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Renal Pharmacology

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Warfarin

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Use: Anticoagulant for AFib, DVT; Mechanism: Vitamin K antagonist; Dosing in kidney disease: No dose adjustment necessary, but more frequent monitoring is recommended.

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Sevelamer

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Use: Hyperphosphatemia in CKD; Mechanism: Phosphate binder; Dosing in kidney disease: Initiates at low doses and titrates according to phosphate levels, no systemic absorption.

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Sildenafil

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Use: Erectile dysfunction, pulmonary hypertension; Mechanism: PDE5 inhibitor; Dosing in kidney disease: Start with a lower dose in patients with kidney impairment.

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Metformin

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Use: Type 2 Diabetes Mellitus; Mechanism: Decreases hepatic glucose production; Dosing in kidney disease: Contraindicated if GFR <30 mL/min/1.73 m^2.

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Spironolactone

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Use: Hypertension, CHF; Mechanism: Potassium-sparing diuretic; Dosing in kidney disease: Use with caution, may cause hyperkalemia, especially in advanced CKD.

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Heparin

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Use: Anticoagulant for DVT, PE; Mechanism: Activates antithrombin III; Dosing in kidney disease: No major dose adjustment needed, but monitor aPTT more frequently.

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Cinacalcet

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Use: Secondary hyperparathyroidism in CKD; Mechanism: Calcimimetic; Dosing in kidney disease: Adjusted based on PTH, calcium, and phosphorus levels. Use with caution.

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Lisinopril

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Use: Hypertension, CHF; Mechanism: ACE inhibitor; Dosing in kidney disease: Adjust dose in renal impairment, potential for elevated potassium.

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Calcitriol

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Use: Hypocalcemia, secondary hyperparathyroidism; Mechanism: Active form of vitamin D; Dosing in kidney disease: Requires dose adjustment depending on calcium and phosphate levels.

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Furosemide

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Use: Edema, CHF; Mechanism: Loop diuretic; Dosing in kidney disease: May require higher doses in renal impairment, watch for ototoxicity.

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Epoetin alfa

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Use: Anemia in chronic kidney disease; Mechanism: Stimulates RBC production; Dosing in kidney disease: Dose based on hemoglobin levels, ESA resistance may occur.

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Insulin

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Use: Diabetes mellitus; Mechanism: Lowers blood glucose levels; Dosing in kidney disease: May require dose reduction due to decreased insulin clearance.

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Prednisone

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Use: Anti-inflammatory, immunosuppression; Mechanism: Corticosteroid; Dosing in kidney disease: No dose adjustment required, but long-term use may worsen chronic kidney disease.

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Vancomycin

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Use: Serious Gram-positive infections; Mechanism: Inhibits cell wall synthesis; Dosing in kidney disease: Requires monitoring of levels and dose adjustment due to nephrotoxicity risk.

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Gabapentin

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Use: Neuropathy, seizures; Mechanism: GABA analog; Dosing in kidney disease: Requires dose adjustment in renal impairment, monitor for CNS side effects.

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Doxazosin

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Use: Hypertension, BPH; Mechanism: Alpha-blocker; Dosing in kidney disease: Generally no adjustment needed, but monitor for hypotension.

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Amlodipine

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Use: Hypertension, angina; Mechanism: Calcium channel blocker; Dosing in kidney disease: No dose adjustment needed, but monitor for edema.

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Levothyroxine

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Use: Hypothyroidism; Mechanism: Synthetic thyroid hormone; Dosing in kidney disease: Usually no dose adjustment required, but monitor thyroid function tests routinely.

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