Dosages adjustment

Czock D, Giehl M, Keller F (2000) A concept for pharmacokinetic-pharmacodynamic dosage adjustment in renal impairment the case of aminoglycosides. Clin Pharmacokinet 38(4) 367—375. Erratum in Clin Pharma-cokinet 2000 39(3) 231... 

The older adult is more susceptible to the nephrotoxic effects of the cephalosporins particularly if renal function is already diminished because of age or disease. If renal impairment is present, a lower dosage and monitoring of blood creatinine levels are indicated. Bood creatinine levels greater than 4 mg/dL indicate serious renal impairment. In elderly patients with decreased renal function, a dosage adjustment may be necessary. 

The aminoglycosides are used cautiously in patients with renal failure (dosage adjustments may be necessary), in the elderly, and in patients with neuromuscular disorders. 

Before administering this drug to an elderly patient or one that has renal impairment, the primary health care provider may order a creatinine clearance. The initial dose is 50 to 100 mg PO or IV, depending on the results of the creatinine clearance. The nurse reports the laboratory results to the primary health care provider because dosage adjustments may be made on the results of the creatinine clearance. 

The patient s response to drug therapy on an inpatient basis requires around-the-clock assessments because frequent dosage adjustments may be necessary during therapy. 

When administering the antipsychotic drugs, the nurse observes the patient for extrapyramidal effects , which include muscular spasms of the face and neck, the inability to steep or s t still, tremors rigidity, or involuntary rhythmic movements The nurse notifiesthe primary health care provider of the occurrence of these symptoms because they may indicate a need for dosage adjustment. 

Propranolol may alter the effectiveness of insulin or oral hypoglycemic dm. Dosage adjustments may be necessary. 

ADMINISTERING PROPRANOLOL. The nurse monitors die ECG frequendy for cardiac arrhythmias. Fhtients receiving IV propranolol must have continuous cardiac monitoring. The nurse must monitor the blood pressure and pulse frequendy during die dosage adjustment period and periodically throughout dierapy. 

If die patient has frequent chest pain or reports dizziness or light-headedness, the nurse monitors die blood pressure frequendy. The patient may need help during ambulation if dizziness occurs. In addition, the nurse must evaluate die patient s response to therapy by questioning the patient about die anginal pain. In some patients, die pain may be entirely relieved, whereas in others it may be less intense or less frequent or may occur only widi prolonged exercise. The nurse records all information in the patient s chart because tiiis helps die primary health care provider plan future therapy, as well as make dosage adjustments if required. 

The older adult may have a greater hypotensve effect after taking the antianginal drugs than younger adults The nurse must monitor the older aduft dosely during dosage adjustments... 

The number and amount of daily insulin doses, times of administration, and diet and exercise requirements require continual assessment. Dosage adjustments may be necessary when changing types of insulin, particularly when changing from the single-peak to the more pure Humulin insulins. 

During die ongoing assessment die nurse monitors the blood pressure, pulse, and respiratory rate every 4 hours or as ordered by the primary healtii care provider. The primary health care provider is notified if tiiere are any significant changes in tiiese vital signs because a dosage adjustment may be necessary. 

Keep follow-up appointments to determine if a dosage adjustment is necessary. 

The dosage is individualized to the needs of the patient. The dose of thyroid hormones must be carefully adjusted according to the patient s hormone requirements. At times, several upward or downward dosage adjustments must be made until the optimal therapeutic dosage is reached and the patient becomes euthyroid. 

When asparaginase is administered to a patient witii diabetes, die risk for hyperglycemia is increased a dosage adjustment of die oral antidiabetic drug may be necessary. Glucocorticoids decrease die effectiveness of aldesleukin. When aldesleukin is administered witii antihypertensive drugs, tiiere is an additive hypotensive effect Etoposide may decrease the immune response to live viral vaccines. 

Salmeterol is also available in a fixed ratio combination product containing fluticasone, and a new drug application has been filed for a fixed combination product containing budesonide and formoterol. Combination products have the potential advantage of increasing patient adherence due to the decreased number of inhalers and inhalations however, these products offer less flexibility with respect to dosage adjustments when necessary. 

The side-effect profile for entecavir is similar to lamivudine and adefovir dipivoxil and comparable to placebo. Patients treated with entecavir should be monitored for signs and symptoms associated with lactic acidosis and severe hepatomegaly with steatosis, because some cases have been fatal. Dosage adjustments are required in patients with renal dysfunction. 

Lamotrigine is effective for the maintenance treatment of bipolar disorder. It is more effective for depression relapse prevention than for mania relapse. Its primary limitation as an acute treatment is the time required for titration to an effective dosage. In addition to maintenance monotherapy, it is sometimes used in combination with lithium or divalproex, although combination with divalproex increases the risk of rash, and lamotrigine dosage adjustment is required.37... 

Develop a plan for monitoring therapeutic outcomes, focusing on the individual symptom profile and level of function of each patient. Include a plan for dosage adjustments or alternate therapy if the patient fails to respond adequately. Include serum drug concentration monitoring as appropriate. 

Reductions in HbAlc of 0.7%-0.8% were found in clinical trials verses placebo in both monotherapy and combination therapy using the recommended dose of sitagliptin 100 mg daily taken with or without food. Dosage adjustments to 50 mg and 25 mg daily are recommended for patients with moderate... 

Develop a formal plan to assess response (increase in height and change in height velocity) and adverse effects of GH replacement therapy. Make dosage adjustments when appropriate. 

The dose of basiliximab is 20 mg intravenously (IV) given within 2 hours prior to the transplant, followed by a second 20 mg dose on postoperative day 4.7,9,11 This dosing schedule can be used for both children weighing 35 kg (77 lb) or more and adults. Two 10 mg doses with the same dosing schedule should be used for children weighing less than 35 kg (77 lb). No specific dosage adjustments is needed in renal or hepatic impairment.7,9,11... 

Monitor and assess laboratory data WBC count with differential (goal is a reduction in WBC count if elevated initially and resolution of left shift), renal and/or hepatic function (consider need for dosage adjustments), other labs as indicated (e.g., ESR, CRP). 

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