Sarayu, B (2018) Dosage Individualization of Anti Microbials and Cardiovascular Drugs in Patients with Chronic Renal Dysfunction. Masters thesis, College of Pharmacy, Sri Ramakrishna Institute of Paramedical Sciences, Coimbatore.
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Abstract
BACKGROUND: Chronic kidney disease is a common and progressive illness that may be harmful and may have deleterious effects. Inappropriate dosing in patients with renal dysfunction can cause toxicity or ineffective therapy. Dose adjustment in patients with renal failure reduces both the cost of the drug therapy and the risk of ADRs. OBJECTIVES: 1. To understand the prescribing pattern of antimicrobials and cardiovascular drugs in patients with renal function impairment. 2. To understand drug dosage individualization of all renally excreted antimicrobials and cardiovascular drugs that necessitates dosage adjustment in patients with renal function impairment. DESIGN: Prospective descriptive study. STUDY DURATION: 9 months (from December 2018 to August 2018). SETTING: A 700 bedded multi-specialty tertiary care teaching hospital. PATIENTS: All in patients with estimated serum creatinine value more than 1.7mg/dL (Normal range: 0.8 – 1.2 mg/dL), prescribed with at least one antimicrobial drug or cardiovascular drug or both were included in the study. METHOD: Clinical and demographic details of the eligible patients were collected in a structured proforma after obtaining approval from the Institutional Review Board. Creatinine clearance or estimated glomerular filtration rate of the patient were calculated using Cockroft-Gault equation and Modified Diet in Renal Disease equation respectively with the help of Micromedex calculators. The dose of all drugs with potential nephrotoxicity or renally excreted drugs was evaluated using the published drug dosing guidelines. When necessary the new dosages or dosing intervals were optimized to the patient’s individual degree of renal impairment using relevant equations. RESULTS: 20 patients had moderate renal impairment while 46 had severe and 37 had end stage renal dysfunction. 1016 drugs in 103 patients were evaluated in the present study with an average of 10 drugs per patient. Of these 1016 studied drugs 98 (9.64%) required dose adjustment where 244 (24.01%) were adjusted and 83 (8.16%) were not adjusted. It was found also that most of the drugs requiring dose adjustment were antibiotics (41.77%) followed by antihypertensives (13.67%). Major category of errors identified were overdose (61.53%) and wrong frequency of administration (23.07%). About 15.38% of the drugs were to be avoided strictly. It was also found that 13.12% of prescribed drugs had interaction. The most common interaction was identified as Pantaprazole vs Torsemide and was found in 4.17% of patients. Nephrotoxic drug interactions were observed in 2.79% of patients. Around 1.84% of drugs had narrow therapeutic index. These were prescribed in 13.5% of patients. Prazosin (2%) theophylline (8%) and Digoxin (4%) were the drugs with narrow therapeutic index. CONCLUSION: Recommended dosage guidelines in renally impaired patients were followed in 82.6% of prescriptions whereas only 17.39% were found to be deviated. Findings of the present study revealed that the overall consistency was good when compared with similar studies reported.
| Item Type: | Thesis (Masters) |
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| Additional Information: | REG.No.261640108 |
| Uncontrolled Keywords: | Dosage Individualization ; Anti Microbials and Cardiovascular Drugs ; Chronic Renal Dysfunction. |
| Subjects: | PHARMACY > Pharmacy Practice |
| Depositing User: | Subramani R |
| Date Deposited: | 02 Jul 2019 14:56 |
| Last Modified: | 03 Jul 2019 01:36 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/10685 |
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