الفهرس 
Anatomy and physiology of urinary tractOnly 14 pages are availabe for public view
 |  | from | 111 |  |  |
| | | from | 111 | | |
Abstract
Patients in an ICU are approximately twice as likely to experience an adverse drug event when compared to patients in a general medicine unit. This increased risk is resulting from the greater number of medical risk factors faced by patients in the ICU, plus their wider range of drug exposures , Renal failure is a major risk factor for adverse drug events that not only place patients at increased risk for morbidity and mortality, they also have a tremendous impact financially.
Patients with renal impairment have more risk for adverse drug events as they often have alterations in their pharmacokinetic parameters such as drug absorption, distribution, protein binding, biotransformation and renal excretion ,leading to drug-related proإblems and medication dosing errors
Appropriate drug selection and dosing for patients with renal impairment can maximise therapeutic efficacy and minimisetoxicity , in addition to avoidance of costs associated with drug-related toxicity and in cost savings in terms of drug costs.
For patients with non-dialyzed renal failure , physician and pharmacist can work together to have a safe drug prescription using a stepwise approach that entails intial assessment of the patient general condition and co-morbidities , then evaluation of the degree of the renal impairment ,then proper choice of drugs of no or minimal toxicity , in addition to dose adjustment of drugs according to the degree of renal impairment not only via drug dose modification but also via proper choice of method of adminisration and considering drug-drug interaction and dosing according to clinical condition of the patient .
For patients with dialyzed renal failure ,dialysis drug clearance may significantly reduce drug efficacy if it is not accounted for , the extent to which a drug is affected by dialysis isdetermined primarily by complexinteraction of many factors, including the characteristics of the drug such as molecularsize, protein binding, volume of distribution, watersolubility, and plasma clearance ,and technical aspects ofthe dialysis procedure that also may determine theextent to which a drug is removed by dialysis.
Many drug properties that affect removal by hemodialysis also apply to peritoneal dialysis, but peritoneal dialysis is usually less efficient , on the contrary , drug clearance by continuous renal replacement therapy differs from intermittent hemodialysis , relying on continuous ultrafiltration of plasma water, continuous renal replacement can remove large quantities of ultrafilterable drug .
We conclude from the above that special consideration should be taken when drugs are prescribed to patients with impaired renal function , This can be complex and require a stepwise approach to ensure effectiveness, minimise further damage and prevent drug nephrotoxicity.