Clinical Therapeutic I: Renal Disorders Management

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Questions and Answers

What is the primary effect of decreased gastric acidity on drug bioavailability when administering antacids, H2-blockers, or PPIs?

No significant change in bioavailability.

Increased drug absorption due to enhanced dissolution.

Reduced drug absorption leading to decreased bioavailability. (correct)

Unpredictable changes in drug bioavailability.

In patients with Chronic Kidney Disease (CKD), how is the volume of distribution (VD) of hydrophilic drugs, such as aminoglycosides, typically affected?

The VD decreases by up to 150%.

The VD is increased, potentially by up to 150%. (correct)

The VD remains unchanged.

The VD is decreased due to increased protein binding.

Which of the following is NOT a method for modifying drug dosage in patients with renal impairment?

Altering both the dose and interval.

Decreasing both the dose and the interval. (correct)

Administering a lower dose at the same interval.

Increasing the dosage interval.

Which electrolyte abnormalities are commonly associated with digoxin and diuretic use in patients with renal impairment?

Digoxin: hypercalcemia and hypokalemia; Diuretics: hyperkalemia. Signup and view all the answers

What is a critical consideration when administering medications to patients with impaired renal function?

Avoiding nephrotoxic drugs and drugs that cause fluid retention. Signup and view all the answers

Which of the following is NOT a key component of a pharmacotherapy care plan?

Patient's medical history Signup and view all the answers

What should be the first step in a patient-focused approach to case problems?

Identification of real or potential drug therapy problems Signup and view all the answers

What is one of the primary objectives of intervening in a drug-related problem (DRP)?

To achieve stated goals of therapy Signup and view all the answers

Which action is used to resolve a drug-related problem?

Change the drug product Signup and view all the answers

What is NOT a function of the kidneys, according to the text?

Digestive Signup and view all the answers

How does impaired renal function impact drug absorption?

May result in drug interactions that decrease bioavailability Signup and view all the answers

Which of these could influence the bioavailability of a drug due to renal issues?

Use of antacids or vitamin supplements Signup and view all the answers

In the context of renal impairment, what does the phrase 'altered pharmacokinetics' refer to?

Changes in how the body handles drugs Signup and view all the answers

According to Cipolle's definition, what is a key characteristic of a Drug-Related Problem (DRP)?

It involves or is suspected to involve drug therapy and interferes with achieving desired therapy goals. Signup and view all the answers

What is the primary focus when assessing a patient's drug-related needs?

To gather, organize, and integrate patient, drug, and disease information, to determine if the therapy is appropriate, effective, safe, and convenient for the patient. Signup and view all the answers

Which of the following best describes a 'potential' Drug-Related Problem (DRP)?

A problem that might occur if the drug therapy continues as is. Signup and view all the answers

A patient is taking a medication that is not addressing their medical condition. According to the text, this is an example of which type of DRP?

Ineffective drug therapy. Signup and view all the answers

Which of the following is associated with 'Unsafe drug therapy'?

The patient is experiencing an adverse drug reaction or drug-drug interactions. Signup and view all the answers

What does 'Inappropriate adherence or compliance' refer to in the context of Drug-Related Problems?

The patient is not able, or willing to take the medication as prescribed. Signup and view all the answers

What is a key diagnostic criterion for acute kidney injury based on serum creatinine (SCr) levels?

An increase in SCr of 0.3 mg/dL within 48 hours, or an increase of 1.5 times the baseline in 7 days Signup and view all the answers

According to the pharmaceutical care related questions, which question assesses the appropriateness of a drug therapy?

Does the patient have a clinical indication for each of his or her drug therapies, and is each of the patient's indications being treated with drug therapy? Signup and view all the answers

A patient has a known allergy to an active ingredient in a prescribed medication but took the medication anyway. According to the text, which type of DRP is this?

Unsafe drug therapy. Signup and view all the answers

Which of the following is a common clinical presentation of severe acute kidney injury (AKI)?

Decline in mental status, confusion, and neurological symptoms Signup and view all the answers

In prerenal AKI, what is a typical finding in the urine?

High urine osmolality and low urine sodium Signup and view all the answers

What is the primary cause of postrenal acute kidney injury?

Outflow obstruction in the urinary tract Signup and view all the answers

Which of the following laboratory findings is typically seen in prerenal AKI?

High BUN to creatinine ratio Signup and view all the answers

Which condition is NOT a likely cause of intrinsic AKI?

Urethral obstruction Signup and view all the answers

Which of the following is a key monitoring parameter for a patient with established acute kidney injury?

Monitoring of the patient’s urine output and acid-base balance Signup and view all the answers

What are typical symptoms associated specifically with postrenal acute kidney injury?

