What is the triple whammy effect?

The term “triple whammy” refers to the concurrent use of an angiotensin converting enzyme (ACE) inhibitor or an angiotensin-II receptor blocker (ARB), with a diuretic and a non-steroidal anti-inflammatory drug (NSAID), including cyclo-oxygenase-2 (COX-2) inhibitors.

Why is triple whammy bad?

Triple Whammy – ‘three simultaneous deleterious blows with compounded effect’. The combination of medicines above can result in significant harm. Used individually or combined, these three types of medicines are involved in more than half of all reported iatrogenic acute renal failure cases.

Why do ACE inhibitors cause Aki?

ACE-I in the setting of hypovolemia can cause acute kidney injury due to inadequate renal perfusion. The RAAS is activated when decreased blood flow is detected in the kidneys, which can happen in normal states such as dehydration but can also happen in pathological states such as heart or liver failure.

Is ACEI nephrotoxic?

For instance, the Kidney Disease Improving Global Outcomes guideline on CKD advises clinicians to review or stop the medications in patients with or at risk of AKI, and it includes ACEI and ARB under the umbrella term “potentially nephrotoxic drugs” (guideline 4.4.

How do NSAIDs cause Aki?

The first mechanism of acute kidney injury (AKI) from NSAIDs is due to reduced renal plasma flow caused by a decrease in prostaglandins, which regulate vasodilation at the glomerular level.

What are the 5 types of diuretics?

Thiazides are the most commonly prescribed diuretics. They’re most often used to treat high blood pressure. These drugs not only decrease fluids, they also cause your blood vessels to relax….Thiazide diuretics

  • chlorthalidone.
  • hydrochlorothiazide (Microzide)
  • metolazone.
  • indapamide.

What is an Aki?

Acute kidney injury (AKI) is where your kidneys suddenly stop working properly. It can range from minor loss of kidney function to complete kidney failure.

When Should ACE inhibitors be discontinued in AKI?

The concept that ACEIs/ARBs cause AKI during intercurrent illness is also embedded in the idea of “sick-day rules.” These are recommendations for patient-led drug cessation (including ACEIs/ARBs) if they become unwell with diarrhea and vomiting or with features suggestive of sepsis.

Are ACE inhibitors bad for kidneys?

ACE inhibitors and creatinine Treatment with ACE inhibitors is associated with an acute increase in serum creatinine; a sign of mild kidney damage. Increased creatinine levels are attributed to the decline in the blood pressure in the kidney, caused by the inhibition of the renin-angiotensin system.

Can ARBs cause kidney damage?

We reviewed the literature along these lines and submit that ACEIs and ARBs often cause unrecognized significant worsening renal failure in CKD patients, sometimes irreversible, and that more caution is required regarding their use, especially in the older hypertensive patients, with likely ischemic hypertensive …

Which NSAID is safest for kidneys?

Ibuprofen was the safest NSAID, conferring a significant 12% increased risk of incident eGFR less than 60, 32% increased risk of an eGFR decline of 30% or greater, and 34% increased risk of the composite outcome. Etoricoxib had the largest negative effect on kidney function.

Is ibuprofen hard on the kidneys?

Ibuprofen and other NSAIDs block prostaglandins, natural body chemicals that normally dilate blood vessels leading to the kidneys. Blocking prostaglandins may lead to decreased blood flow to the kidneys, which means a lack of oxygen to keep the kidneys alive. That can cause acute kidney injury.