How does narcotic pain management differ in patients with CKD? Meperidine This drug should be avoided in patients with kidney failure because of accumulation of its metabolite (normeperidine), which undergoes kidney elimination. Normeperidine also has an excitatory effect on the central nervous system and causes seizures if it accumulates. Propoxyphene should also be avoided in patients …
New guidelines for the use of metformin in various degree of kidney disease What is the new guideline for the appropriate use of metformin in patients with various degree of kidney disease? Historically, metformin was contraindicated in patients with CKD. The U.S. Food and Drug Administration (FDA) required a labeling change for metformin. Dosing is …
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What adjustments should be made for patients with diabetes? The breakdown of insulin decreases as kidney function deteriorates. Patients with diabetes must be monitored for symptoms of hypoglycemia because their insulin requirement may decrease concurrently. Sulfonylureas that are excreted primarily by the kidneys can accumulate and result in a prolonged hypoglycemic effect. For example, glyburide …
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What adjustments should be made for administering vancomycin to patients receiving hemodialysis? It is important to load patients receiving dialysis with 15 to 20 mg/kg based on ABW. Maintenance doses will depend on the dialysis membrane used during hemodialysis. Vancomycin Administration in Patients Undergoing Dialysis HEMODIALYSIS (HD) (HIGH FLUX) CONTINUOUS VENOVENOUS HEMOFILTRATION (HD, HEMODIAFILTRATION) PERITONEAL …
How should aminoglycosides be adjusted for hemodialysis? First, the patient’s dosing weight should be determined. Use ideal body weight (IBW) unless total body weight (TBW) is less. • Nonobese is: TBW < 130% of IBW • IBW (males) = 50 kg + (2.3 × height in inches >60 inches) • IBW (females) = 45 kg + (2.3 × …
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How can changes in distribution from CKD alter the pharmacokinetic behavior of drugs? The volume of distribution (V D ) represents the ratio of administered dose to the resulting plasma drug concentration. The calculated V D is a theoretic representation of the size of the anatomic space occupied by the drug if it were present throughout the body in …
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How can chronic kidney disease (CKD) alter the pharmacokinetic behavior of most drugs? Chronic kidney disease directly and indirectly affects the pharmacokinetic properties of most drugs. Alterations of drug pharmacokinetics in patients with kidney failure are based on changes in absorption, distribution, metabolism, and elimination.