🛑Sulindac

✅has become the NSAID of choice in some
centres for patients with renal impairment because of
reports of its renal sparing effects.

✅There is evidence
that this sparing effect is dose-related and is lost if
doses above 100 mg twice daily are used.

#Basel
Renal handbook
https://t.me/pharma_Note

🛑Which ARBs in "what if scenarios?

✅Enteropathy»
All but olmesartan

✅gout-drug induced hepatotoxicity» losartan, irbesartan

✅DM, Obesity, non alcohol fatty liver»
Telimisartan, azilsartan

✅liver impairment» all but losartan

✅renal stones, polypharmacy»
All but losartan

✅non compliant» azilsartan

✅non-dipper, morning surge in BP»
Telimsartan, irbesartan, candedsartan


#Basel
https://t.me/pharma_

❇️للفائدة هناك طريقة لحساب
antidote for heparin

✅اولا لازم نشوف كمية الهيبارين المعطاه اخر ساعتين الى ثلاث ساعات.. ثم
نعطي نصفها بالإضافة يعني
ثم ربعها!

♻️فمثلا لو مريض بيأخذ 1000unite /h
كم بتكون جرعة protamine هنا ؟

بنقول 1000+500+250=1750unite

والمعروف ان كل وحده من الهيبارين بنغطيها ب100mg من protamine

اذا 1750÷100=17.5mg

وبالتالي الجرعة هنا بتكون 17.5mg

💠ملحوظه
انها الmaximum dose 50mg
بإستثناء CABG

💠أيضا ممكن نعتمد ع الوقت لو كان معروف كما موضح بالصورة التالي👇
#Basel
https://t.me/pharma_Note

❇️Remember

alpha-blockers should generally not be
used as initial agents to treat hypertension—

❇️except perhaps
in men with symptomatic prostatism or nightmares linked
to PTSD.

#Basel
Current medication 2024

❇️Remember

✅Resistant hypertension:
Uncontrolled BP despite use of maximally tolerated dose of 3 antihypertensive drugs including diuretics.

✅Refractory hypertension:
Uncontrolled BP despite use of 5 or more antihypertensive agent of different classes including along acting thiazide like diuretic and an MR mineralocorticoid receptor antagonist at maximal or maximally tolerated dose .

#Basel

❇️Remember

✅Maximum time allowed for thrombolytic therapy in STEMI is 24h


✅Maximum time allowed for primary PCI in stable STEMI patients is 48h

#Basel

❇️Remember

✅Normal D-Dimer value for male patient above 50 years can be calculated as
Age *10 ug/L

#Basel

❇️ in UTI infection

Asymptomatic bacteriuria need to be treated only in:

✅pregnant women
✅patients undergoing urological intervention
✅renal transplant recipients in the first few months after transplant

#Basel

⚫The definition of nephrotoxicity for vancomycin :

☑️Generally defined as minimum of 2 to 3 consecutive documented increases in serum creatinine levels:

1️⃣Increase of 0.5mg/ml for patients with scr WNL or

2️⃣Increase greater than 20%from baseline (especially for patients with abnormal baseline creatinine)

#Basel
IDSA

❇️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.

❇️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

❇️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

⏺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

2⃣for 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

❇️Management of resistant HTN: Progress to next step if blood pressure remains uncontrolled

1⃣Step 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.

2⃣Step 2: Substitute optimally dosed thiazide diuretic (chlorthalidone or indapamide) for previous diuretic

3⃣Step 3: Add mineralocorticoid (aldosterone) receptor antagonist: spironolactone or eplerenone

4⃣Step 4:

🔴If heart rate ≥70 beats/min, add β-blocker
🔴If β-blocker is contraindicated, add central α1-agonist (clonidine or guanfacine)

5⃣Step 5: Add hydralazine and titrate to maximal dose (use concomitantly with a β-blocker and diuretic)

6⃣Step 6: Substitute minoxidil for hydralazine and titrate

7⃣Step 7: Refer to HTN specialist or ongoing clinical trial

#BASEL
#ACCP -ASHP - Cardiology 2023

.

Handbook of Nephrology and Hypertension ALGrawany 7E 2023 .pdf