Branden D. Nemecek - Demystifying Drug Dosing in Renal Dysfunction

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Vice President, Publishing: DANIEL COBAUGH
Editorial Project Manager, Special Publishing: RUTH BLOOM
Editorial Project Manager, Production Publications Center: BILL FOGLE
Cover & Page Design: DAVID WADE
Editorial Consultant: HEATHER MARTIN, PharmD, CDE, CHWC

Library of Congress Cataloging-in-Publication Data

Names: Nemecek, Branden D., editor. | Hammond, Drayton A., editor. | American Society of Health-System Pharmacists.

Title: Demystifying drug dosing in renal dysfunction / [edited by] Branden D. Nemecek, Drayton A. Hammond.

Description: Bethesda, MD : American Society of Health-System Pharmacists, [2019] | Includes index.

Identifiers: LCCN 2018060777 | ISBN 9781585285518 (pbk.)

Subjects: | MESH: Kidney Diseasesdrug therapy | Drug Dosage Calculations

Classification: LCC RC918.R4 | NLM WJ 300 | DDC 616.6/1061dc23 LC record available at https://lccn.loc.gov/2018060777

2019, American Society of Health-System Pharmacists, Inc. All rights reserved.

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ISBN: 978-1-58528-551-8

10 9 8 7 6 5 4 3 2 1

DEDICATION

We dedicate this book to our family and friends for all of their support through this process.

To my brilliant and supportive wife, Alissa, and my parents and my brother for all of their support through my education, training, and early career.

- Branden

To my parents and my sister for their encouragement; and to the countless mentors Ive grown with throughout my career.

- Drayton

CONTENTS

Erin Frazee Barreto, PharmD, MSc, FCCM, BCPS, BCCCP, and Branden D. Nemecek, PharmD, BCPS

Anthony J. Guarascio, PharmD, BCPS; Jarrett R. Amsden, PharmD, BCPS; and David E. Zimmerman, PharmD, BCPS, BCCCP

Caroline Der-Nigoghossian, PharmD, BCCCP, and Karen Berger, PharmD, BCPS, BCCCP

Jacqueline M. Lucey (Klootwyk), PharmD, BCPS, BCACP; Amber E. King, PharmD, BCPS; Drayton A. Hammond, PharmD, MBA, MSc, BCPS, BCCCP; and Branden D. Nemecek, PharmD, BCPS

Justin M. Julius, PharmD, and Karen M. Fancher, PharmD, BCOP

Jessica L. Ho, PharmD, BCPS, BCPP

Nicole M. Bohm, PharmD, BCPS, and Emmeline Tran, PharmD, BCPS

Carolyn E. Ragsdale, PharmD, BCPPS, and Kathryn Givens Merkel, PharmD, BCPS, BCPPS

Kimberly A. Trobaugh, PharmD, BCPS; Alexander H. Flannery, PharmD, BCPS, BCCCP; and Melissa L. Thompson Bastin, PharmD, BCPS

Branden D. Nemecek, PharmD, BCPS

Drayton A. Hammond, PharmD, MBA, MSc, BCPS, BCCCP, and Kirstin J. Kooda, PharmD, BCPS

PREFACE

Most of the conversations we have with other healthcare professionals when taking care of a patient can be grouped under the general topic of appropriately dosing a medication. A goal may be to push the limits to achieve a particular efficacy endpoint for one medication while we may be trying to mitigate the potential adverse effects with another. In most patients with stable end-organ function, these conversations are short and without much controversy. However, the conversations are much juicier and ripe for differences in opinion as the patient complexity increases. An area that has generated the greatest amount of discussion in our practices and the impetus for this book is dosing medications in patients with acute and chronic renal dysfunction to achieve our desired safety and efficacy endpoints.

How will this book help you in your practice?

Whether you are a junior or more seasoned physician, advanced practice provider, pharmacist, or a student or resident in any of these professions, this book will meet your needs through efficient, evidence-based presentation of the data behind dosing recommendations, monitoring parameters, and mitigation of adverse effects for commonly used medications in patients with renal dysfunction in the in- and out-patient settings. We have brought together experts in pharmacy and pharmacology with advanced training and credentials to delve into the most widely prescribed medication classes, complex patient subpopulations, and the commonly used renal replacement modalities in easy-to-read and easy-to-apply manners. Early- and middle-career practitioners will find clinical pearls on most every page that they can incorporate into their practice to improve their patients outcomes. Late-career practitioners will find the summary tables to be a significant timesaver and helpful update on dosing and monitoring strategies that have evolved in recent years.

Examples of medication classes and organ systems:

Analgesics (e.g., opioids, gabapentinoids, muscle relaxants)

Anti-epileptics

Anti-infectives (e.g., antibiotics, antifungals, antivirals)

Cardiovascular (e.g., antiarrhythmics, anticoagulants, antihyperlipidemics)

Oncology (e.g., alkylating agents, antimetabolites, topoisomerase inhibitors)

Psychiatry (e.g., antipsychotics, antidepressants, anxiolytics)

Complex patient subpopulations:

Chronic kidney disease

Critical illness

Pediatrics

Solid organ transplantation

Renal replacement modalities:

Continuous and accelerated renal replacement therapies

Hemodialysis

Plasmapheresis

How should I use this text to improve my patient care?

This text works on multiple levels to meet practitioners where they are with their previous knowledge of dosage adjustments and monitoring in renal dysfunction for medications, subpopulations, and renal replacement modalities and helps them to extend that knowledge. Practitioners who want to use this text as a quick reference for medication dosing given varying degrees of renal dysfunction and/or use of renal replacement modalities will find cleanly presented and evidence-based tables for each chapter that summarize the data into dosing recommendations. When the desire is to investigate the