1. Dialysis and hemofiltration are methods used to remove drugs and toxins from the bloodstream of patients with end-stage renal disease or drug overdoses.
2. They work by diffusing or conveying waste products across a semi-permeable membrane from the blood into dialysate fluid or through ultrafiltration.
3. The effectiveness of these methods depends on factors like the drug's molecular weight, protein binding, and volume of distribution within the body.
THIS SLIDE GIVES AN INSIGHT TO THE DIFFERENT METHODS THAT COULD BE USED FOR THE DOSAGE ADJUSTMENT IN PATIENTS WITH RENAL DISEASE.
RENAL FUNCTION OF THE PATIENT IS ASSESSED TO DETERMINE THE DOSAGE ADJUSTMENT
Clinical pharmacokinetics and its application--
1)definition
2) APPLICATIONS OF CLINICAL PHARMACOKINETICS
Design of dosage regimens:
a) Nomograms and Tabulations in designing dosage regimen,
b) Conversion from intravenous to oral dosing,
c) Determination of dose and dosing intervals,
d) Drug dosing in the elderly and pediatrics and obese patients.
Pharmacokinetics of Drug Interaction:
a) Pharmacokinetic drug interactions
b) Inhibition and Induction of Drug metabolism
c) Inhibition of Biliary Excretion.
Therapeutic Drug monitoring:
a) Introduction
b) Individualization of drug dosage regimen (Variability – Genetic, Age and Weight, disease, Interacting drugs).
c) Indications for TDM. Protocol for TDM.
d) Pharmacokinetic/Pharmacodynamic Correlation in drug therapy.
e) TDM of drugs used in the following disease conditions: cardiovascular disease, Seizure disorders, Psychiatric conditions, and Organ transplantations
Dosage adjustment in Renal and Hepatic Disease.
a. Renal impairment
b. Pharmacokinetic considerations
c. General approach for dosage adjustment in renal disease.
d. Measurement of Glomerular Filtration rate and creatinine clearance.
e. Dosage adjustment for uremic patients.
f. Extracorporeal removal of drugs.
g. Effect of Hepatic disease on pharmacokinetics.
Population Pharmacokinetics.
a) Introduction to Bayesian Theory.
b) Adaptive method or Dosing with feedback.
c) Analysis of Population pharmacokinetic Data
THIS SLIDE GIVES AN INSIGHT TO THE DIFFERENT METHODS THAT COULD BE USED FOR THE DOSAGE ADJUSTMENT IN PATIENTS WITH RENAL DISEASE.
RENAL FUNCTION OF THE PATIENT IS ASSESSED TO DETERMINE THE DOSAGE ADJUSTMENT
Clinical pharmacokinetics and its application--
1)definition
2) APPLICATIONS OF CLINICAL PHARMACOKINETICS
Design of dosage regimens:
a) Nomograms and Tabulations in designing dosage regimen,
b) Conversion from intravenous to oral dosing,
c) Determination of dose and dosing intervals,
d) Drug dosing in the elderly and pediatrics and obese patients.
Pharmacokinetics of Drug Interaction:
a) Pharmacokinetic drug interactions
b) Inhibition and Induction of Drug metabolism
c) Inhibition of Biliary Excretion.
Therapeutic Drug monitoring:
a) Introduction
b) Individualization of drug dosage regimen (Variability – Genetic, Age and Weight, disease, Interacting drugs).
c) Indications for TDM. Protocol for TDM.
d) Pharmacokinetic/Pharmacodynamic Correlation in drug therapy.
e) TDM of drugs used in the following disease conditions: cardiovascular disease, Seizure disorders, Psychiatric conditions, and Organ transplantations
Dosage adjustment in Renal and Hepatic Disease.
a. Renal impairment
b. Pharmacokinetic considerations
c. General approach for dosage adjustment in renal disease.
d. Measurement of Glomerular Filtration rate and creatinine clearance.
e. Dosage adjustment for uremic patients.
f. Extracorporeal removal of drugs.
g. Effect of Hepatic disease on pharmacokinetics.
