True or False: A renal dosing program is designed to improve patient care by preventing toxicity without compromising efficacy.
What is true?
100
Creatinine is released as a by-product of what?
What is muscle breakdown
100
Name at least three methods to assess renal function or GFR
What is measurment of creatinine elimination via 24 hour urine collection, inulin and isotropic clearances, estimate creatinine clearance via calculation
100
What method should be used to estimate the creatinine clearance in spinal cord injury?
What is due to the change in muscle mass over time, a 24 hours creatinine clearance measurment is necessary for accuracy in these patients.
200
According to the study by Cantu et al what % of patients receive drugs at a dose exceeding the manufacturers recommended dose based on the estimated creatinine clearance
What is 44% (accept ~40-45%)
200
A decrease in the Glomerular Filtration Rate (GFR) is directly related to an increase in what?
What is serum creatinine
200
Name at least two problems with using creatinine elimination via 24 hours urine collection
What is incomplete bladder emptying, lag time for results, inadequate or imcomplete collection or urine, expensive, labor intensive
200
Name the two methods for dose alteration in patients with renal insufficiency
What is (1) reduce the dose and maintain the usual dosage intereval and (2) maintain the dose for normal function and lengthen the dosing interval
300
Which of the following therapeutic classes is not most likely to be administered in excessive doses: antibacterials, antivirals, antifungals, antihypertensives, or digitalis glycosides
What is antihypertensives
300
What determines the primary rate of the formation of creatinine?
What is individual muscle mass or lean body weight
300
Name the most widely accepted formula to accurately and rapidly calculate renal function without a 24 hour urine collection.
What is Cockcroft-Gault equation
300
When adjusting the dose in patients with renal insufficiency, when should you adjust the dose versus the interval?
What is
reduce dose: narrow therapeutic ranges or short plasma half lives (results in a constant blood level)
lenghthen the interval: wide therapeutic ranges and long plasma half lives (results in wide swings of the plasma drug concentrations from peak to trough levels)
400
What is caused when medications are not adjusted for renal dysfunction and they may accumulate?
What is adverse effects
400
True or False: Glomerular filtration rate and the patient's creatinine are inversely proportionate.
What is false. Creatinine levels and the patient's renal function are inversely proportionate
400
True or False: the Cockcroft-Gault equation should be used on all patients.
What is false. The Cockcroft-Gault equation assumes the serum creatinine is at steady state and weight reflects the normal muscle mass. Patients with rapid changing renal function or low/high muscle mass may result in an over or under estimation of creatinine clearance.
400
Name the equation that has the advantage of being more accurate than the Cockcroft-Gault equation in persons with a GFR less than 90 ml/minute/1.73 m2 and takes into consideration the race of the patient?
What is Modification of Diet in Renal Disease (MDRD)
GFR=186x [(Pcr)^-1.154] x [(age)^-0.203] x (0.742 if female) x (1.210 if African American)
500
Change in renal function can be associated with which of the following: age, dehydration, medication and/or hospitalization?
What is age, medication, dehydration
500
After creatinine is released from the muscles into the ____(1)__ it is completely filtered at the ___(2)___ and undergoes minimal tubular secretion.
What is (1) Plasma and (2) glomerulus
500
Name at least four drugs that produce a significant false elevation in serum creatinine.
What is cefaclor, cefazolin, ceforanide, cefoxitin, ceftrizoxime, cephalexin, cephalothin, cephradine, ceftibuten, moxalactam
500
Ruth is a 36 year old female, admitted to the hospital due to symptoms of Lupus. During her hospital stay she developed signs of sepsis. Urine culture is + for Pseudomonas aeruginosa. You recommend that she start ceftazidime.
wt: 140 lbs; ht: 5'8"; SrCr: 3.4 mg/dL; BUN: 38 mg/dL
What dose and frequency of ceftazidime should be given to Ruth?
What is 2 grams every 24 hours. Ruth's CrCl is 27.15ml/min.