Hyperkalemia NSAIDs

NSAIDs can cause renal insufficiency when administered to patients whose renal function depends on prostaglandins. Patients with chronic renal insufficiency or left ventricular dysfunction, the elderly, and those receiving diuretics or drugs that interfere with the renin-angiotensin system are particularly susceptible. Decreased glomerular filtration also may cause hyperkalemia. NSAIDs rarely cause tubulointerstitial nephropathy and renal papillary necrosis. 

The hypotensive effects of most antihypertensive dru are increased when administered with diuretics and other antihypertensives. Many dnigp can interact with the antihypertensive drugs and decrease their effectiveness (eg, antidepressants, monoamine oxidase inhibitors, antihistamines, and sympathomimetic bronchodilators). When the ACE inhibitors are administered with the NSAIDs, their antihypertensive effect may be decreased. Absorption of the ACE inhibitors may be decreased when administered with the antacids. Administration of potassium-sparing diuretics or potassium supplements concurrently with the ACE inhibitors may cause hyperkalemia. When the angiotensin II receptor agonists are administered with... 

The COX-2 enzyme is also produced normally in the kidney thus COX-2 inhibitors exert renal effects similar to those of conventional NSAIDs. Both drug classes may increase sodium reabsorption and fluid retention and can provoke renal insufficiency and hyperkalemia. COX-2 inhibitors should be used with caution in patients with heart failure or hypertension. 

Potassium-sparing diuretics may cause hyperkalemia, especially in patients with chronic kidney disease or diabetes, and in patients receiving concurrent treatment with an ACE inhibitor, ARB, NSAID, or potassium supplement. Eplerenone has an increased risk for hyperkalemia and is contraindicated in patients with impaired renal function or type 2 diabetes with proteinuria. Spironolactone may cause gynecomastia in up to 10% of patients, but this effect occurs rarely with eplerenone. 

ACE inhibitors decrease aldosterone and can increase serum potassium concentrations. Hyperkalemia occurs primarily in patients with chronic kidney disease or diabetes and in those also taking ARBs, NSAIDs, potassium supplements, or potassium-sparing diuretics. 

K /Na exchange in distal tubule Dose Adults. 5-10 mg PO daily Peds. 0.625 mg/kg/d X in renal impair Caution [B, ] Contra T K, SCr >1.5 mg/dL, BUN >30 mg/dL, diabetic neuropathy Disp Tabs SE T K HA, dizziness, dehydration, impotence Interactions T Risk of hyperkalemia W/ ACEI, K-sparing diuretics, NSAIDs, K salt substitutes T effects OF Li, digoxin, antihypertensives, amantadine T risk of hypokalemia W/ licorice EMS Monitor ECG for signs of hyperkalemia (peaked T waves) T effects of digoxin OD May cause bradycardia, light-headedness, and syncope symptomatic and supportive... 

Benazepril (Lotensin) [Antihypertensive/ACEI] Uses HTN DN, CHF Action ACE inhibitor Dose 10 0 mg/d PO Caution [C (1st tri), D (2nd 3rd tri), +] Contra Angioedema, Hx edema, bilateral RAS Disp Tabs 5, 10, 20, 40 mg SE Symptomatic i BP w/ diuretics dizziness, HA, nonproductive cough Interactions T Effects W/ a-blockers, diuretics, capsaicin effects W/ NSAIDs, ASA T effects OF insulin, Li T risk of hyperkalemia W/ trimethoprim K-sparing diuretics EMS Monitor EGG for signs of hyperkalemia angioedema is rare but can occur persistent cough /or taste changes may develop OD Profound hypotension treat w/ IV fluid... 

Use in PRG in 2nd/3rd tri can result in fetal death Uses HTN, CHF, LVD, post-AMI Action ACE inhibitor Dose HTN 2- mg/d CHF/LVD 4 mg/d i w/ severe renal/h atic impair Caution [D, +] ACE inhibitor sensitivity, angioedema w/ ACE inhibitors Disp Tabs SE X BP, bradycardia, dizziness, t K, GI upset, renal impair, cough, angioedema Notes African Americans, minimum dose is 2 mg vs 1 mg in Caucasians Interactions t Effects W/ diuretics t effects OF insulin, Li -1- effects W/ ASA, NSAIDs EMS Monitor ECG for hyperkalemia (peaked T waves), esp in pts taking K-suppl OD May cause profound hypotension give IV fluids... 

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