1. LECTURE FILES f:\callab\lectures\dhollo.

2. PHARMACOLOGY route of elimination –kidney –liver –both

3. PHARMACOLOGY half-life major toxicity renal function

4. SERUM CREATININE AND GLOMERULAR FILTRATION RATE TIME SERUM CONCENTRATION ) HALF-LIFE 100 50 T 1/2

5. PCT DCT LOOP DESCENDING ASCENDING COLLECTING DUCT 5 NSAIDS ACE Tetracycline Gold Penicillamine Aminoglycosides Penicillin Lithium Chemotherapy Lithium 1 2 34 6

6. DRUGS & RENAL FAILURE SYNDROMES altered blood flow (1) glomerulonephritis (2) Fanconi syndrome (3) acute tubular necrosis (4)

7. DRUGS & RENAL FAILURE SYNDROMES acute interstitial nephritis (5) chronic interstitial nephritis (5) obstruction/diabetes insipidus (6)

8. DRUGS & RENAL FAILURE drugs may reach toxic levels and cause renal damage e.g.. ATN drugs accumulate and cause toxicity in other organ systems e.g.. digoxin toxicity

9. DRUGS & RENAL DISEASE loading dose - same for everyone does not change in renal failure maintenance dose depends on route of excretion and drug toxicity –most drugs are renaly excreted and require dose modification

10. DOSE MODIFICATION in RENAL FAILURE NEW DOSE INTERVAL = NORMAL DOSE INTERVAL x PATIENTS CREATININE NORMAL CREATININE NEW DOSE = NORMAL CREATININE x NORMAL DOSE PATIENTS CREATININE

11. GFR vs AGE Lancet 1 1133-1134 1971

12. CALCULATION OF GFR GFR = (140 - AGE) x WT (Kg) x 1.2 SCr (umol/l) For males multiply by 1.25 For females multiply by 1.09 Gault Nephron 62: 249-256 1992

13. DOSE MODIFICATION in RENAL FAILURE NEW DOSE INTERVAL = NORMAL DOSE INTERVAL x NORMAL GFR PATIENTS GFR

14. CALCULATION OF GFR GFR = (140 - AGE) x WT (Kg) SCr (mg/dl) X 72 For Females multiply by 0.85 Gault Nephron 62: 249-256 1992