Clinical Therapeutic I: Renal Disorders Management

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.

Drug-Related Problem

• 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 of Patient's Drug-Related Needs

• 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

Drug-Related Problem Types

• 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

Identification of Drug-Related Problems (DRPs)

• 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.