Appendix E 419

Drug Method Adjustment Elimination by PD

Gentamicin i q24–48 h Yes

d 20%–30%

Heparin Unchanged

Hydrocortisone Unchanged

Hydralazine i q8–16 h No

Indomethacin Unchanged

Insulin (reg) d 25%–50%

Isoniazid Unchanged Yes

Kanamycin i q24 h Yes

d 23%–30%

Ketoconazole Unchanged No

Labetalol Unchanged

Lidocaine Unchanged

Lorazepam d 50%

Meperidine d 50% No

Metoprolol Unchanged

Metronidazole i q12–24 h No

Morphine To avoid

Nafcillin Unchanged

Naloxone Unchanged No

Nicardipine d, i Titrate ?

Oxacillin Unchanged

Penicillin G i q12–16 h No

d 25%–50%

Pentobarbital Unchanged

Phenobarbital i q12–16 h Yes

Phenytoin Unchanged

Piperacillin i q24 h No

Prednisone Unchanged

Propranolol Unchanged

Ranitidine d 50% No

Rifampin Unchanged No

Secobarbital Unchanged No

Sodium nitroprusside Unchanged

Theophylline Unchanged Yes

Thiazide Avoid

Ticarcillin i q24–48 h Yes

Tobramycin i q24 h Yes

d 20%–30%

Valproic acid Unchanged No

Vancomycin i q24 h No

Verapamil d 50%–75%

Renal failure alters the clearance of most drugs to a degree that is inversely proportional to the glomerular filtration rate. Drugs that are entirely cleared by the liver are administered without renal adjustment. Dose is adjusted by either administering a percentage of normal dose (d) or increasing the interval (i) between the doses by hours (18–20). The

normal loading dose can be administered for virtually all drugs. Unlike hemodialysis, peritoneal dialysis usually has no significant effect on the clearance of most drugs.

However, a supplemental dose is sometimes required. Blood levels of drug, if available, are the best guide. PD, peritoneal dialysis; q, every.

Table E.1 Drugs Requiring Adjustment in Severe Renal Failure (Continued)

420

Bedside Checklist for Each Infant while on b-CPAP

To Be Completed by Infant’s Nurse Each Shift

Date: _________________

Check Points Time Time Time

Blended air/oxygen supply is appropriate

Flow meter at 5 –7 L/min

Humidifier water lever is correct

Excess rainout in the afferent tubing is drained

Nasal prong size is correct

Nasal prongs positioned correctly and not touching the septum

Head cap fits snugly

Corrugated tubing correctly placed

Velcro moustache is correctly placed

Septum is intact

Neck roll is of correct size and position

Head position is correct

Preductal oxygen saturation probe

Excess rainout in the efferent tube is drained

Tape at 7 cm at base of bottle

Sterile water (or acetic acid) level is at 0 cm

Tubing securely fixed at 5 cm under water

Gas bubbling in the bottle continuously

Date circuit is due for a change (7 days max)

Date CPAP prongs is due for a change (3 days max)

Nurse Signature

Appendix F