
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HypertensionHypertension
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J Am Soc Nephrol 26: 1248–1260, June 2015
Hypertension: Drug Interactions
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Weir, et al. J Am Soc Nephrol 26: 987–996, 2015.
Hypertension: BB Dialysability
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IronIron
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JAMA. 17 November 2015;314(19):2062-2068
Pharmacodynamics: Iron Induced Anaphylaxis
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Am J Kidney Dis. 2016, in press
Iron
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Nephrol Dial Transplant (December 2015) 30: 2019–2026
CRUISEContinuous Replacement Using Iron Soluble
Equivalents: Phase 3, RCT, n 599, 48 w
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PPIPPI
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PPI and Myocardial Infarction
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PPI and CDI
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Am J Kidney Dis. 2015;66(5):775-782
PPI and Hypomagnesemia
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International Journal of Cardiology (2016), in press
PPI, Hypomagnesemia and AF
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Bone 81 (2015) 675–682
PPI and
Osteoporosis
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PPI and Pediatrics
SBBOCDI, Salmonella, Campylob.URTICAP, HAP, VAPCeliacFundic gastric polypRebound acidhypersecretion
Ca Malabsorption and BMDVC, B12MgCVSInterstitial NephritisMicrobiome
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HyperkalemiaHyperkalemia
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Hyperkalemia: New Treatment
N Engl J Med 2015;372:222-31.
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CKD-MBDCKD-MBD
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COMBINE Study
J Am Soc Nephrol 26: 2328–2339,October 2015
The CKD Optimal Management With BInders and NicotinamidE study
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StatinsStatins
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Expert Opin. Drug Saf. (June 2015) 14(6):935-955
Statins IntoleranceStatins Intolerance
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Nephrol Dial Transplant (May 2015) 30: ii1–ii142
DKD: Use of Statins
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CMAJ, February 17, 2015, 187(3)
Clarithromycin and StatinClarithromycin and Statin
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Drug Prescription in Drug Prescription in DialysisDialysis
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Am J Kidney Dis. 2015;66(1):125-132
Drugs in Dialysis
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JAMA Nov 2015