NRNP 6566: Main Discussion (The Role of the Kidneys in Pharmacokinetics/ Renal Dosing of Bactrim/ Monitoring for Bactrim Effects with Renal Failure - $10   Add to cart

Case

NRNP 6566: Main Discussion (The Role of the Kidneys in Pharmacokinetics/ Renal Dosing of Bactrim/ Monitoring for Bactrim Effects with Renal Failure

NRNP 6566: Main Discussion Purpose The purpose of this discussion post is to describe how an advanced practice nurse would alter the medication dose of Bactrim in a patient with chronic renal failure. The Role of the Kidneys in Pharmacokinetics Excretion, a component of pharmacokinetics, describes a drugs elimination through kidney filtration and waste removal via urine (Sakai, 2008). The most common organ of drug excretion is the kidneys. Drugs that are not excreted by the kidneys will continue to be recirculated in the bloodstream, potentially leading to toxic drug levels and adverse effects (Doogue & Polasek, 2011). A patient’s creatine clearance and GFR are utilized to estimate how fast blood is filtering through the kidney (Doogue & Polasek, 2011). Thus, the creatinine clearance or GFR can be utilized for renal dosing of medications. Excretion of Bactrim occurs via the urinary tract (Wolters Kluwer, 2020). Therefore, a patient with chronic renal failure will exhibit prolonged excretion of Bactrim (Doogue & Polasek, 2011). Bactrim is composed of the compounds TMP and SMX and is available in single concentration; 80mg TMP/400mg SMX, or double strength; 160mg TMP/800mg SMX (Wolters Kluwer, 2020). The half -life elimination of TMP is 6-11 hours, and SMX is 9-11 hours. Since Bactrim can be dosed every 12 hours (Kenmic & Coleman, 2020), and available in a double concentration strength, renal failure has the potential to lead to higher steady state levels of Bactrim. When there are higher steady state levels of Bactrim, toxicity signs of nausea and vomiting, dizziness, headache, mental depression, confusion, thrombocytopenia, uremia, loss of appetite, colic, drowsiness, or bone marrow depression can occur (Kemnic & Coleman, 2020). Since TMP has the ability to reduce renal potassium excretion (Nickels, Jones, & Stead, 2012), a coexisting renal failure places the patient at risk for hyperkalemia. Dosing guidelines for Bactrim based upon creatinine clearance (CrCl) include: a CrCl greater than 30mL/min=no change in dose, a CrCl of 15-30 mL/min=reduction in dose by 50%, a CrCl less that 15mL/min=do not prescribe (Kemnic & Coleman, 2020). Monitoring for Bactrim Effects with Renal Failure An APRN will screen the patient for potential contraindications, or dosing adjustments for the use of Bactrim. This includes a history of renal failure, prescribed potassium sparing medications, allergies to sulfa, weight, and age (Wolters Kluwer, 2020). The APRN will also want to obtain a serum chemistry to reflect renal function and potassium level prior to prescribing, and periodically while

Preview 1 out of 3  pages

avatar-seller
EXAMINER

The benefits of buying summaries with Stuvia:

Guaranteed quality through customer reviews

Guaranteed quality through customer reviews

Stuvia customers have reviewed more than 450,000 summaries. This how you know that you are buying the best documents.

Quick and easy check-out

Quick and easy check-out

You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.

Focus on what matters

Focus on what matters

Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!

$ 10
  • (0)
  Add to cart