Potassium disorder drugs

drug induced hypokalemia

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

Potassium supplements

• KCl

• potassium phosphate

• potassium bicarbonate

Potassium phosphate

for concomitant hypophosphoremia

potassium bicarbonate

for concomitant metabolic acidosis

Drug induced hyperkalemia

• ACE-I (lisinopril), ARBs (valsartan), direct renin inhibitors

• beta blockers (metoprolol)

• digoxin

• potassium drugs (KCl, Penicillin G)

• aldosterone antagonists (Spironolactone)

• K sparing diuretics (triamterene, amiloride)

• heparin

• cyclosporin/tacrolimus

• NSAIDs

Sodium Polystyrene Sulfonate (SPS)

• 1 hr onset

• removes excess K

• ADRs: 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)

• CI: bowel dysfunction or recent GI surgery

Patiromer (Velatassa)

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

• DDI: 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)

• separate from other meds for 2 hours

• ADRs: edema

Avoid with Veltassa

• cirpofloxacin

• levothyroxine

• metformin

Avoid with Lokelma

• clopidrogrel

• dabigatran

• warfarin