Drugs to give/not give before dialysis

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    I work nights on a medical unit and we have a number of hemodialysis patients on our unit at any given time. For many of these patients I'm charged with getting them set up for breakfast and ready to go to HD between 0600 and 0700. There's an ongoing debate/confusion on my unit about which meds to give before patients go to dialysis and which to hold because they'll just dialyze off. All "daily" or "BID" meds have scheduled administration times at 0900. The dialysis nurses do not give meds and do not let patients eat during HD, so if I don't give those meds before they go they end up being late (as in early afternoon or later). I always give synthroid (scheduled for 0600) as well as renagel, phoslo, insulin, and any other meds that MUST go with breakfast, but what about the rest of the AM meds? I've heard "don't give the antibiotics," but today's pharmacist contradicted that idea. Can any one give me some hints, classification by classification, which meds I should hold until after dialysis? Thanks for you help!!!
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  3. 5 Comments so far...

  4. 4
    Alot of factors influence drug removal by dialysis, the major ones being type of filter used in your facility, whether or not a drug is protein bound or water soluble, molecular size, and the sieving coefficient (rate it is removed) of a particular drug. Yes, it's alot of factors involved. Synthroid is protein bound so it will not pass through the dialysis filter. So is dilantin and digoxin. Your pharmacist isn't being particularly helpfull as most antibiotics will dialyze right out, at least with the F180 filters used in my institution. I participated in a study on Vancomycin in which we drew labs every 15 minutes and it was nearly 100% gone at the end of even a 3 hour treatment. Pain medications are different because receptors in the body latch on to the drug so although some may be removed by dialysis the patient will still obtain relief. BP meds are held not because they are removed by dialysis but because it hinders fluid removal. As fluid is removed BP drops. You also might want to ask one of the nephrologists if he/she would be willing to give a short inservice in your unit about drug removal by dialysis.
    KarlyRN, Guttercat, NocturneNrse, and 1 other like this.
  5. 1
    I agree with above poster.. I work a renal floor for a year. We held all BP meds and ABX prior to HD. If the pt needed vanc, the MD would write for to be given the last 30 minutes of hemo. All other meds were held until they came back.. They were late but we had a spot where we could state is was because of hemo..
    foodieRN likes this.
  6. 0
    Thank you both! Very helpful. I'll ask what kind of filters they use the next time I talk to the dialysis RNs.
  7. 2
    Save yourself some time. There is a little book 2011 Dialysis of Drugs by genzyme that gives you the most common drugs and whether or not they are dialyzed off during dialysis. Type in this link and you can download it at no cost http://renalpharmacyconsultants.com/...sUS2011web.pdf
    Lucky724 and Chisca like this.
  8. 0
    Your inhouse dialysis nurses can be great resources. If I am unsure, I will call them and ask which meds they want me to give/hold. I never give vitamins because they are water soluable. As for blood pressure meds, you can get parameters from the renal doc. The other day I had an order to hold all bp meds for systolic <150. Any non-dialysis patient, we would still give their bp meds when their bp is 110-130 systolic, but with a dialysis patient, taking fluid off decreases their bp and when their sbp gets dopwn to 70's/80's, the dialysis nurses aren't able to safely continue with dialysis and end up having to give fluid instead of taking off. As for antibiotics, our pharmacy dosing will sometimes include aditional does after dialysis, so we will still give them med, but then will give another dose after dialysis based on the pharmacists order.

    Just a few tips, but bottom line: Use your resoureces... Pharmacist, dialysis nurses or renal doc if you are unsure about giving a med.


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