Identifying Chronic Kidney Disease – Medication List Review

In this medication list review, I going to show you to keep an eye out for trigger medications that may be important in identifying chronic kidney disease.  The med list:

  1. Aspirin 325 mg daily
  2. Warfarin as directed
  3. PhosLo 2 tabs TID with meals
  4. Acetaminophen 1000 mg TID
  5. Calcitriol 0.25 mcg daily
  6. Protonix 40 mg daily
  7. Zantac 150 mg twice daily
  8. Gabapentin 600 mg three times daily
  9. Ibuprofen 400 mg as needed

A medication list can certainly help you identify trends or potential problems that you will need to dig into further.  With the medication list above, this patient likely has chronic kidney disease (CKD).  The PhosLo and calcitriol are frequently used in CKD.  Lab monitoring is obviously pretty important.  Knowing whether this patient is on dialysis or not is also an important thing to note in the strong likelihood they have CKD.

Let’s assume they have CKD, there are two medications that I would look at appropriate dosing first.  I would look at the gabapentin and Zantac to assess if they are tolerated and appropriate to continue.

With the CKD assumption, I would next look at the ibuprofen.  NSAIDs and CKD are not a great combination, and then you also add in the bleed risk with patient being on warfarin and aspirin, and use of two GI medications, there are definitely a few strikes against the use of ibuprofen.

What else would you like to investigate?

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  1. Alka Bhalla, PharmD

    Off the top, I would like to know what the indications are for everyone of these medications. There seems to be some duplication of therapy with the Protonix and Zantac (indication? all PCP aboard with this duplication?) Another combination as you so rightly pointed out for the risk of bleed – warfarin +ASA + ibuprofen (looking for indications for warfarin + ASA 325 mg – if required can this be lowered to 81 mg). Also, pain control? On acetaminophen 1 g TID + gabapentin + ibuprofen. Source of pain? I would clean up the list and renally dose meds.

  2. Evans

    I dnt understand this episode, if only u cud explain


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Written By Eric Christianson

April 20, 2016

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