Potassium disorder drugs

drug induced hypokalemia

diuretics, acetazolamide, amphotericin, corticosteroids, cisplatin, sorbitol, SPS, penicillin, b2 agonists, insulin and glucose

Drug induced hyperkalemia

ACEI/ARB, beta blockers, digoxin, K drugs (KCl, Penicillin G), aldosterone antagonists, K sparing diuretics (triamterene, amiloride), heparin, cyclosporin/tacrolimus, NSAIDs

Sodium Polystyrene Sulfonate (SPS) AEs

GI upset (anorexia, N/V/C), electrolyte disturbances (dec K, Mg, Ca; inc Na), intestinal necrosis (highest risk when combined with 70% sorbitol or enema route)

SPS CI

bowel dysfunction, GI surgery

Patiromer (Velatassa)

• MOA: K binder in exchange for calcium (sodium free)

• DDI: ciprofloxacin, levothyroxine, metformin; separate from other meds for 3 hrs

• ADRs: GI upset, hypomagnesemia

Sodium Zirconium Cyclosilicate (Lokelma)

• MOA: inorganic cation exchanger, K specific (contains sodium, more rapid correction)

• DDI: clopidogrel, dabigatran, warfarin separate from other meds for 2 hours

• ADRs: edema

Avoid with Veltassa

cipro, levo, metformin THREE HOURS

Avoid with Lokelma

clop, dabig, warfarin TWO HOURS

K supplements

KCl (PO or IV) — Klor-Con wax matrix, K-dur microencapsulated

Potassium phosphate (PO or IV) if hypophos.

Potassium bicarb (PO only) if acidotic

difference between Klor-Con and K-dur?

Klor-Con is smaller but higher risk of GI erosion, K-dur is very large pill but lower risk of erosion

IV potassium supp. AEs

thrombophlebitis, hyperkalemia, pain/burning infusion site

Oral potassium supp. AEs

GI irritation and erosion, dose <40 mEq