Applied Clinical Pharmacokinetics, 2e
Chapter 3. Drug Dosing in Special Populations: Renal and Hepatic Disease, Dialysis, Heart Failure, Obesity, and Drug Interactions
Sections: Drug Dosing in Special Populations: Renal and Hepatic Disease, Dialysis, Heart Failure, Obesity, and Drug Interactions: Introduction, Renal Disease, Hepatic Disease, Heart Failure, Dialysis, Hemodialysis, Hemofiltration, Peritoneal Dialysis, Obesity, Drug Interactions, Problems, Answers to Problems, References.
Topics Discussed: dose; select the dosage, dosage form or route of administration.
Excerpt:"All medications have specific disease states and conditions that
change the pharmacokinetics of the drug and warrant dosage modification.
However, the dosing of most drugs will be altered by one or more
of the important factors discussed in this chapter. Renal or hepatic
disease will decrease the elimination or metabolism of the majority
drugs and change the clearance of the agent. Dialysis procedures,
conducted using artificial kidneys in patients with renal failure,
removes some medications from the body while the pharmacokinetics
of other drugs are not changed. Heart failure results in low cardiac
output which decreases blood flow to eliminating organs, and the
clearance rate of drugs with moderate-to-high extraction ratios
are particularly sensitive to alterations in organ blood flow. Obesity
adds excessive adipose tissue to the body which may change the way
drugs distribute in the body and alter the volume of distribution
for the medication. Finally, drug interactions can inhibit or induce
drug metabolism, alter drug protein binding, or change blood flow
to organs that eliminate or metabolize the drug...."