Expired CME Article

Improper Renal Dosing in Long-Term Care Facilities

Authors: Ali R. Rahimi, MD, FACP, AGSF, Klugh Kennedy, PharmD, BCPP, Misha Thomason, PharmD, Jennifer Crumley, PharmD, Amanda Bugg, PharmD candidate, Erin Peacock, PharmD candidate

Abstract

Objectives: With advancing age, physiologic changes occur that affect drug metabolism. Possibly the most predictable function decline in geriatric population is renal function.


Methods: The prescribing habits of physicians and the attention given to patient renal function was investigated. Data was collected from two nursing facilities in southeastern Georgia.


Results: Based on two models of prescribing habits and using logistic regression estimates, we concluded that physicians do not follow recommendations for dose adjustment of renally excreted medications in these two facilities.


Conclusion: We recommend that physicians consider evaluating current medications and establishing a base line for renal function and degree of decline.


Key Points


* With advancing age, many physiological changes occur that affect drug metabolism.


* Inappropriate medication prescribing in nursing facilities is common.


* Ideally, physicians should assess their patient’s renal function before prescribing renally excreted medications.


* Guidelines recommend estimating glomerular filtration rate in elderly patients utilizing either the Modification of Diet in Renal Disease (MDRD) study or the Cockcroft-Gault formula.

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