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Related Concept Videos

Factors Affecting Renal Clearance: Renal Impairment01:17

Factors Affecting Renal Clearance: Renal Impairment

114
Renal dysfunction significantly impairs the renal clearance of drugs, leading to potential complications in drug therapy. Renal failure, which can be caused by various factors, poses a significant challenge in the elimination of drugs from the body.
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...
114
Renal Failure: Dose Adjustments01:11

Renal Failure: Dose Adjustments

109
In patients with renal impairment, drugs undergo significant changes in their pharmacokinetics, which require dosage adjustments to ensure safe and effective therapy.
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
109
Factors Affecting Renal Clearance: Drug's Physicochemical Properties and Plasma Levels01:31

Factors Affecting Renal Clearance: Drug's Physicochemical Properties and Plasma Levels

258
Renal clearance of a drug is influenced by various factors, including its physicochemical properties and plasma levels. These factors play a significant role in determining how efficiently the kidneys eliminate a drug.
One important factor is the drug's molecular size. The kidneys readily excrete smaller molecules below 300 Daltons (Da). On the other hand, molecules weighing between 300 and 500 Da are excreted through both urine and bile. Larger molecules above 500 Da tend to be excreted...
258
Factors Affecting Renal Clearance: Drug Distribution and Drug Interactions01:09

Factors Affecting Renal Clearance: Drug Distribution and Drug Interactions

154
Renal clearance plays a pivotal role in drug elimination from the body and can be influenced by drug distribution and interactions. Understanding these factors is crucial in pharmacology as they impact the effectiveness and duration of drug therapy.
One important factor is the relationship between renal clearance and the apparent volume of distribution. Renal clearance tends to be inversely proportional to the apparent volume of distribution. Drugs with an extensive distribution volume or those...
154
Nonlinear Pharmacokinetics: Dependence of Elimination Half-Life and Dose Clearance01:23

Nonlinear Pharmacokinetics: Dependence of Elimination Half-Life and Dose Clearance

186
The elimination half-life and drug clearance of drugs following nonlinear kinetics can vary with dosage. The Michaelis-Menten parameters and drug concentration influence these factors. As the dose increases, the elimination half-life tends to lengthen, resulting in a reduction in clearance and a disproportionately larger area under the curve. The total clearance can be derived from the Michaelis-Menten equation for drugs following a one-compartment model.
A study on guinea pigs examined the...
186
Nonlinear Pharmacokinetics: Causes of Nonlinearity01:22

Nonlinear Pharmacokinetics: Causes of Nonlinearity

219
Nonlinearity in drug pharmacokinetics is caused by various factors influencing how a drug is absorbed, distributed, metabolized, and excreted. Understanding these nonlinear processes is crucial for predicting drug behavior in the body and optimizing drug dosing regimens.
Nonlinear drug absorption can occur when the process is rate-limited by solubility, carrier-mediated transport systems, or saturation of the presystemic gut wall or hepatic metabolism. For instance, high doses of riboflavin...
219

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Early Detection of Drug-Induced Renal Hemodynamic Dysfunction Using Sonographic Technology in Rats
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Meropenem PK/PD Variability and Renal Function: "We Go Together".

Jacopo Angelini1,2, Simone Giuliano3, Sarah Flammini3

  • 1Clinical Pharmacology and Toxicology Institute, University Hospital Friuli Centrale ASUFC, 33100 Udine, Italy.

Pharmaceutics
|September 28, 2023
PubMed
Summary
This summary is machine-generated.

Therapeutic drug monitoring (TDM) for meropenem optimizes dosing in real-world settings. TDM identified significant meropenem dose adjustments needed in 64% of patients, particularly those with renal impairment, to improve outcomes.

Keywords:
antibioticsantimicrobial resistanceclinical pharmacologycontinuous infusioncritical illnessdose optimizationmeropenempharmacokineticrenal functiontherapeutic drug monitoring

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Area of Science:

  • Pharmacology
  • Infectious Diseases
  • Clinical Pharmacy

Background:

  • Meropenem is a critical carbapenem antibiotic for severe bacterial infections.
  • Therapeutic drug monitoring (TDM) is essential for optimizing meropenem dosing, especially in critically ill patients.
  • This study evaluates meropenem TDM's impact on clinical management outside intensive care units.

Purpose of the Study:

  • To assess the influence of meropenem therapeutic drug monitoring (TDM) on dosing strategies in a real-world clinical setting.
  • To investigate the relationship between meropenem exposure and patient renal function.
  • To identify patient subgroups requiring meropenem dose adjustments.

Main Methods:

  • Retrospective analysis of 195 meropenem serum concentrations (Css) from December 2021 to February 2022.
  • Patient characterization based on meropenem exposure levels (therapeutic, underexposed, overexposed).
  • Correlation analysis between renal function and meropenem Css, including dose-normalized exposure (Css/D) across different renal function categories.

Main Results:

  • Only 36% of patients achieved therapeutic meropenem Css (8-16 mg/L); 64% required dose modification.
  • Significant correlation (r = -0.7, p < 0.001) found between renal function and meropenem concentrations.
  • Dose-normalized meropenem exposure (Css/D) varied significantly with renal function (p < 0.001), with higher exposure in impaired renal function.

Conclusions:

  • Meropenem TDM in clinical practice facilitates necessary dosing adjustments for patients with inadequate exposure.
  • Optimizing meropenem dosing via TDM can enhance antibiotic efficacy and mitigate resistance risks.
  • Renal function significantly impacts meropenem exposure, necessitating TDM even with standard dose adjustments.