Population Pharmacokinetics.
a) Introduction to Bayesian Theory.
b) Adaptive method or Dosing with feedback.
c) Analysis of Population pharmacokinetic Data
Genetic polymorphism in drug transport and drug targets.pavithra vinayak
Genetic polymorphism in drug transport and targets.--pharmacogenetics
DRUG TRANSPORTER
Two types of transporter :
•ATP binding Cassette (ABC) – Found in ABCB, ABCD and ABCG family. Associated with multidrug resistance (MDR) of tumor cells causing treatment failure in cancer.
•Solute Carrier (SLC) – Transport varieties of solute include both charged or uncharged
P-glycoprotein
• ATP binding cassette subfamily B member- 1 (ABCB 1)
• Multidrug resistance protein 1 (MDR1)
• Transport various molecules, including xenobiotic, across cell membrane
• Extensively distributed and expressed throughout the body
Mechanism of Pglycoprotein
Substrate bind to P-gp form the inner leaflet of the membrane
ATP binds at the inner side of the protein
ATP is hydrolyzed to produce ADP and energy
Pharmacological Approach to Drug DiscoverySuhas Reddy C
For better understanding of students. This will give you a detailed explanation of Pharmacological approach. Contact me through comment section if you need any assistance in understating
Definition and scope of Pharmacoepidemiology ABUBAKRANSARI2
In these slides I shared the information of definition and scope of pharmacoepidemiology. Types of studies - cohort studies, cross-sectional studies etc.
Effectiveness and safety of CPNB and continuous local wound infusion
Basal infusion with PCA option
Types of pumps – elastomeric vs. electronic
Outpatient and home infusion pumps
Genetic polymorphism in drug transport and drug targets.pavithra vinayak
Genetic polymorphism in drug transport and targets.--pharmacogenetics
DRUG TRANSPORTER
Two types of transporter :
•ATP binding Cassette (ABC) – Found in ABCB, ABCD and ABCG family. Associated with multidrug resistance (MDR) of tumor cells causing treatment failure in cancer.
•Solute Carrier (SLC) – Transport varieties of solute include both charged or uncharged
P-glycoprotein
• ATP binding cassette subfamily B member- 1 (ABCB 1)
• Multidrug resistance protein 1 (MDR1)
• Transport various molecules, including xenobiotic, across cell membrane
• Extensively distributed and expressed throughout the body
Mechanism of Pglycoprotein
Substrate bind to P-gp form the inner leaflet of the membrane
ATP binds at the inner side of the protein
ATP is hydrolyzed to produce ADP and energy
Pharmacological Approach to Drug DiscoverySuhas Reddy C
For better understanding of students. This will give you a detailed explanation of Pharmacological approach. Contact me through comment section if you need any assistance in understating
Definition and scope of Pharmacoepidemiology ABUBAKRANSARI2
In these slides I shared the information of definition and scope of pharmacoepidemiology. Types of studies - cohort studies, cross-sectional studies etc.
Effectiveness and safety of CPNB and continuous local wound infusion
Basal infusion with PCA option
Types of pumps – elastomeric vs. electronic
Outpatient and home infusion pumps
Patient Controlled Analgesia: Return to Nursing ProgramIHNA Australia
This presentation outlines how nurses can use Patient Controlled Analgesia (PCA) to benefit patients/clients. This presentation covers:
1. Indications and contraindications of PCA use
2. The advantages of PCA
and
3. The pharmacological principles of pain management
This presentation was compiled by Gulzar Malik, an experienced and qualified Nursing Educator at IHNA. For more information about our return to nursing programs, please call 1800 22 52 83.
PCA is neither “ one size fits all “ or a “ set and forget “ therapy
An Anesthesiologist style ……….
no fixed dose of drug fits all patient
make patient analgesia and take care
Hemodialysis: management of chronic kidney diseaseSapana Shrestha
Hemodialysis is a mechanical process of removing waste products (toxic nitrogenous substances) and replacing essential substances by the process of diffusion and removal of excess water from body by the process of osmosis by means of artificial kidney (made with modified cellulose or synthetic) through semi-permeable membranes.
Hemodialysis is a treatment to filter wastes and water from your blood; In hemodialysis, the blood is cleaned outside the body using a dialysis machine and then sent back into the body.
