JAWAHARLAL NEHRU TECHNOLOGICAL UNIVERSITY HYDERABAD Pharm. D III Year PHARMACOTHERAPEUTICS – II Previous Question Paper (July/August - 2021 - R08)

The management of chronic renal failure (CRF) focuses on slowing disease progression, managing complications, and preparing for renal replacement therapy. Key strategies include blood pressure control using ACE inhibitors or ARBs, glycemic control in diabetics, dietary protein restriction, and correction of anemia with erythropoiesis-stimulating agents.

The management algorithm follows these steps:

1. Identify and treat reversible causes of renal dysfunction.
2. Implement lifestyle modifications: smoking cessation, weight management, and sodium restriction.
3. Pharmacological intervention: Use ACE inhibitors/ARBs to reduce proteinuria and manage hypertension.
4. Manage metabolic complications: Control hyperphosphatemia with phosphate binders, manage secondary hyperparathyroidism with Vitamin D analogs, and treat metabolic acidosis with sodium bicarbonate.
5. Monitor GFR and adjust medications to prevent nephrotoxicity.
6. Prepare for renal replacement therapy (hemodialysis, peritoneal dialysis, or transplantation) when GFR falls below 15 mL/min/1.73m².

Meningitis pharmacotherapy requires prompt initiation of empiric intravenous antibiotics that achieve adequate cerebrospinal fluid (CSF) penetration. Treatment is typically adjusted once the causative organism is identified via lumbar puncture.

For bacterial meningitis, the standard empiric regimen for adults is a third-generation cephalosporin (e.g., ceftriaxone or cefotaxime) combined with vancomycin to cover penicillin-resistant Streptococcus pneumoniae. In patients over 50 years or those who are immunocompromised, ampicillin is added to provide coverage against Listeria monocytogenes.

Adjunctive therapy with dexamethasone is recommended to reduce neurological sequelae and inflammation, particularly in cases of pneumococcal meningitis; it should be administered 15–20 minutes before or concurrently with the first dose of antibiotics. Duration of therapy varies by pathogen, typically ranging from 7 to 21 days. Supportive care includes fluid management, seizure prophylaxis, and monitoring for increased intracranial pressure.