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24 Cards in this Set
- Front
- Back
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Which 2 medications have reduced absorption in CKD? |
Propranolol and dihydrocodeine |
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Reasons for altered drug absorption in CKD |
1. GI edema 2. N/V 3. Gastroparesis 4. Delayed gastric empyting |
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2 Factors affecting VD in CKD |
1. Altered plasma protein binding 2. Fluctuations in fluid status |
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Decreased protein binding leads to |
increased VD (less drug in vascular space): possible increased effects |
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ESRD effect on VD aminoglycosides |
normal: 0.2 to 0.3 |
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ESRD effect on VD of beta-lactams |
increased (0.13-0.16) |
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ESRD effect on VD of vanc |
0.64 to 0.85 |
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ESRD effect on VD of bactrim |
increased: 1.36 to 1.83 |
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Increased fluids in CKD effect on drugs |
decrease serum concentrations: may need dose adjustments (no clinically significant effects have been noted) |
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Enzyme systems impaired in patients with CKD |
2C6, 3A1/2 -degree of reduction not as great in those with AKI compared to ESRD |
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Alterations in GF and tubular secretion in CKD |
Filtered drugs: dec. GFR = dec. clearance |
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Most common PK changes in AKI |
Increased VD of water-soluble drugs d/t EC volume expansion Altered protein binding Dec. systemic clearance d/t kidney failure |
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PK changes in shock/sepsis |
Increased cap permeability, interstitial edema, and large-volume fluid resus leads to increased VD of water-soluble AB |
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Non-renal conditions that can subsequently affect drug metabolism/clearance |
decreased blood flow to liver (shock liver, vasopressor use, overwhelming sepsis), cirrhosis, variability in CYP inhibition or induction |
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Antimicrobial PD |
Killing profile (bacteriostatic vs cidal, PAE, concentration-depend vs. time-dependent) |
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AUC: MIC |
FQ and ketolides linezolid, macrolides, clindaymcin, tetracyclines, vancomycin |
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Optimization of time-dependent killing agents |
shorter dosing intervals extended infusions continuous infusions |
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Diffrences between RRT |
1. Filter/dialyzer material composition and SA 2. Duration of the procedure 2. Blood flow rate 3. Dialysate flow rate 4. UF rate 5. Preversus post replacement fluid admin |
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Diffusion |
passive movement of subs down conc gradient across semipermeable hemofilter or dialyzer membrane |
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diffusion removal of drugs influences |
1. dialyzer filter compsition and SA 2. UF rate |
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Convection |
solutes and drugs are actively removed from blood by a pump-driven pressure gradient (solvent drag) independent of conc. gradient or molecualr size |
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Diffusion methdods |
IHD CVVHD |
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Convection drug and solute removal methods |
CVVH |
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Both convection and diffusion methods |
CVVHDF (greater drug removal than convection or diffusion methods alone) |
