Medication Management
Renal Dosing
Several studies have corroborated high rates (28-44%) of inappropriate prescribing in patients with moderate to severe kidney disease [1,2].
As a pharmacist, you can help your patient by:
Adherence
Patients have complex medication regimens, and adherence is often an issue [3]. Poor adherence has also been linked to sub-target immunosuppressive levels [3]. Pill burden has also been related to poorer transplant outcomes [4].
As a pharmacist, you can help your patient by:
1. Pillans PI, Landsberg PG, Fleming AM, Fanning M, Sturtevant M. Evaluation of dosage adjustments in patients with renal impairment. 2003. Intern Med J. 33(1-2):10-3.
2. Sheen SS, Choi JE, Park RW, Kim EY, Lee YH, Kang UG. Overdose rates of drugs requiring renal dose adjustment: data analysis of 4 years prescriptions at a tertiary care teaching hospital. 2008. J Gen Intern Med. 23(4):423-8.
3. Griva K, Davenport A, Harrison M, Newman SP. Non-adherence to immunosuppressive medications in kidney transplantation: intent vs forgetfulness and clinical markers of medication intake. 2012. Ann Behav Med. 44(1): 85-93.
4. Hardinger KL, Hutcherson T, Preston D, Murillo D. Influence of pill burden and drug cost on renal function after transplantation. 2012. Pharmacotherapy. 32(5):427-32.
Several studies have corroborated high rates (28-44%) of inappropriate prescribing in patients with moderate to severe kidney disease [1,2].
As a pharmacist, you can help your patient by:
- Encourage patients to know their SCr
- Use Cockcroft Gault
- Do NOT assume the doctor knows best
- Advocate for your patient
Adherence
Patients have complex medication regimens, and adherence is often an issue [3]. Poor adherence has also been linked to sub-target immunosuppressive levels [3]. Pill burden has also been related to poorer transplant outcomes [4].
As a pharmacist, you can help your patient by:
- Preparing weekly pill packs
- Simplifying medication regimens
- Reviewing medications to see if any can be eliminated
- Providing strategies for remember medications (Ie. alarms)
- Following up with your patient regarding adherence
- Helping patients obtain funding for medications
1. Pillans PI, Landsberg PG, Fleming AM, Fanning M, Sturtevant M. Evaluation of dosage adjustments in patients with renal impairment. 2003. Intern Med J. 33(1-2):10-3.
2. Sheen SS, Choi JE, Park RW, Kim EY, Lee YH, Kang UG. Overdose rates of drugs requiring renal dose adjustment: data analysis of 4 years prescriptions at a tertiary care teaching hospital. 2008. J Gen Intern Med. 23(4):423-8.
3. Griva K, Davenport A, Harrison M, Newman SP. Non-adherence to immunosuppressive medications in kidney transplantation: intent vs forgetfulness and clinical markers of medication intake. 2012. Ann Behav Med. 44(1): 85-93.
4. Hardinger KL, Hutcherson T, Preston D, Murillo D. Influence of pill burden and drug cost on renal function after transplantation. 2012. Pharmacotherapy. 32(5):427-32.