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Related Concept Videos

Renal Failure: Dose Adjustments01:11

Renal Failure: Dose Adjustments

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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...
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Rational Dosage Regimen: Maintenance Dose and Loading Dose01:24

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A rational dosage regimen considers a drug's pharmacokinetics, including its absorption, distribution, metabolism, and elimination from the body. By understanding these factors, the appropriate dosage can be determined, and the dosing schedule can be designed to achieve and maintain the desired therapeutic effect while minimizing adverse effects.
In most cases, drugs are administered repetitively or infused continuously to maintain a steady-state concentration in the body. At a steady...
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Dosage Regimen: Fixed Dose01:01

Dosage Regimen: Fixed Dose

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Fixed-dose regimens are a common approach to administer drugs to achieve and maintain desired levels of the drug in the body. In this dosing strategy, a specific amount of medication is given at regular intervals, often multiple times a day, to ensure a consistent drug concentration in the bloodstream.
Fixed-dose regimens can be used for various routes of administration, including intravenous (IV) injections and oral medications. For IV administration, a predetermined amount of the drug is...
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Factors Affecting Renal Clearance: Renal Impairment01:17

Factors Affecting Renal Clearance: Renal Impairment

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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...
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Drug Dosage Regimen: Overview01:15

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A drug dosage regimen describes the specific instructions and schedule for administering a drug to a patient. It considers factors such as drug dosage, frequency, route of administration, and duration of treatment. Designing an appropriate dosage regimen for a patient aims to achieve a target drug concentration at the site of action.
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Renal Drug Excretion: Tubular Secretion01:28

Renal Drug Excretion: Tubular Secretion

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Active tubular secretion is a robust, energy-demanding process that utilizes carrier systems to transport drugs into renal tubules. The active renal secretion systems include the organic anion transporter (OAT) for weak acids and the organic cation transporter (OCT) for weak bases. Structurally similar drugs can compete for the same transporter, potentially leading to drug accumulation and toxicity. However, this principle can be exploited therapeutically. One example is probenecid (Probalan),...
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Antimicrobial dosing recommendations during continuous renal replacement therapy: different databases, different

Aysel Pehlivanli1,2, Tuğba Yanik Yalçin3, Fatma İrem Yeşiler4

  • 1Pharmacology Department, Faculty of Pharmacy, Başkent University.

Journal of Chemotherapy (Florence, Italy)
|February 27, 2024
PubMed
Summary

Accurate antimicrobial dosing is crucial for critically ill patients with acute kidney injury requiring continuous renal replacement therapy (CRRT). The Micromedex database most closely aligns with the gold standard for CRRT drug dosing adjustments.

Keywords:
CRRTantimicrobial dosingantimicrobial stewardshipdatabasesgold standardpharmacokineticssepsis

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Area of Science:

  • Pharmacology
  • Nephrology
  • Critical Care Medicine

Background:

  • Effective antimicrobial therapy is vital for critically ill patients with acute kidney injury (AKI).
  • Drug removal during continuous renal replacement therapy (CRRT) complicates antimicrobial dosing.
  • Accurate dosing adjustments are necessary to ensure therapeutic efficacy and avoid toxicity in AKI patients on CRRT.

Purpose of the Study:

  • To evaluate and compare the accuracy of commonly used databases for adjusting antimicrobial drug dosages in patients undergoing CRRT.
  • To identify the most reliable database for guiding CRRT-specific antimicrobial dosing against a established gold standard.

Main Methods:

  • Dosage recommendations for antimicrobials cleared by CRRT were extracted from various databases.
  • A recognized pharmacotherapy reference book was designated as the gold standard for comparison.
  • The concordance rates of Micromedex, UpToDate, and Sanford databases with the gold standard were calculated.

Main Results:

  • Significant variations were observed among the evaluated databases regarding antimicrobial dosage recommendations for CRRT.
  • Micromedex demonstrated the highest similarity to the gold standard, with a 45% concordance rate.
  • UpToDate and Sanford showed lower concordance rates of 35% and 30%, respectively.
  • Expert panel meetings were convened to discuss discrepancies and reach a consensus on dosing recommendations.

Conclusions:

  • Current databases exhibit variability in providing accurate antimicrobial dosage adjustments for CRRT patients.
  • The Micromedex database appears to be the most reliable resource among those evaluated for CRRT antimicrobial dosing.
  • Further consensus-building among experts is recommended to refine antimicrobial dosing guidelines in AKI patients on CRRT.