Renal Dosing & Adjustments Flashcards

A patient with stage 4 CKD (CrCl 20 mL/min) is started on enoxaparin for DVT treatment. What is the recommended dosing adjustment?

Answer: Reduce dose to 1 mg/kg once daily

For CrCl < 30 mL/min, enoxaparin DVT treatment dose is reduced to 1 mg/kg subcutaneously once daily.

Which of the following describes the 'drug interval extension' strategy for renal dosing adjustments?

Answer: Giving the same dose at longer intervals

Interval extension maintains the same dose size but increases the time between doses to compensate for slower elimination.

A patient on peritoneal dialysis requires antibiotic therapy for peritonitis. Which route of administration is preferred?

Answer: Intraperitoneal

Intraperitoneal antibiotic administration delivers drug directly to the site of infection in peritoneal dialysis patients.

Dabigatran is contraindicated in patients with CrCl below what threshold due to risk of bleeding?

Answer: 30 mL/min

Dabigatran is contraindicated when CrCl < 30 mL/min because 80% is renally eliminated, leading to dangerous drug accumulation.

Which pharmacokinetic parameter determines how much drug is removed by hemodialysis?

Answer: Both volume of distribution and protein binding

Drugs with low protein binding and small volume of distribution are most readily removed by hemodialysis.

A patient with CrCl of 35 mL/min needs antifungal therapy. Which agent requires dose adjustment?

Answer: Fluconazole

Fluconazole is primarily renally excreted and requires 50% dose reduction when CrCl falls below 50 mL/min.

Which statement about metformin and renal function is CORRECT per current guidelines?

Answer: Metformin can be continued with dose reduction when eGFR is 30–45 mL/min/1.73m²

Current guidelines allow metformin use at reduced doses when eGFR is 30–45, but it should be discontinued below 30 mL/min/1.73m².