Which drug should be avoided in a patient with renal failure?

Succinylcholine should be avoided in a patient with renal failure primarily because it can lead to complications related to hyperkalemia. In individuals with compromised kidney function, the body's ability to excrete potassium is reduced. Succinylcholine, when administered, can cause a transient release of potassium from the muscle cells into the bloodstream. This can lead to elevated potassium levels, potentially resulting in dangerous cardiac arrhythmias or even cardiac arrest.

In contrast, the other drugs listed are generally safer for patients with renal failure. Albuterol is a bronchodilator that primarily acts on the respiratory system and is not significantly affected by kidney function. Sodium bicarbonate can be administered with caution, as it may be used to treat acidosis, although careful monitoring of electrolyte levels is necessary. Calcium plays various critical roles in the body, and while its levels must be monitored in renal failure, it is not directly contraindicated.

Overall, the specific mechanism of action and potential side effects of succinylcholine in the context of renal dysfunction make it necessary to avoid its use in these patients.