Impairment renal

Because of fluoride ion associated renal impairment, the duration of anesthesia using methoxyflurane must be limited (51,52). 

NS AIDs Cyclooxygenases (COX-1, COX-2) l Prostaglandins l Thromboxanes l Sensitization of sensory neurons f Inhibition of spinal neurons Nonselective gastrointestinal ulcers, perforation, bleeding, renal impairment COX-2 thrombosis, myocardial infarction, stroke... 

The recommended dose of pemetrexed is 500 mg/m2 administered as an intravenous infusion over 10 min on Day 1 of each 21-day cycle. Pemetrexed is not metabolized to an appreciable extent and is primarily eliminated in the urine, with 70-90% of the dose recovered unchanged within the first 24 h following administration. Pemetrexed has a steady-state volume of distribution of 16.1 L. Pemetrexed is highly bound (approximately 81%) to plasma proteins. Binding is not affected by the degree of renal impairment. Plasma... 

Capecitabine is used for the treatment of colorectal and breast cancers. It is contraindicated in patients with known hypersensitivity to capecitabine or any of its components or to 5-fluorouracil and in patients with known dihydropyrimidine dehydrogenase (DPD) deficiency. The use of capecitabine is restricted in patients with severe renal impairment. The drag can induce diarrhea, sometimes severe. Other side effects include anemia, hand-foot syndrome, hyperbilirubinemia, nausea, stomatitis, pyrexia, edema, constipation, dyspnea, neutropenia, back pain, and headache. Cardiotoxicity has been observed with capecitabine. A clinically important drag interaction between capecitabine and warfarin has been demonstrated. Care should be exercised when the drag is co-administered with CYP2X9 substrates. 

The volume will decrease when renal impairment is associated with a decrease in the elimination rate beta (betaNorm => betaFail). On the other side, the volume will increase when the free plasma fraction (fp) increases in renal impairment where jp = 1 - PB%. The volume decreases, when the free tissue fraction (ft) increases in renal impairment. 

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... 

Urinary tract Early ionic urographic agents including iodamide Uromiro Tubular secretion Difazio LT et al (1978) Pharmacokinetics of iodamide in normal subjects and in patients with renal impairment. J Clin Pharmacol 18 35-41... 

Because renal impairment is common in older adults the nurse should give the sulfonamides with great caution. There isan increased danger of the sulfonamidescausng additional renal damage when renal impairment is already present. An increase of fluid intake up to 2000 mL (if the older adult can tolerate this amount) decreases the risk of crystals and stones forming in the urinary trad. 

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 fluoroquinolones are used cautiously in patients with renal impairment or a history of seizures, in geriatric patients, and in patients on dialysis. 

The drug is contraindicated in die presence of an allergy to die drug, pregnancy (Category C), lactation, and phenylketonuria (oral form only). Linezolid is used cautiously in patients with bone marrow depression, hepatic dysfunction, renal impairment, hypertension, and hyperthyroidism. 

Amantadine is used cautiously in patients with seizure disorders, psychiatric problems, renal impairment, and cardiac disease. Amantadine is a Pregnancy Category B drug and is used cautiously during pregnancy and lactation. Concurrent use of antihistamines, phenothiazines, tricyclic antidepressants, disopyramide, and quinidine may increase the anticholinergic effects (dry mouth, blurred vision, constipation) of amantadine... 

Administration may result in nausea, vomiting, diarrhea, rash, anemia, leukopenia, and thrombocytopenia Signs of renal impairment include elevated blood urea nitrogen (BUN) and serum creatinine levels. Periodic renal function tests are usually performed during therapy. 

Flucytosine is contraindicated in patients with known hypersensitivity to the drug. Flucytosine is used cautiously in patients with bone marrow depression and with extreme caution in those with renal impairment. The drug is also used cautiously during pregnancy (Category C) and lactation. When flucytosine and amphotericin B are administered concurrently, the risk of flucytosine toxicity is increased. 

FLUCONAZOLE Because older adults are more likely to have decreased renal function, they are at increased risk for further renal impairment or renal failure. 

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 NSAIDs prolong bleeding time and increase the effects of anticoagulants, lithium, cyclosporine, and the hydantoins. These dru may decrease the effects of diuretics or antihypertensive drug >. Long-term use of the NSAIDs with acetaminophen may increase the risk of renal impairment. 

These dragp are contraindicated in patients who are hypersensitive to the bisphosphonates. Alendronate and risedronate are contraindicated in patients with hypocalcemia Alendronate is a pregnancy Category C drug and is contraindicated during pregnancy. These drugp are contraindicated in patients with renal impairment with serum creatinine less than 5 mg/dL. Concurrent use of these dm with hormone replacement therapy is not recommended. 

The miscellaneous anticonvulsants are contraindicated in patients with known hypersensitivity to any of the dru. Carbamazepine is contraindicated in patients with bone marrow depression or hepatic or renal impairment and during pregnancy (Category D). Valproic acid is not administered to patients with renal impairment or during pregnancy (Category D). Oxcarbazepine (Trileptal), a miscellaneous anticonvulsant, may exacerbate dementia... 

The narcotic antitussives are used cautiously in patients with head injury and increased intracranial pressure, acute abdominal disorders, convulsive disorders, hepatic or renal impairment, prostatic hypertrophy, and asthma or other respiratory conditions. 

Phenazopyridine is contraindicated in patients with renal impairment and in undiagnosed urinary tract pain. Phenazopyridine is used cautiously during pregnancy (Pregnancy Category C) and lactation. 

Laxatives are contraindicated in patients with known hypersensitivity and those with persistent abdominal pain, nausea, or vomiting of unknown cause or signs of acute appendicitis, fecal impaction, intestinal obstruction, or acute hepatitis. These dragp are used only as directed because excessive or prolonged use may cause dependence. Magnesium hydroxide is used cautiously in patients with any degree of renal impairment. Laxatives... 

The a-glucosidase inhibitors are contraindicated in patients with a hypersensitivity to the drug, diabetic ketoacidosis, cirrhosis, inflammatory bowel disease, colonic ulceration, partial intestinal obstruction or predisposition to intestinal obstruction, or chronic intestinal diseases. Acarbose and miglitol are used cautiously in patients with renal impairment or pre-existing gastrointestinal (GI) problems such as irritable... 

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