Which medication should be withheld before a patient undergoes hemodialysis?

Which medication should be withheld before a patient undergoes hemodialysis?

• A. Cardiac glycosides
• B. Antibiotics
• C. Antihypertensives
• D. Antiplatelets

Answer: (A)

The main idea is that some drugs require withholding before dialysis because they can cause problems during the procedure or aren’t effectively cleared by dialysis. Cardiac glycosides, like digoxin, have a narrow margin between benefit and toxicity and rely heavily on kidney function for clearance. Dialysis does not remove digoxin well, so in a patient with renal impairment its level can accumulate. The intradialytic environment also involves shifts in electrolytes and fluid, which can precipitate dangerous arrhythmias in the presence of digoxin. For this reason, withholding this medication before hemodialysis helps prevent toxicity and rhythm disturbances. Antibiotics, antihypertensives, and antiplatelets have different considerations around dialysis and aren’t categorized as the single best choice for withholding in this scenario, since their management around dialysis depends on the specific drug, dose, and patient situation.

The main idea is that some drugs require withholding before dialysis because they can cause problems during the procedure or aren’t effectively cleared by dialysis. Cardiac glycosides, like digoxin, have a narrow margin between benefit and toxicity and rely heavily on kidney function for clearance. Dialysis does not remove digoxin well, so in a patient with renal impairment its level can accumulate. The intradialytic environment also involves shifts in electrolytes and fluid, which can precipitate dangerous arrhythmias in the presence of digoxin. For this reason, withholding this medication before hemodialysis helps prevent toxicity and rhythm disturbances.

Antibiotics, antihypertensives, and antiplatelets have different considerations around dialysis and aren’t categorized as the single best choice for withholding in this scenario, since their management around dialysis depends on the specific drug, dose, and patient situation.