• Korean Journal of Clinical Pharmacy
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• v.22 no.3
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• pp.220-227
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• 2012

Kidney and liver are the major organs of metabolism and excretion of drugs. Renal and Hepatic impairment may affect the pharmacokinetics/pharmacodynamics and the safety of drugs. Adjusting the dosage based on organ function is the essential role of pharmacists. However, differences have been noted on the recommended dosage among the literatures. We compared and analyzed the recommendations of 4 literature sources which are commonly used for dosage adjustment. From April, 2011 to August, 2011, we selected data on recommendations for dosage adjustment for impaired renal and hepatic function of 100 drugs through a protocol. We analyzed the definition terms of renal and hepatic impairment, recommendations for dosage adjustment, evidenced references in four literature sources: Korean National Formulary (KNF), American Hospital Formulary System Drug Information (AHFS), Micromedex (MM) and Drug Prescribing of Renal Failure (DPRF). We further examined the data homogeneity by comparing how drugs that required no adjustment according to one source were categorized by the other. Sources use different definition terms among themselves except DRPF. Presence or absence of evidenced references about renal/hepatic functional states are KNF (0%/0%), AHFS (78%/62.6%), MM (87.5%/65.6%) and DPRF (93.2%/no recommendation) respectively. Recommendations of specific dosage and dosing interval are KNF (24%/13%), AHFS (39.6%/12.1%), MM (50%/17.7%), and DPRF (55.4%/no recommendation) respectively. Regarding the data homogeneity, the differences were remarkable. Drugs with no adjustment according to AHFS were categorized to be adjusted/ contraindicated by KNF, MM, DPRF and the values were (44%/5.6%), (22%/0%), and (36%/0%) in renal function, (39%/6.5%), (19%/3.2%), and (no recommendation/no recommendation) in hepatic function respectively. Our study shows remarkable definite variation in definitions and recommendations about definition terms, information of dosage and interval, presence or absence of evidenced references. Especially for KNF, quantitative recommendations on dosages and dosing intervals should be made in the near future. To maximize the drug effect and safety and to minimize the heterogeneity of the literature sources, reviewing at least two sources are suggested when recommending the proper dosage adjustment based on organ function.

• Proceedings of the Korea Concrete Institute Conference
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• 2004.11a
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• pp.549-552
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• 2004

This paper investigated the drying and autogenous shrinkage of high performance concrete(HPC) with mixture adjustment under various specimen size. For fresh concrete properties, HPC with mixture adjustment need a higher dosage of SP agent due to fluidity reduction, and a larger dosage of AE agent due to the reduction of air content. HPC with mixture adjustment exhibited a smaller strength development than control HPC. For drying shrinkage, an increase in specimen size occurred with small expansion during water curing and at air curing, less drying shrinkage was observed. Autogenous shrinkage was not affected by specimen size. Autogenous shrinkage of HPC with mixture adjustment exhibited less than half of control HPC.

• Proceedings of the Korea Concrete Institute Conference
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• 2004.11a
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• pp.545-548
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• 2004

This paper is to investigate the shrinkage properties of high performance concrete (HPC) with mixture adjustment by using mock-up specimens. HPC with mixture adjustment needed a higher dosage of SP agent due to fluidity reduction and a larger dosage of AE agent due to the reduction of air content. Setting time of HPC with mixture adjustment exhibited earlier than that of control HPC by as much as 6 hours. HPC with mixture adjustment gained more than 70MPa of compressive strength. Autogenous shrinkage of Control HPC was found to be $-340\times40^{-6}$ at 49days when the expansion value by thermal effect was excluded and HPC with mixture adjustment $-175\times10^{-6}$, which was the half of the value of control HPC. Drying shrinkage of center section of HPC with mixture adjustment showed similar tendency with autogenous shrinkage because of no internal moisture movement, while surface section had larger drying shrinkage. The specimen embedded with reinforcing bar had smaller deformation caused by confinement of reinforcing bar.

• Quality Improvement in Health Care
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• v.9 no.2
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• pp.230-240
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• 2002

Background : The purpose of this study was to develop, implement and evaluate the pharmacist intervention program designed to identify and correctly adjust the dosage of $H_2$-receptor antagonists ($H_2RA$) in renally impaired patients and promote timely conversion of $H_2RA$ from IV to PO therapy. Methods : The study population consisted of renally impaired patients who received $H_2RA$ therapy from April 9 to May 8, 2001 at Hallym Medical Center. Each morning a specifically developed software program identified patients with serum creatinine (Scr) greater than 1.2 mg/dl or age greater than 65 years. The pharmacist, then screened the pharmacy profiles of the identified patients to determine if the patient was on $H_2RA$. For these patients on $H_2RA$ with renal impairement the creatinine clearance (CrCl) was calculated using Cockroft & Gault equation. The pharmacist determined the proper dosage for each identified patients based on the calculated CrCl and the oral dosage that would be appropriate for whom IV therapy was no longer indicated. Result : A total of 149 cases (101 patients) were monitored during the study period. The dosage was inappropriately prescribed for renal function in 61 of 149 cases (41%), and of those, pharmacist made recommendations for 58 cases of which 33 cases (57%) were accepted by the physicians. The administration route of H2RA was inappropriately used as IV in 22 of 53 cases (42%), and pharmacist made recommendations for those 22 cases of which 15 cases (68%) were accepted. Conclusion : Monitoring of patients with renal dysfunction by a pharmacist improved the dosing of $H_2RA$ and a dosing program of patients with renal impairment would be of benefit to other clinicians and institutions seeking to optimize patient care.

