Difference between revisions of "Medications requiring dosage adjustments in renal insufficiency"
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| − | + | A brief summary of several studies involving CDS for renally cleared medications | |
| + | Many medications must be carefully monitored in the setting of compromised renal function. Clinical decision support has been shown in several studies to improve compliance with guidelines. A study by Chertow1 suggested that incorporation directly into CPOE led to significant compliance improvements. A study by Roberts2 showed that clinical decision support, even outside of CPOE can improve conformity, but continued education is required or levels of compliance will return to their pre-implementation levels. Oppenheim showed that a CDS system for renally dosing medications could be implemented without adversely affecting educational benefits by allowing a "first crack" by the housestaff. | ||
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Revision as of 04:28, 27 May 2010
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A brief summary of several studies involving CDS for renally cleared medications
Many medications must be carefully monitored in the setting of compromised renal function. Clinical decision support has been shown in several studies to improve compliance with guidelines. A study by Chertow1 suggested that incorporation directly into CPOE led to significant compliance improvements. A study by Roberts2 showed that clinical decision support, even outside of CPOE can improve conformity, but continued education is required or levels of compliance will return to their pre-implementation levels. Oppenheim showed that a CDS system for renally dosing medications could be implemented without adversely affecting educational benefits by allowing a "first crack" by the housestaff.
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References
KAISER PERMANENTE:SAFETY IN PRESCRIBING (SIP). Recommendations for dosing and drug alternatives. Dosing Recommendation in renal dysfunction. FEBRUARY 10, 2003 UPDATE.
| Examples of Medications Requiring Dosage Adjustments in Renal Insufficiency | ==|||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Drug | GFR | Dosing recommendation in alert | Potential safety problem listed in alert |
|---|---|---|---|
| Allopurinol | 51-60
10-50 <10 |
200mg per day maximum
150mg per day maximum Do not use |
Liver and hematoligic toxicity.
|
| Co-trimoxazole | 15-30
<15 |
80/400mg twice per day maximum
Do not use |
Crystalluria and kidney stone formation.
|
| Metformin | <10 | Do not use | Lactic acidosis. |
