Lect 8 Flashcards
how does renal failure affect volume of distribution?
reduction in tissue binding
decreased binding of acidic drugs
alteration in binding of basic drugs
total serum conc may not accurately reflect unbound drug conc
normal phenytoin conc
10-20 mcg/mL
90% is protein bound normally but diff in renal failure
when do you use hypoalbuminuria and renal insuffienciency equation?
CrCl less than 10 mL/min (pts who are completely anuric or are at end stage)
equation for hypoalbuminuria
0.2 x albumin
equation for hypoalbuminuria and renal insufficiency
0.1 x albumin
adjusting doses
- obtain history
- CrCl
- review current meds
- calculate individualized treatment regimen
- monitor
- revise
intermittent drug dosing in dialysis
maintain a high conc until dialysis, then drops
continuous drug dosing in dialysis
more like normal kidney function
which drugs will have less clearance?
high molecular size/weight
highly protein bound
which drugs will have higher vol of distribution?
fluid overloaded
peritoneal dialysis
not as effective as hemodialysis at removing substances
if drug is not removed by hemodialysis, not likely to be removed by PD
anticoags that have to be renally adjusted
warfarin and LMWH
anticonvulsants that have to be renally adjusted
phenytoin
cardiac meds that have to be renally adjusted
spironolactone, digoxin, procainamide
analgesics that have to be renally adjusted
NSAIDs, meperidine, morphine