• Proceedings of the PSK Conference
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• 2001.10a
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• pp.321.1-321.1
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• 2001

• Journal of Pharmaceutical Investigation
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• v.25 no.3
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• pp.265-270
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• 1995

The pharmacokinetics of norfloxacin (100 mg/kg, oral) in renal failure rabbits was studied. Renal failure rabbits were induced by the i.v. injection of folate (50,100 and 150 mg/kg). These produced significant increases of serum creatinine concentration $(S_{cr})$ and blood urea nitrogen (BUN). Plasma concentration and AUC of norfloxacin significantly increased. Elimination rate constant $(K_{el})$ of norfloxacin significantly decreased, and half-life $(t_{1/2})$ of norfloxacin significantly increased. Correlation between serum creatinine concentration $(S_{cr})$ and half-life $(t_{1/2})$ of norfloxacin, and correlation between BUN and AUC of norfloxacin have linear relationship respectively. These results suggest that adjustment or the dosage regimen of norfloxacin is desirable, and serum creatinine concentration $(S_{cr})$ as well as BUN can be used an index for adjusting the dosage regimen of norfloxacin in renal failure.

• Korean Journal of Clinical Pharmacy
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• v.7 no.2
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• pp.64-66
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• 1997

Zinc is employed in body cell growth and immune function. Zinc deficiency causes growth retardation, night blindness, delay of wound healing, skin disorders, alopecia, et al. Pharmacokinetic study of zinc in Korean has not yet been proceeded to apply to patient. In this study, we investigated to adjust zinc dosage for maintaining constant zinc optimum serum level. Five NPO inpatients (3 males, 2 females) in Seoul National University of Hospital were evaluated, retrospectively. Zinc was mixed with parenteral nutrition solution and administrated intravenously in 24 hour-continuous infusion, and zinc dosage range was 0.17-0.45 mg/kg/day. AUC to zinc dose (AUC/Dose) was $2.421\pm1.007\;kg{\cdot}min/ml.$ 0.5 mg/kg/day zinc administration may achieve the plasma zinc concentration of $120\;{\mu}g/dl.$(Kor. J. Clin. Pharm. 1997; 7: 64-66)

• Journal of Korean Society of Water and Wastewater
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• v.28 no.5
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• pp.601-608
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• 2014

A coagulation-flocculation (CF) process using aluminum sulfate as a coagulant was employed to treat highly suspended solids in tunnel wastewater. Response surface methodology (RSM) based on a Box-Behnken design was applied to evaluate the effects of three factors (coagulant dosage, pH and temperature) on total suspended solids (TSS) removal efficiency as well as to identify optimal values of those factors to maximize removal of TSS. Optimal conditions of coagulant dosage and pH for maximum TSS removal changed depending on the temperature ($4{\sim}24^{\circ}C$). As temperature increased, the amount of coagulant dosage and pH level decreased for maximum TSS removal efficiency during the CF process. Proper adjustment of optimal pH and coagulant dosage to accommodate temperature fluctuations can improve TSS removal performance of the CF process.

• Korean Journal of Clinical Pharmacy
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• v.9 no.2
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• pp.92-96
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• 1999

The pharmacokinetics of carbamazepine(100 mg/kg, oral) in the folic acid-induced renal failure rabbits was studied. Renal failure was induced by the i.v. injection of folic acid (50, 100, and 200 mg/kg). At folic acid dose of 100 and 200 mg/kg, the serum creatinine concentration (Scr) and blood urea nitrogen (BUN) increased significantly compared with control rabbits. Plasma concentrations and area under the plasma level-time curve (AUC) of carbamazepine increased significantly at folic acid dose of 100 and 200 mg/kg. The elimination rate constant (Kel) of carbamazepine decreased significantly, and half-life $(t_{1/2})$ of carbamazepine increased significantly at folic acid dose of 100 and 200 mg/kg. The serum creatinine concentration (Scr) correlated well with AUC and elimination rate constant (Kel) of carbamazepine, as well as BUN with AUC and elimination rate constant (Kel) of carbamazepine. These results suggest that adjustment of the dosage regimen of carbamazepine is desirable, and serum creatinine concentration (Scr) as well as BUN can be used for adjusting the dosage regimen of carbamazepine in renal failure.

• YAKHAK HOEJI
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• v.36 no.4
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• pp.321-325
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• 1992

Pharmacokinetic interaction of theophylline with pefloxacin following i.v. administrations was investigated in rabbits. Pefloxacin was coadministrated at doses of 10 and 20 mg/kg or previously administered for 6 days 10 and 20 mg/kg. Plasma concentration and AUC of theophylline were increased significantly (p<0.05) and the renal clearance $(CL_r)$, total body clearance $(CL_r)$ and the volume of distribution $(Vd_{ss})$ were decreased significantly (p<0.005) by the pretreatment. It demonstrates that adjustment of dosage regimen of theophylline should be considered when concomitant administration of pefloxacin is prescribed.