Drug therapy renal function

Maintenance of Betapace AF therapy Regularly re-evaluate renal function and QT if medically warranted. If QT is at least 520 msec (JT 430 msec or greater if QRS is greater than 100 msec), reduce the dose of Betapace AF therapy and carefully monitor patients until QT returns to less 520 msec. If the QT interval is 520 msec or more while on the lowest maintenance dose level (80 mg), discontinue the drug. If renal function deteriorates, reduce the daily dose in half by administering the drug once daily as described in Initiation of Therapy, step 3. 

RISK FOR INEFFECTIVE TISSUE PERFUSION RENAL When the patient is taking a drag tiiat is potentially toxic to die kidneys, die nurse must carefully monitor fluid intake and output. In some instances, die nurse may need to perform hourly measurements of die urinary output. Periodic laboratory tests are usually ordered to monitor the patient s response to therapy and to detect toxic drag reactions. Seram creatinine levels and BUN levels are checked frequentiy during the course of therapy to monitor kidney function. If the BUN exceeds 40 mg dL or if the serum creatinine level exceeds 3 mg cIL, the primary health care provider may discontinue the drug therapy or reduce the dosage until renal function improves. 

The primary health care provider may also order laboratory and diagnostic tests, renal and hepatic function tests, complete blood count, serum enzymes, and serum electrolytes. The nurse reviews these test results before the first dose is given and reports any abnormalities to the primary health care provider. The patient is usually placed on a cardiac monitor before aiitiarrhytiuiric drug therapy is initiated. The primary health care provider may order an ECG to provide baseline data for comparison during therapy. 

The drug is used cautiously during surgery. Metformin use is temporarily discontinued for surgical procedures. The drug therapy is restarted when the patient s oral intake has been resumed and renal function is normal. 

Based on the patient s renal function, would other drug therapy recommendations be warranted at this time ... 

In patients with a history of AED use, a baseline serum concentration may be useful to determine if the drug concentration is below the desired range and if a loading dose is needed. Albumin levels, renal function tests, and liver function tests can also be helpful when assessing antiepileptic therapy. 

Electrolytes Daily doses based on daily maintenance requirements, renal function, gastrointestinal losses, acid-base status, concomitant drug therapy, nutritional and anabolic status Pa lion I has hyponatremia, hypokalemia, hypomagnesemia, and hypophosphatemia, also has low serum bicarbonate concentration, could be component of metabolic acidosis due to sepsis... 

Allopurinol is the antihyperuricemic drug of choice in patients with a history of urinary stones or impaired renal function, in patients who have lymphoproliferative or myeloproliferative disorders and need pretreatment with a xanthine oxidase inhibitor before initiation of cytotoxic therapy to protect against acute uric acid nephropathy, and in patients with gout who are overproducers of uric acid. 

The major side effects associated with uricosuric therapy are GI irritation, rash and hypersensitivity, precipitation of acute gouty arthritis, and stone formation. These drugs are contraindicated in patients who are allergic to them and in patients with impaired renal function (CLcr <50 mL/min) or a history of renal calculi, and in patients who are overproducers of uric acid. 

Metabolic abnormalities / Renal and hepatic function / Concomitant drug therapy... 

Patients with diminished renal and/or hepatic function will accumulate certain drugs unless dosage is adjusted. Any concomitant therapy the patient is receiving may influence the selection of drug therapy, the dose,... 

In patients who cannot tolerate voriconazole, amphotericin B can be used. Full doses (1 to 1.5 mg/kg/day) are generally recommended, with response measured by defervescence and radiographic clearing. The lipid-based formulations may be preferred as initial therapy in patients with marginal renal function or in patients receiving other nephrotoxic drugs. The optimal duration of treatment is unknown. 

Elderly In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy. 

Monitoring Before initiation of therapy and at least annually thereafter, assess renal function. In patients at risk of renal dysfunction, assess renal function more frequently and discontinue the drug if renal impairment is present. 

Pericardial effusion Pericardial effusion, occasionally with tamponade, has occurred in approximately 3% of treated patients not on dialysis, especially those with inadequate or compromised renal function. Many cases were associated with connective tissue disease, the uremic syndrome, CHF or fluid retention, but were instances in which these potential causes of effusion were not present. Observe patients closely for signs of pericardial disorder. Perform echocardiographic studies if suspicion arises. More vigorous diuretic therapy, dialysis, pericardiocentesis, or surgery may be required. If the effusion persists, consider drug withdrawal. 

Renai function impairment Some patients with preexisting renal disease or poor urate clearance have increased BUN during allopurinol administration. Patients with impaired renal function require less drug and careful observation during the early stages of treatment reduce dosage or discontinue therapy if increased abnormalities in renal function appear and persist. 

Myopathy and neuropathy Colchicine myoneuropathy appears to be a common cause of weakness in patients on standard therapy who have elevated plasma levels caused by altered renal function. It is often unrecognized and misdiagnosed as polymyositis or uremic neuropathy. Proximal weakness and elevated serum creatine kinase are generally present, and resolve in 3 to 4 weeks following drug withdrawal. Maiabsorption of vitamin B-f2- Colchicine induces reversible malabsorption of vitamin B-12, apparently by altering the function of ileal mucosa. 

Speciai risk Seizures, irrespective of drug relationship, occurred in 0.5% of patients during study therapy plus 14-day follow-up period. These experiences have occurred most commonly in patients with CNS disorders (eg, brain lesions or history of seizures) or compromised renal function. 

Ototoxicity Perform audiometric measurements and assessment of vestibular function prior to initiation of therapy and at regular intervals during treatment. Nephrotoxicity Perform regular tests of renal function throughout treatment, and reduce dose in patients with renal impairment. Renal injury with tubular necrosis, elevation of BUN or serum creatinine, and abnormal sediment have been noted. Reduce the dosage or withdraw the drug. 

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