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Drugs and Kidney: The 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/.
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Drugs and Kidney:The 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
Outline • Introduction • Use of renally inappropriate medication • Pharmaco (kinetics, dynamics, genomics) • Special drugs and situations • Closure
Introduction: Drug Use JAMA. November 2015;314(17):1818-1831
Introduction: Cost and cost Clin J Am Soc Nephrol 10: 1822–1830, October 2015.
Inappropriate Medications J Am Geriatr Soc 2015 in press
Inappropriate Medications J Am Geriatr Soc 2015 in press
Inappropriate Medications J Am Geriatr Soc 2015 in press
Pharmacokinetics:Bioavailability in CKD • Bioavailability: • Furosemidedosing oral/IV • Gancyclovir • Drug absorption • Iron • Iron and thyroxin
Pharmacokinetics:Distribution in CKD • Distribution: • Free and total • Digoxin example
Pharmacokinetics:Metabolism • Cytochrome system: • Enzyme inducers and inhibitors
Pharmacokinetics: Oral Antidiabetics Nephrol Dial Transplant (July 2014) 29: 1284–1300
Pharmacodynamics: Antidiabetics
Pharmacodynamics: Antibiotics
Pharmacodynamics: Perioperative Management ACEi /ARBS OCS
Pharmacodynamics: Glomerular Disease Clin J Am Soc Nephrol 10: 1287–1290, July 7th, 2015.
Preemptive Pharmacogenomics J Am Med Inform Assoc 2014;21:e93–e99.
TPMT Nat Rev Drug Discov 2005; 4:639.
Pharmacogenetics:Tacrolimus Scenario CLINICAL PHARMACOLOGY & THERAPEUTICS | VOLUME 98 NUMBER 1 | JULY 2015
Tacrolimus Scenario: RCT, 240 Patients Erasmus MC, Rotterdam, The Netherlands American Journal of Transplantation, 2016; Accepted article
Glycemic Control Nephrol Dial Transplant (May 2015) 30: ii1–ii142
Hypertension: Drug Interactions J Am Soc Nephrol 26: 1248–1260, June 2015
Hypertension: BB Dialysability Weir, et al. J Am Soc Nephrol 26: 987–996, 2015.
Pharmacodynamics: Iron Induced Anaphylaxis JAMA. 17 November 2015;314(19):2062-2068
Iron Am J Kidney Dis. 2016, in press
CRUISE Continuous Replacement Using Iron Soluble Equivalents: Phase 3, RCT, n 599, 48 w Nephrol Dial Transplant (December 2015) 30: 2019–2026
PPI and Hypomagnesemia Am J Kidney Dis. 2015;66(5):775-782
PPI, Hypomagnesemia and AF International Journal of Cardiology (2016), in press
PPI and Osteoporosis Bone 81 (2015) 675–682
PPI and Pediatrics • SBBO • CDI, Salmonella, Campylob. • URTI • CAP, HAP, VAP • Celiac • Fundic gastric polyp • Rebound acidhypersecretion • Ca Malabsorption and BMD • VC, B12 • Mg • CVS • Interstitial Nephritis • Microbiome
Hyperkalemia: New Treatment N Engl J Med 2015;372:222-31.
COMBINE Study The CKD Optimal Management With BInders and NicotinamidE study J Am Soc Nephrol 26: 2328–2339,October 2015
Statins Intolerance Expert Opin. Drug Saf. (June 2015) 14(6):935-955
DKD: Use of Statins Nephrol Dial Transplant (May 2015) 30: ii1–ii142