Meds before dialysis?

[gospursgo07]

I had a pt with a few meds scheduled for 0800 (Lopressor, Amiodarone, and Plavix). Gave the meds on time, pt was OOBTC for breakfast, and transporter comes for pt at approx 0900 for dialysis. This pt was not on a reg MWF or TThS dialysis schedule, it was more like what the doc's felt depending on her labs, so I had no idea she was going on that day. I know most meds are "washed out" during dialysis...what would you do in this situation?

I called the MDs and they stated not to gove another dose of the Lopressor (BID dose and pt HR was in the 60s), or the Amiodarone ( TID dose and pt was NSR, though the day before she converted to a-fib), and not the Plavix either...

just curious...

[GeminiTwinRN, BSN]

If I ever have a question about meds, I call the HD unit and ask them. I understand you may not have had enough notice about the pt going to dialysis at all that day, so it may not have been an option.

That said, if my pt. has a HR of 60, I always hold the lopressor anyway. This would go double depending on the BP, and whether or not the pt was fluid overloaded or not. A lot of factors go into whether or not to give the meds, dialysis notwithstanding.

If you think you'll have this pt again, I'd call the HD unit and ask them a "for future reference" type question. You may get them to give you a pamphlet on dialyzed meds. I'm sure there's online info as well.

HTH! :)

[BillieRN]

We will occasionally have the dialysis team come up to the floor to do dialysis for a patient who is on isolation. The dialysis nurse has a book on the cart with meds that are flushed out of the system with dialysis and which ones are not. They are always more than willing to help you out. The doctors who write dialysis orders usually tell us to give certain drugs after dialysis. That said, I would advise calling the dialysis unit and asking them if the specifics drugs you need to give are flushed.

Billie

[twarlik]

I don't think you did anything wrong. Generally, we always hold medications prior to dialysis unless the MD states otherwise. This is especially true for blood pressure medications.

I agree with the one poster who suggested calling the dialysis nurse for advice on what medications should be given/held. They are usually the experts in that area.