Hemodialysis is a treatment to filter wastes and water from your blood, as your kidneys did when they were healthy. Hemodialysis helps control blood pressure and balance important minerals, such as potassium, sodium, and calcium, in your blood.
Hemodialysis is one way to treat advanced kidney failure and can help you carry on an active life despite failing kidneys.
Mechanism of Hemodialysis:
Hemodialysis is a procedure by which waste products and excess water are removed from a patient’s blood. This is done by directly removing blood from the patient’s circulation, passing it through the dialysis filter, and then returning it directly back into the circulation.
Apparatus needed:
Dialyzer or dialysis filter
Dialysate (dialysis solution)
Tubing for transport of blood and dialysate
Machine that powers and monitors the filtration
Hemodialysis has 5 main steps which are as follows:
1.Two sets of tubing are connected to the patient’s dialysis access:
Connected directly to central venous catheter
Two needles inserted into AVF/AVG and taped down
2. Azotemic blood pumped from patient into dialysis filter
3. Dialysis filter removes toxins primarily through diffusion:
Dialysis filter is a plastic cylinder filled with thousands of tiny individual tubes composed of the filtering material.
Blood flows through the inside of the tiny tubes in one direction.
Dialysis fluid (dialysate) flows on the outside of the tiny tubes (but still within the single plastic cylinder that contains them) in the opposite direction.
The opposing directions of blood and dialysate result in maximal concentration gradients that drive the diffusion of toxins:
Known as “countercurrent” mechanism
Also results in correction of electrolyte/acid–base abnormalities via diffusion.
4. Dialysis filter removes excess water from the blood through ultrafiltration.
Suction force is applied by the dialysis machine across the dialysis filter.
Water is pulled from the blood side into the dialysate side.
5. Clean blood and waste-filled dialysate exit the dialysis filter.
Clean blood is pumped back into the patient’s Circulation.
Waste-filled dialysate is disposed of (including the excess water from the patient’s body that was removed during ultrafiltration).
Chronic dialysis
3–4 hours each session
3 times a week (Monday/Wednesday/Friday or Tuesday/Thursday/Saturday)
Acute dialysis:
Treatment duration and daily schedule are
Variable.
Priscriptions: The nephrologist may control many variables within the dialysis procedure:
Duration of treatment
Ultrafiltration goal
Anticoagulation
Electrolyte composition of the dialysate
Speed of blood flow and dialysate flow
Presented by: Mohammadsaleh Moallem
RENAL DIALYSIS.
RRT
Renal Replacement Therapy.
Dialysis is the artificial process of eliminating waste (diffusion) and unwanted water (ultra filtration) from the blood.
Dialysis is a procedure that cleans and filters the blood. It rids the body of harmful wastes and extra salt and fluids. It also controls blood pressure and helps our body keep the proper balance of chemicals such as potassium, sodium, and chloride.
Dialysis is a Greek word meaning "loosening from something else".
2. Patients with ESRD or who have been
intoxicated due to overdose of a drug may require
supported treatment to remove accumulated
drugs.
Methods:
Dialysis
Hemofiltration
Hemoperfusion.
Objective:
Rapidly remove undesirable drugs and
metabolites without disturbing the fluid and electrolyte
balance in the patient.
3. Artificial Process, acculmulation of drug
removed by diffusion into dialysis fluid.
Two Methods:
Peritoneal Dialysis.
Hemodialysis.
4. Helps to clean the blood and remove
excess of water in the body – peritoneal
Membrane in the abdomen.
A catheter inserted in peritoneal cavity,
dialysis fluid enters into the peritoneal
cavity via tube -> filters blood and
remove waste products from the body.
Two Types
CAPD(Continous Ambulatory Peritoneal Dialysis)))
APD (Automated Peritoneal Dialysis)
5. Fluid flows in and out of the body using
gravity.
Over time, waste and fluid build up in the
blood which slowly float across into
peritoneal membrane by diffusion and
exchange remove dialysis fluid from the
peritoneal cavity and replaces with new fluid.
To be done everyday
1 Exchange takes 30 mins.
6. Solution is clear.
Check the solution type and % is correct.
Expiration date has not passed.
Volume is correct.
