-
increased F due to a reduction in first-pass
dihydrocodeine, propranolol, dextropropoxy
-
decreased PPB uremia causing increase Vd
pheny, valc, warfa, salicy, diazepa,, clorazepate
-
decreased tissue binding due to compeptivee displacement by accumlation of uremic toxins causing a dec in Vd
digoxin, dec by 30-50%
-
increase in Vd due to increase in tbw
ags, and vanco
-
drugs metabolized to pharmacologically active metabolites and eliminated by kidney
APAP, codeine, meperidine (CNS toxin), morphine, procainamide, propxy (CNS and cardiac toxin), sulfonamides, tramadol (contributes to CNS effect)
-
fraction of drug elininated unchanged
>=75% of concern, usually don't dose adjust until <50ml/min
-
reasons for dose adjusting(4)
- >=75%
- drug or metab has narrow TI
- kidney is major site of elim-insulin
- sign decr in binding of narrow therpeutic range drug to plasma protein
-
analgesics
meperidine, morphine, ketoralac, tramadol
-
abx need ad
cepha, ags, vanco, ampici, imipenem, quiniolones, SMX/TMP, metronid
-
antifungals adj
flucon, flucytosine
-
antidiabetics adj
glyburide, met, insulin
-
-
misc adj
allopu, LMWH, metoclo, neurontin, pheny, statins
-
quick estimation of CrCl
(140-age)/Crx.85 if female
-
rowland and tozer eq
Q=1-[fe-(1-KF)], KF=crclf/crcln, fe=fraction excreted unchanged
-
keep same dose, extend interval
cmax and cmin are of concern, concentration dep, abs, antiarr, theoy, antiepill-may have prolonged period below min effective conc
-
decrease dose, keep same interval
same avg conc desired, antidep, antihyp, statins, chronic therapy
-
exceptions for adjusting LD
Vd small, LD smaller-dig, vd larger, ld larger-vanco and ags
-
correction for hypoalbumineria for phenytoin
<3.5, C adjusted=meas con/(.2 X meas alb)+.1
-
correction for renal failure-pheny
<15, C adjusted = meas conc/(0.1 X meas alb) + 0.1
-
mW dialyz
<500 D or <20000 high flux, less than <70%unchaged will pass
-
Vd dialy
- <1L/kg-most likely
- 1-2-margin
- >2-not removed
-
redistribution phase length
lithium-unkonw, ags-2 hr, vanco-4 hr
-
commom medicqtions that are dialyzed ou5
APAP, ASA, water sol vitamins, many abx, give antihyper after and warfarin after
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