Drug Dosing in Renal Insufficiency - Philippine College of Physicians

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Calculating individualized regimen • Loading dose (LD) required if: drug has a long half-life there is need to rapidly achieve desired steady-state concentration volume of distribution (VD) is significantly increased LD P t = Usual LD x Vd Pt Normal Vd
Calculating individualized regimen • Generally no change in LD EXCEPT for digoxin (50-75% of usual LD due to reduced Vd in renal failure) • With volume contraction, lower standard LD of aminoglycosides by 20-25% to avoid toxicity • In AKI, increased Vd of many drugs, especially hydrophilic antibiotics (Beta lactams, cephalosporins, penems) necessitates administration of aggressive loading doses (25- 50% greater)
Page 1 and 2: Drug Dosing in Renal Insufficiency
Page 3 and 4: Objectives • Discuss the effects
Page 5 and 6: Drug Pharmacokinetics • Bioavaila
Page 7 and 8: Bioavailability in CKD • Drug abs
Page 9 and 10: Volume of distribution (V d ) in CK
Page 15 and 16: Renal handling of drugs in CKD •
Page 17 and 18: Mathematics of drug elimination •
Page 19 and 20: Approach to adjust drug dosage 1. O
Page 21 and 22: Estimation of GFR and Creatinine Cl
Page 23 and 24: Estimation of GFR in AKI • No est
Page 25: Prescribing for a patient with rena
Page 29 and 30: Calculating individualized regimen
Page 31 and 32: ke = 0.693 / T 1/2 Dtsch Arztebl In
Page 33 and 34: Calculating individualized regimen
Page 35 and 36: Dtsch Arztebl Int 2010; 107(37): 64
Page 38 and 39: Drug dosing considerations for CKD
Page 40 and 41: Drug level monitoring • Ensures t
Page 42 and 43: Drug dosing considerations for PD
Page 44 and 45: Key points • Monitoring drug leve
Page 46: References Am Fam Physician 2007; 7

Drug Dosing in Renal Insufficiency - Philippine College of Physicians

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