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Antipsychotic drugs are a crucial treatment method for acute and chronic psychoses, bipolar illness, and behavioral disorders. The selection of these drugs depends on several factors, including the state of the disease, clinical judgment, possible drug interactions, and the patient's sensitivity to adverse effects. In immediate scenarios, such as delirium and dementia, short-term treatment with low doses of high-potency typical or atypical agents can effectively manage symptom exacerbation.
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Assessment of Vascular Function in Patients With Chronic Kidney Disease
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[Pharmacotherapy in patients with reduced kidney function].

Deborah Schumacher1, Jörg Seckinger1, Daniel Varga1

  • 11 Medizinische Klinik, Zuger Kantonsspital, Baar.

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|March 19, 2019
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Summary

Managing medications for chronic kidney disease (CKD) patients requires careful dose adjustments and understanding drug properties. Special considerations are needed for anticoagulants, diabetes drugs like GLP-1 agonists and SGLT-2 inhibitors, and NSAIDs due to their effects on kidney function.

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Area of Science:

  • Nephrology
  • Clinical Pharmacology
  • Pharmacotherapy

Background:

  • Chronic kidney disease (CKD) necessitates careful medication management, considering renal function and drug clearance.
  • Non-renal drug clearance can also be impacted by impaired kidney function.
  • Specific drug classes require tailored approaches in CKD patients.

Purpose of the Study:

  • To review pharmacotherapy principles in patients with reduced kidney function.
  • To discuss the use of direct-acting anticoagulants, GLP-1 agonists, SGLT-2 inhibitors, and NSAIDs in CKD.
  • To highlight the importance of dose adaptation and potential renal side effects.

Main Methods:

  • Review of current literature on pharmacotherapy in CKD.
  • Analysis of drug characteristics and dose adjustment strategies.
  • Examination of clinical data for specific drug classes in renal impairment.

Main Results:

  • Direct-acting anticoagulants show potential utility in CKD, including end-stage renal disease.
  • SGLT-2 inhibitors' glucose-lowering efficacy decreases in CKD, but cardiovascular benefits may persist.
  • NSAIDs can negatively affect renal hemodynamics and tubular function, especially with concurrent RAAS inhibitors and diuretics.

Conclusions:

  • Pharmacotherapy in CKD demands meticulous assessment of renal function and drug-specific knowledge.
  • Careful selection and dosing of medications are crucial to optimize outcomes and minimize risks in CKD patients.
  • Emerging therapies and established drug classes require distinct management strategies in patients with impaired kidney function.