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Zorluk: KolayPharmacologic Interventions

A 68-year-old man comes to the clinic for a routine follow-up. He feels well but reports he recently recovered from a severe bout of gastroenteritis that lasted for 4 days. His blood pressure is 135/85 mm Hg and his pulse is 78/min. Physical examination is unremarkable. Laboratory studies show a serum creatinine level of 2.4 mg/dL, up from a baseline of 1.1 mg/dL three months ago. His current home medications include metformin, lisinopril, acetaminophen, amlodipine, and atorvastatin. The physician decides to hold certain medications while the patient's renal function recovers. Which of the following home medications should be temporarily held in the setting of this patient's acute kidney injury? (Select all that apply)

  1. A
    Acetaminophen
  2. LisinoprilCevap
  3. C
    Amlodipine
  4. D
    Atorvastatin
  5. MetforminCevap

Cevap

Metformin and Lisinopril should be temporarily held.
Metformin must be held because its renal clearance is compromised in acute kidney injury, leading to a high risk of severe lactic acidosis. Lisinopril must be held because it dilates the efferent arteriole, which lowers intraglomerular pressure and reduces the glomerular filtration rate, potentially worsening the acute kidney injury.

Adım Adım Çözüm

1
Identify the primary clinical problem from the laboratory findings.
The patient has acute kidney injury (AKI), likely prerenal in etiology secondary to volume depletion from recent severe gastroenteritis.
Serum creatinine has more than doubled from his baseline of 1.1 mg/dL to 2.4 mg/dL.
2
Evaluate the patient's home medication list for drugs that are nephrotoxic, alter renal hemodynamics, or carry a high risk of toxicity when renally retained.
The medication list includes metformin, lisinopril, acetaminophen, amlodipine, and atorvastatin.
This is a critical step in preventing further iatrogenic harm during an episode of AKI.
3
Select the specific medications that must be temporarily held.
Metformin and lisinopril must be held.
Metformin carries a high risk of lactic acidosis when renal clearance is impaired. Lisinopril reduces efferent arteriolar resistance, which decreases the glomerular filtration rate and can worsen the AKI.

Anahtar Kavram

Pharmacologic management during acute kidney injury involves holding medications that alter renal hemodynamics (e.g., ACE inhibitors) or cause systemic toxicity when renally retained (e.g., metformin).
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Pharmacologic Interventions

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