❇️ 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

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Handbook of Nephrology and Hypertension ALGrawany 7E 2023 .pdf