To give or not to give meds before Dialysis?

[GoECU]

I'm a home health nurse with a question for you dialysis nurses. I prefill my patients medications a week at a time in medication planners/boxes. On days patients go to dialysis what morning medications should wait to be taken after dialysis so they won't be filtered out? I want to make sure that I time the medications appropriately for the medications maximum benefit.

[traumaRUs, MSN, APRN]

Hi. Sorry I missed your post. As a general rule you would give the following meds prior to dialysis:

Vitamins

Some oral hypoglycemics

Insulin if the pt can eat prior to dialysis

Basically you would hold all htn meds

All cardiac meds

And most everything else too.

However many caveats:

What time is your pt dialyzing? Obviously if the pt doesn't dialyze till 6 at night you wouldnt necessarily hold all am meds. Similarly with some pts you would not hold BP meds.

Sorry if I'm confusing the issue but there are many variables. You might want to call the midlevel provider at the dialysis unit.

Good luck.

[jamsabraham]

Hi

from my understanding we should not give water soluble vitamins ( Vit B and Vit C)prior to dialysis as theyare going to dialyse out.

[traumaRUs, MSN, APRN]

Usually dialysis pts receive a renal vitamin which I tell them to take after dialysis.

You are correct about water soluble vitamins

[jamsabraham]

thanks!!!!!!!!!!!

[bsquared]

what if the patient is hypertensive before dialysis and he has Q6h PRN BP meds, is it okay to give this? ...say he was given PRN hydralazine @ 2400 for elevated BP and VS check pre dialysis @ 0600, the BP remains high, should you give the PRN BP med before he leaves for dialysis?

[rogue_maverick]

In our institution, hypertensive patients are usually given clonidine 75mg or 150mg SL while on dialysis. When post-dialysis the patient is still hypertensive, we give nifedipine 5mg SL.

[MandarinOrange]

I noticed this is an old thread but felt compelled to comment. IMO, before holding any meds you have to get a physician's order. It is not within the scope of nursing practice to say what meds should be held and which ones should be given, each patient is different with different disease states. While it is customary to hold the anti-hypertensives, this may not be the case for every patient, since there are some patients who once they start HD their BP goes sky high. If you want to know what meds are dialyzed out you can do an internet search for "Dialysis of Drugs 2011" the most recent listing of drugs and their ability to get dialyzed out.

[traumaRUs, MSN, APRN]

I just have to comment on rogue maverick's post: Clonidine is 0.1 to 0.3 mg usually. Are you maybe thinking lopressor?

[rogue_maverick]

Tnx for pointing that out. It's supposed to be 75 mcg or 150 mcg.