RT Book, Section A1 Bauer, Larry A. A2 Bauer, Larry A. SR Print(0) ID 3518709 T1 Chapter 3. Drug Dosing in Special Populations: Renal and Hepatic Disease, Dialysis, Heart Failure, Obesity, and Drug Interactions T2 Applied Clinical Pharmacokinetics, 2e YR 2008 FD 2008 PB The McGraw-Hill Companies PP New York, NY SN 978-0-07-147628-7 LK accesspharmacy.mhmedical.com/content.aspx?aid=3518709 RD 2021/04/13 AB All medications have specific disease states and conditions that change the pharmacokinetics of the drug and warrant dosage modification. However, the dosing of most drugs will be altered by one or more of the important factors discussed in this chapter. Renal or hepatic disease will decrease the elimination or metabolism of the majority drugs and change the clearance of the agent. Dialysis procedures, conducted using artificial kidneys in patients with renal failure, removes some medications from the body while the pharmacokinetics of other drugs are not changed. Heart failure results in low cardiac output which decreases blood flow to eliminating organs, and the clearance rate of drugs with moderate-to-high extraction ratios are particularly sensitive to alterations in organ blood flow. Obesity adds excessive adipose tissue to the body which may change the way drugs distribute in the body and alter the volume of distribution for the medication. Finally, drug interactions can inhibit or induce drug metabolism, alter drug protein binding, or change blood flow to organs that eliminate or metabolize the drug.