A 55-year-old female who has chronic renal failure due to a history of poorly controlled diabetes has a estimated glomerular filtration rate (eGFR)= 28 ml/min/1.73m2. Which of the following statement(s) described pharmacokinetics issues(s) if special concern for this patient?
Patients with chronic renal failure, like the 55-year-old female in this case, often experience significant alterations in pharmacokinetics due to impaired kidney function. Several issues should be of special concern when prescribing medications to such individuals.
1. The half-life of drugs cleared by glomerular filtration would be shorter.
This statement is incorrect. In patients with chronic renal failure, the half-life of drugs cleared by glomerular filtration is typically prolonged. The impaired renal function results in a reduced clearance rate, leading to a slower elimination of these drugs from the body.
2. Plasma concentration of drugs eliminated by the kidney may be higher in this individual than those without chronic renal failure.
This statement is accurate. Due to the reduced renal clearance, drugs eliminated primarily by the kidneys tend to accumulate in the bloodstream, leading to higher plasma concentrations. This can increase the risk of drug toxicity.
3. Drugs cleared by biliary excretion will have a longer half-life
This statement is not directly related to renal function. Drugs eliminated through biliary excretion are primarily processed by the liver and excreted in bile. Chronic renal failure mainly affects drugs eliminated by the kidneys, and it does not have a direct impact on drugs cleared via biliary excretion.
4. Drugs with a narrow therapeutic window that are eliminated by the kidney are more likely to cause adverse effects in this individual than those without chronic renal failure.
This statement is accurate. Drugs with a narrow therapeutic window, which have a small margin between their therapeutic and toxic doses, pose a higher risk of adverse effects in patients with chronic renal failure. The impaired renal clearance can lead to drug accumulation and potential toxicity.
Considering the accuracy of statements 2 and 4, the correct answer is **”b and d.”** Patients with chronic renal failure require careful consideration of medication selection, dosing adjustments, and monitoring to ensure optimal therapeutic outcomes and minimize the risk of adverse effects.
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