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Here is the classic pocket guide to drug-dosing for patients with impaired renal function in a revised and updated New Edition! Easy-to-read tables put the information physicians need when determining dosages for more than 450 drugs at their fingertips. Plus, this New Edition features brand-new guidance on pediatric dosing, making it the most complete resource of its kind.
- Sales Rank: #168380 in Books
- Brand: Brand: American College of Physicians
- Published on: 2007-06-06
- Original language: English
- Number of items: 1
- Dimensions: 8.25" h x .69" w x 4.94" l, .74 pounds
- Binding: Paperback
- 272 pages
- Used Book in Good Condition
Most helpful customer reviews
8 of 8 people found the following review helpful.
Update Much Appreciated. Loses some efficiency as a pocket reference.
By Quadradox
Several features in Edition 5 are welcomed, these were on my wish list.
1. Expanded information about metabolism and excretion. Numerous entries do include limited details on P450 enzyme systems and the bibliography at the end gives references which could provide more specific data.
2. Percent plasma binding & volume of distribution are still given, these do help with predicting dialyzability of meds or anticipating difficulties in patients with large BSAs.
3. More supplementation guidelines are provided for intermittent hemodialysis, CRRT and PD when known.
4. There is, in fact, a mobile version for Palm, Blackberry, PocketPC, Tablet PC, Laptops and Desktops available through [...] and called RFDrugs which I have not yet explored.
5. Also I appreciate the consistent and concise categorization of CrCl (>50, 10-50 and 6. Where specific side-effects are more likely in renal patients, these are frequently highlighted as well.
7. A new pediatric section. In my training, this would have been useful though I have less practical need for it now.
SKEPTICISMS:
Unfortunately several years of experience do not bear out for me the range of dosages listed for persons with renal insufficiency for nonsteroidal drugs nor for the narcotics. I am not sure why these continue to be listed so generously -- pharmacologic clearance studies separated from the whole person might lead to these predictions and should not be trusted readily. Caution, close observation, starting with low doses and titrating to least effective dose, and supplementing with other nonpharmacologic practices such as temperature, physical manipulation and therapy, acupuncture, etc are long standing principles for these particular drugs that still have major merit in renal patients. My experience is that patients with renal insufficiency frequently also have other co-morbidities such has diabetic gastroparesis, autonomic neuropathy, sleep apnea, liver compromise, interactions amount many entities on their very long med lists, and cerebral and renal vascular disease, etc. which result in relatively poor tolerance or no tolerance of any NSAIDS except 81 mg of aspirin per day, and a very limited therapeutic window for narcotics. I strongly suspect that the clearance studies were obtained in controlled setting in which the subjects were likely to only be on the study drug or a limited number of non-interfering drugs -- unfortunately not simulating the profound and sometimes necessary polypharmacy occurring in chronic renal patients. Thus, I would not leave these potentially life-threatening issues to pharmaceutical industry/manufacturer's claims in their product data sheets or to any textbook/reference alone. Rescuing hyperkalemia, apneic breathing, profound constipation/bowel obstruction/perforation and blood pressure too low to maintain adequate renal perfusion in someone wishing to not be on dialysis -- these seem a bit higher priority than is addressed here. I do understand and obviously have seen that people with normal kidneys and livers seem to be able to develop tolerance to massive amount of narcotics -- my reality is that this tolerance at times is much slower, much less impressive and sometimes never develops in my renal patients.
There may be other pharmaceutical categories that likewise should be started at lower doses than indicated here, as well. I unfortunately don't see a discrimination between potential initiation doses and chronic doses which might have been more helpful. For example, the first initiation dose for a narcotic in a patient presenting with acute pain who has renal insufficiency may be appropriately given a higher dose -- as no accumulation has yet occurred. The issue is the prolonged action, not all of which is predicted by drug clearance of the major metabolite -- there are minor metabolites, depletion of metabolic enzymes, changes in organ level function which may not bounce back as readily as the metabolite is claimed to clear, progressive hypoventilation in patients iwht sleep apnea, etc. Obviously the practitioner needs to make direct observation and take the safety of their patient very seriously regardless of the fact that higher doses might be "authorized" in this reference.
WISHES FOR THE NEXT UPDATE:
In order to keep the book small, concise and better for the coat pockets, I would reccommend the authors provide a website where corrections, updates, additions between formal revisions and specific drug-related commentary regarding issues noted in practice by the users of the book can be viewed by authorized purchasers. This would be an appropriate place to list the very extensive bibliography which currently takes up 30% of the pages of the book, even though it contains straightforward reference citations without annotations. Many college textbook companies now provide websites for supplemental information such as this and the ACP could probably do so very easily as well.
Fellows, hospitalists, nephrology offices and dialysis units would all be benefitted by having this reference readily available.
1 of 1 people found the following review helpful.
LMWH and bisphosphonates
By K. Stille
Certainly a very useful book and I am glad that it is available!
I would like to mention two points though that have disappointed me.
- Bisphosphonates, useful in some areas of nephrology, are not mentioned at all.
- The guidance on low-molecular-weight heparins (LMWH) is too short. The article listed in the bibliography section does not support the recommendations in the book. There are differences in the use of LMWH in renal impairment amongst the different preparations available. This is not noted at all.
1 of 3 people found the following review helpful.
dosing drugs in CKD
By Matias E. Abuchanab
Complete and specific information about drug prescribing in renal failure. Dosing for adults and pediatrics. A source of information to trust. The information includes supplementation for dialysis. All in pocket size.
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