In renal failure

Diuretics are one of the dmg categories most frequendy prescribed. The principal uses of diuretics are for the treatment of hypertension, congestive heart failure, and mobilization of edema fluid in renal failure, fiver cirrhosis, and ascites. Other applications include the treatment of glaucoma and hypercalcemia, as well as the alkafinization of urine to prevent cystine and uric acid kidney stones. 

Elevated serum creatinine will be present in renal failure patients... 

Because they are hepatically cleared, isoniazid and rifampin do not require dose modification in renal failure.31,36,39 Pyrazinamide and ethambutol typically are reduced to three times weekly to avoid accumulation of the parent drug (ethambutol) or metabolites (pyrazinamide).28,31 Renally cleared TB drugs include the aminoglycosides (e.g., amikacin, kanamycin, and streptomycin), capreomycin, ethambutol, cycloserine, and lev-ofloxacin.28,31,33,39 Dosing intervals need to be extended for... 

Exchange transfusion that may be required in patients with P. falciparum malaria in whom parasitemia may be between 5% and 15% remains a questionable modality. Either peritoneal or hemodialysis may be indicated in renal failure. 

Calcitonin 4-8 lU/kg SQ or IM q6-12 hours 2-4 hours 1-3 days 2-3 mg/dL Salmon-derived formulation preferred 1-unit test dose recommended can be given in renal failure may cause flushing, nausea. 

TABLE 98-7. Enteral Feeding Products Designed for Use in Renal Failure... 

Based upon the available data, derivation of AEGL-1 values was considered inappropriate. The continuum of arsine-induced toxicity does not appear to include effects consistent with the AEGL-1 definition. The available human and animal data affirm that there is a very narrow margin between exposures that result in little or no signs or symptoms of toxicity and those that result in lethality. The mechanism of arsine toxicity (hemolysis that results in renal failure and death), and the fact that toxicity in humans and animals has been reported at concentrations at or below odor detection levels (-0.5 parts per million (ppm)) also support such a conclusion. The use of analytical detection limits (0.01 to 0.05 ppm) was considered as a basis for AEGL-1 values but was considered to be inconsistent with the AEGL-1 definition. 

Analgesics are given to reduce abdominal pain. In the past, parenteral meperidine (50 to 100 mg) every 3 to 4 hours was usually used because it causes less spasm of the sphincter of Oddi than other opioids. Meperidine is used less frequently today because it is not as effective as other opioids and is contraindicated in renal failure. Parenteral morphine is sometimes used, but it is thought to cause spasm of the sphincter of Oddi, increases in serum amylase and, rarely, pancreatitis. Hydromorphone may also be... 

In nearly all patients, INH and RIF do not require dose modifications in renal failure. Pyrazinamide and ethambutol typically require a reduction in dosing frequency from daily to three times weekly (Table 49-6). 

Use immediate-release productwilh controlled-release product to control "breakthrough" pain in cancer or chronic pain patients Use in severe pain Oral not recommended Do not use in renal failure May precipitate tremors, myoclonus, and seizures... 

Urinary electrolytes in renal failure this table is always difficult to recall but try to remember that in intrinsic renal failure the kidney is unable to concentrate urine effectively and so a poor quality, dilute urine is produced... 

Maintenance 400 mg qh can cause confusion in elderly and in renal failure. 

Maintenance dose 0.125-0.25 mg PO/IV qd low potassium or magnesium levels potentiate toxicity reduce dose in renal failure toxicity indicated by nausea, headache, visual disturbances (yellow-green halos), ventricular arrhythmias. Quinidine, verapamil, and amiodarone elevate digoxin level. 

Cytomegalovirus retinitis induction 5 mg/l IV bid x 14-21 days, folloA by maintenance of 5 mg/kg IV qd or 6 mg/l IV 5 days a week neutropenia, thrombocytopenia adjust in renal failure... 

Encephalitis 10 mg/fg IV over 1 hour, q8h x 14 days Adjust dose in renal failure, headache, rash. 

Adjust dosage in renal failure. Use with cisapride may result in fatal QT prolongation and Torsades de pointes. 

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