No leaks after gentle squeezing.
7. Machine does the exchange
Done by Dialysis team or taught to use .
FLUID AND DIALYSIS SOLUTION
Important to achieve right balance of water in body.
Determined in 3 ways.
Weight
BP
Swelling
Dialysis Solution
Dianeal (1.5%, 2.5%, 4.25%)
Neutroneal (1.1 %)
Extraneal (7.5%)
PRECAUTION
Infection
8. Process that uses artificial kidney to remove waste products
through the process called diffusion.
Artificial kidney contains a number of tubes with a semi
permeable lining, suspended in a tank filled with dialysing
fluid.
9. 1.
•One line connected to artery which is connected to one end of dialysis where
blood is collected from patient for filtration.
2.
•Waste Product from the blood passes into dialysing fluid by diffusion.
3.
•Purified Blood is pumped back into the vein which is connected to other end
of dialysis device.
10. Heparin is used to prevent blood clotting during dialysis.
It is much more effective method for rapid removal of drug (
overdose , poisoning) and preferred method in ESRD.
Dialysis may be required from every 2 days to 3 times a week,
one dialysis period is of 2-4 hrs depending on patient’s size,
weight and renal function.
CHARACTERISTICS OF DIALYSING MACHINE
Higher Blood flow rate.
Permeable dialysis membrane.
High Transmembrane pressure.
Important notes.
11. •Insoluble or fat soluble drugs are not solubilized.( eg
glutethimide – a water insoluble drug.)
Water Solubility
•Tightly bound protein are not dialysed. (eg
propranolol)
Protein Binding
•Mol Wt less than 500 are dialysed. ( eg Vancomycin is
poorly dialysed )
Molecular Weight
Drugs with large
volume of distribution
•Widely distributed drugs are dialysed slowly, drug
concentrated in tissues are difficult to remove by
dialysis.
12. In dialysis involving uremic patient receiving drug for therapy,
drug is removed depending on the flow rate of the blood to
the dialysis machine which is described by the term
Dialysance.
Defined by the equation :
ClD = Q(Ca –CV)
Ca
where, Ca = Drug Concentration in arterial blood.
CV =Drug Concentration in Venous blood.
Q= Rate of Blood flow to kidney.
ClD = Dialysance.
13. Removing the drugs by passing the blood
from the patient through an adsorbent
material and back to the patient.
Molecules which have greater affinity for the
materials will be removed.
14. Useful in accidental poisoning and drug
overdose.
Materials use:
◦ Activated Charcoal (both polar and non polar drugs)
◦ Amberlite resins (non polar organic molecules).
15. Affinity of the drug for the absorbent.
Surface area of the absorbent.
Absorptive capacity of the absorbent.
Rate of blood flow through the absorbent.
Equilibrium rate of the drug from the
peripheral tissue into the blood.
16. An alternative to hemodialysis and
hemoperfusion.
A process by which fluid, electrolytes, small
molecular weight substances are removed
from the blood using hollow artificial fibre.
Loss of water and electrolytes takes place,
that leads to production of ultrafiltrate. As a
result equal volume of fluid is replaced.
17. Synthetic, high flux(permeability), hollow fibre membrane.
Pore size 50000 da
High Surface Area ( 0.6-1.2 m2).
Notes
• Flow rate of 20-35 ml/kg/hr is usually required.
• No benefit shown with higher flow rate, more expensive.
• Although higher flow rate may be used if rapid solute
clearance is necessary.
18. Hemodialysis involves diffusion across a semipermeable membrane
Where as Hemofiltration is a convection process with loss of water
Due to ultrafiltration accompanied by convicted loss of salts.
19. The clearance of the drug depends on sieving coefficient and
ultrafiltration rate.
The sieving coefficient reflects the solute removal ability
during hemofiltration.
When S=1 solute passes freely through the membrane
whereas is S=0 solute is retained in plasma.
S is constant and independent of blood flow , so
Cl=S * Ultrafiltration rate
The Concentration of the drug in the ultrafiltrate is also equal
to the unbound drug concentration in the plasma , so,
amount of drug removed is given as :
Amount removed = CP + ∞ * rate of ultrafiltration