Then, decrease dose of digoxin by 25-50% and monitor digoxin levels once weekly for several weeks. There may also be an additive effect on the sinus node of the heart.Īlternatives to Patient Management: Obtain digoxin level prior to initiation of amiodarone therapy. Amiodarone may decrease the clearance of digoxin, resulting in prolonged digoxin activity. Mechanism of Interaction: Multiple theories exist, but actual mechanism is unknown. Monitoring/Precautions: Potassium levels greater than 5.0 mmol/L and serum creatinine concentrations greater than 2.5mg/dL should be monitored carefully due to risk of severe hyperkalemia and EKG changes. Prior to initiation, obtain a potassium level with a serum creatinine and BUN to further evaluate use of these agents in combination. Spironolactone increased survival in patients with severe CHF. ACE inhibitors are recommended in diabetic patients for nephroprotection. ACE Inhibitors-SpironolactoneĪlternatives to Patient Management: Evaluate need for additional drug therapy. Adjust potassium supplementation if levels increase. Monitoring/Precautions: Potassium levels greater than 5.0 mmol/L should be monitored carefully due to risk of severe hyperkalemia and EKG changes. Mechanism of Interaction: Inhibition of ACE results in decreased aldosterone production and potentially decreased potassium excretion.Īlternatives to Patient Management: Draw potassium level prior to initiation of ACE-inhibitor in a patient. Impact: Potential for elevated serum potassium levels. Potassium gluconate/potassium chloride ( Kolyum)īrand names appear in parentheses above and are trademarks of their respective manufacturers/owners. Potassium gluconate/potassium citrate ( Twin-K) Potassium chloride/potassium bicarbonate/l-lysine monohydrochloride/citric acid ( K*Lyte/Cl, K*Lyte/Cl 50) Potassium chloride/potassium bicarbonate/potassium citrate/lysine hydrochloride ( Klorvess Effervescent Granules) Potassium chloride/potassium bicarbonate/lysine hydrochloride ( Klorvess) Potassium chloride ( Cena-K, Gen-K, K+8, K+10, K+Care, K-Dur 10, K-Dur 20, K-Lease, K-Lor, K-Norm, Kaochlor 10%, Kaochlor S-F, Kaon-Cl 20%, Kaon Cl-10, Kay Ciel, Klor-Con, Klor-Con 8, Klor-Con 10, Klor-Con/25, K*Lyte/Cl, Klotrix, K-Tab, K-vescent Potassium Chloride, Micro-K Extencaps, Micro-K 10 Extencaps, Micro-K LS, Potasalan, Rum-K, Slow-K, Ten-K) Potassium bicarbonate/potassium citrate/citric acid ( K*Lyte DS) Potassium bicarbonate/potassium citrate ( Effer-K, Effervescent Potassium, Klor-Con/EF, K*Lyte) Potassium acetate/potassium bicarbonate/potassium citrate ( Tri-K) It is hoped that this will help members of the team with both increasing surveillance and prompt identification of symptoms. The list will be publicized to members of the interdisciplinary teams via AMDA and ASCP publications, and will include the symptoms to identify. Three lists emerged, and then those that were present in all three lists were chosen for the first round. the frequency with which these drugs are prescribed in nursing homes.the frequency with which the interaction occurs, and.the clinical significance and potential to cause harm.To identify those on which the care team should focus, the group conducted a survey among physicians and pharmacists to identify drug-drug interactions according to: There are numerous possible interactions. While most residents take various combinations of drugs without experiencing interaction-related ADRs, they nonetheless have a risk which is higher for certain combinations as discussed above.Ī group of experts was convened by AMDA, in collaboration with the American Society of Consultant Pharmacists (ASCP), to develop strategies for medication management in nursing homes, identify the need to alert members of the interdisciplinary team of the need to anticipate the risk of ADRs related to drug interactions, and promptly recognize the symptoms of such interactions, so appropriate action can be taken on a timely basis. The likelihood of an interaction is also increased for drugs that are more commonly prescribed in nursing homes. Some combinations of drugs cause interactions more often than others. The severity and clinical significance of the interactions vary from mild and clinically unimportant to severe and life-threatening. The occurrence of an interaction depends on many factors, including the inherent pharmacological properties of the drugs, the resident's medical condition and presence of co-morbidities, the dose of the drugs, and the presence of other drugs. Many ADRs are due to drug-drug interactions. Recent studies have shown that adverse drug reactions (ADRs) are common among nursing home residents, and frequently go unrecognized or the symptoms attributed to another condition.
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