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Conclusion: Clinical decision support implemented with academic detailing improved dosing conformity and management of key renally cleared drugs in a hospitalized population. Study Jan4 M3-Antihypertensives, K and PO4 binders, Renally Cleared Drugs flashcards from Django E.'s Collège André-Grasset class online, or in Brainscape's iPhone … OBJECTIVES. To quantify and compare the extent of inappropriate prescribing (defined as at least one drug prescribed in an excessive dose or when contraindicated with respect to renal function) of renally cleared drugs in elderly patients across the community and aged care settings, and to determine factors associated with patients being prescribed one or more potentially inappropriate renally Request PDF | Dosing of Key Renally Cleared Drugs in the Elderly-Time to be Wary of the eGFR | Background The Cockroft-Gault and Modification of Diet in Renal Disease (MDRD) approaches are Request PDF | Preliminary Physiologically Based Pharmacokinetic Modeling of Renally Cleared Drugs in Chinese Pregnant Women | Aim The aim of this study was to build and verify a preliminary 2011-06-01 During episodes of acute renal impairment, renally cleared drugs were held on 38% of instances in the pre-intervention period compared with 62% post-intervention (p=0.01). Conclusion: Clinical decision support implemented with academic detailing improved dosing conformity and management of key renally cleared drugs in a hospitalized population. Drugs Aging (2015) 32:391–400 DOI 10.1007/s40266-015-0261-1 ORIGINAL RESEARCH ARTICLE Potentially Inappropriate Prescribing of Renally Cleared Drugs in Elderly Patients in Community and Aged Care Settings Aarati Khanal1 • Gregory M. Peterson1 • Ronald L. Castelino1 • Matthew D. Jose2 PDF | Predictive performance of physiologically based pharmacokinetic (PBPK) and population pharmacokinetic (PopPK) models of drugs predominantly | Find, read and cite all the research you need The factors independently associated with patients being prescribed one or more potentially inappropriate renally cleared drugs were advancing age [odds ratio (OR) 1.06 per year increase, 95 % confidence interval (CI) 1.05-1.07; P < 0.001], the total number of renally cleared drugs prescribed (OR 1.44 per unit increase, 95 % CI 1.29-1.61; P < 0.001), presence of diabetes (OR 1.51, 95 % CI 1.30-1.76; P < 0.001), presence of heart failure (OR 1.38, 95 % CI 1.13-1.69; P < 0.005) and living in For renally eliminated drugs, the model can be used to estimate dosing regimens that are based on the adult dosing regimen and the age and weight of the child. MeSH terms Age Factors Drug-specific parameters of 6 renally cleared drugs were validated through PBPK modeling of Caucasian non-pregnant, Caucasian pregnant and Chinese non-pregnant population. The preliminary PBPK model of Chinese pregnant population was then developed by integrating the preliminary Chinese pregnant population and the drug-specific parameters.
will be taken by the authors for the drug doses, which should always be confirmed independently by the prescriber. Drug: ACICLOVIR Usual route of clearance: Aciclovir is predominantly renally cleared (75-80% excreted unchanged in the urine)1,2 by glomerular filtration and tubular secretion.3 There is only one Renal clearance (CLR) is the net result of glomerular filtration of unbound drug plus tubular secretion minus tubular reabsorption.
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protein diet add to renal stress1 High incidence in the elderly in the United States Changes absorption, protein binding, volume of distribution and clearance Other factors Drug interactions Nephrotoxic drugs Dehydration THE AGING KIDNEY Lastly, apart from the well‐recognized effects of kidney disease on renal drug clearance, there is a growing body of evidence demonstrating that renal failure may influence hepatic drug metabolism either by inducing or suppressing hepatic enzymes or by its effects on protein binding, hepatic blood flow, and accumulation of metabolites Drugs eliminated by a combination of renal excretion and biotransformation include levetiracetam, lacosamide, zonisamide, primidone, phenobarbital, ezogabine/retigabine, oxcarbazepine, eslicarbazepine, ethosuximide, and felbamate. Drugs in the latter group can be used cautiously in patients with either renal or liver failure. Renal function declines with age as a result of the anatomical and physiological changes that occur with aging. Because renal function deteriorates with age, even in the seemingly healthy patient, clearance of renally excreted and metabolized drugs may be markedly impaired in the elderly patient.
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Thus, renal impairment with the outcome of a gradual loss of kidney function may have a great effect on the exposure of antibacterial drugs, hence affecting their efficacy or safety (You, Zhang, Yang, & lijun, 2016). Drugs eliminated by a combination of renal excretion and biotransformation include levetiracetam, lacosamide, zonisamide, primidone, phenobarbital, ezogabine/retigabine, oxcarbazepine, eslicarbazepine, ethosuximide, and felbamate.
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In conclusion, this analysis provides a systematic characterization for renally eliminated drugs demonstrating that both PBPK and PopPK approaches can reasonably predict exposure in children. PBPK models provided reasonable prediction of all drugs in children 1 month and older, 33 of 34 of the predicted mean clearances were within twofold of the observed values, and 31 of 34 predictions were within 50% error. Request PDF | Maturation and growth of renal function: Dosing renally cleared drugs in children | A model was developed that characterized the maturation and growth of the renal function
2011-12-29 · Seizures and chronic kidney disease often coexist, but treatment can be challenging, especially for those on dialysis. This practical guide reviews the use of antiepileptic drugs in these patients. 2017-04-08 · Since pregnant women are considerably underrepresented in clinical trials, information on optimal dosing in pregnancy is widely lacking.
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ANALGESICS. NSAIDS. Pregnancy population PBPK models can provide a valuable tool to predict a priori the pharmacokinetics of predominantly renally cleared drugs in pregnant women.
This causes inadvertent overdosing of renally cleared drugs, increasing the incidence of adverse drug events. A clinical decision support system (GFR+) was developed for calculation of renal function and doses of key drugs adjusted for both weight and renal function.
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The preliminary PBPK model of Chinese pregnant population was then developed by integrating the preliminary Chinese pregnant population and the drug‐specific parameters. Due to its ready availability, prescribers are beginning to use the MDRD approach for dosing of renally cleared drugs, despite contrary recommendations.
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The preliminary PBPK model of Chinese pregnant population was then developed by integrating the preliminary Chinese pregnant population and the drug‐specific parameters. Drugs that are Mainly Renally Excreted.
Allopurinol has a renally excreted active metabolite that accumulates in renal impairment and may cause adverse effects if the dose is not adjusted. 18,21 For most older people, a maintenance dose of 100 mg/day is sufficient. 22 An initial dose of 100 mg on alternate days is recommended for patients with a GFR <10 mL/min, 15 or if possible, the medicine should be avoided altogether in this situation. Due to involvement of transporters, renal clearance is possibly associated with renal drug–drug interactions (DDIs) in clinical situations.