Urinary urgency or hesitancy, and gross hematuria Signup and view all the answers

Study Notes

Clinical Therapeutic I - Management of Renal Disorders

The lecture is titled "Clinical Therapeutic I: Management of Renal Disorders"
The lecturer is Rara Merinda Puspitasari
The institution is Universiti Kuala Lumpur
The course is a Bachelor of Pharmacy
Learning outcomes include evaluating patient drug-related problems in renal disorders, demonstrating good communication, teamwork, critical thinking, problem-solving, and lifelong learning.

A drug-related problem is any undesirable event involving drug therapy that interferes with desired therapy goals.
A drug-related problem is an event or circumstance that actually or potentially interferes with desired health outcomes.

Assessment involves collecting, organizing, and integrating pertinent patient, drug, and disease information.
It includes verifying whether the patient's drug therapy is appropriate, effective, safe, and convenient.
Identifying actual and potential drug-related problems is crucial.
Information on patient history, disease, and drug use should be considered

Inappropriate Indication: Unnecessary additional or inappropriate drug therapy.
Ineffective Therapy: Drug therapy is not effective, often due to low dosage.
Unsafe Therapy: Adverse drug reaction, due to high dosage or drug interaction (DDI).
Inappropriate Adherence or Compliance: Inability or unwillingness to take medication as prescribed.

Pharmaceutical Care

Pharmaceutical care is a patient-centered process that ensures the patient's drug therapy is appropriate, effective, safe, and convenient.
Key components in the pharmacotherapy care plan include the current drug regimen, drug therapy problems, therapy goals, therapeutic recommendations, rationale, therapeutic alternatives, monitoring, and patient education.
A systematic approach to case problems involves identifying real or potential drug therapy problems, determining the desired therapeutic outcome, identifying therapeutic alternatives, designing an optimal individualized pharmacotherapeutic plan, identifying parameters to evaluate the outcome, and providing patient education.
Communication and implementation of the pharmacotherapeutic plan also are necessary

DRP identification begins by recognizing the medical condition involved and the associated drug therapy.
Determining the cause of the problem, resolving issues, achieving therapy goals, and preventing new problems are crucial aspects of intervention.
Interventions to solve DRPs can include adjusting the drug regimen, changing dosage, substituting the drug product or discontinuing the drug entirely; all must be part of monitoring.

Actions to Resolve DRPs

Initial new drug therapy.
Changing the dosage regimen.
Changing the drug product
Discontinuing the drug regimen.
Monitoring plan (labs).

Goals of Therapy for Common Medical Conditions

Examples include curing a disease, reducing or eliminating symptoms, slowing or stopping disease progression, preventing a disease, normalizing laboratory values, or assisting in diagnostic procedures.
Conditions like urinary tract infections, diarrhea, and pneumonia are among the examples.

Management of Renal Disorders

Renal disorders include acute kidney injury, chronic kidney disease, and end-stage renal disease.
Acute kidney injury (AKI) is a rapid decrease in kidney function, characterized by decreased renal function lasting several hours to several days.
Symptoms and signs include decreased urine output, accumulation of waste products, and an inability to regulate fluid, electrolyte, and acid-base balance.
Pre-renal, intra-renal, and post-renal AKI are three types of AKI, each with varied causes and specific evaluations.
Fluid balance, electrolyte management, appropriate drug regimens, and monitoring are crucial in management.

Influence of Renal Impaired Function on Pharmacokinetics

Renal impairments significantly affect drug absorption, distribution, metabolism, and elimination, influencing drug therapy.
Absorption can be impacted by factors such as decreased gastric acidity, formation of insoluble salts, and metal chelates, leading to reduced bioavailability.
Distribution may be affected by alterations in body composition and fluid overload, increasing the volume of distribution for certain drugs, and reduced protein binding.
Metabolism and elimination (renal clearance) directly impaired by reduced kidney function, which necessitates drug dosage adjustments to maintain therapeutic efficacy and to prevent toxicity.

Altered Pharmacokinetics

Increased risk of adverse drug reactions (ADRs).
Drug dosage considerations.
Drug selection criteria must appropriately consider renal function.

Acute Kidney Injury (AKI) Management

Primary goal involves managing life-threatening complications, identifying and mitigating underlying causes, correcting intravascular fluid balance (hypovolemia vs volume overload), and initiating supportive therapies.
Early preventive strategies encompass risk identification, minimizing nephrotoxic agent exposure, and monitoring high-risk patients.
Early supportive strategies encompass optimizing renal perfusion, rapidly correcting fluid and electrolyte imbalances, and administering hydration and electrolytes.
Non-dialysis treatments for established AKI focus on supportive therapies, providing adequate nutrition, and addressing electrolyte and acid-base imbalances.

Acute Kidney Injury (AKI) Follow-Up Evaluation

Monitor parameters such as fluid balance, urine output, acid-base balance, and serum creatinine (SCr) to evaluate whether kidney function is stabilising or worsening.

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Description

Explore the fundamentals of managing renal disorders in clinical therapeutic settings. This quiz focuses on evaluating patient drug-related problems and understanding the intricacies of drug therapy in renal care. Enhance your critical thinking and problem-solving skills in patient assessments.