Drug Toxicity in Kidney Disease: A Standardized Patient Case for Clerkship Students

Abstract

Introduction A disconnect appears to exist for medical students between learning drug facts in a basic science context and applying those facts in a clinical context when they begin working with authentic patients. In patients with kidney dysfunction, dosages of medications that are renally eliminated often need to be adjusted, due to potentially toxic accumulation in the body. To gain insight into the thought processes and gaps underlying student thinking, we developed this standardized patient (SP) case featuring a patient with drug-related renal dysfunction. Methods This activity was conducted in a simulation center, in a setting reminiscent of an emergency department. It took place over 2 days, with all 23 third-year medical students at our regional campus. After reporting to the simulation center at their assigned time, students completed four different medication scenarios. This specific case involved two parts. The first part, an SP-student encounter, was allotted 15 minutes, followed by 1 minute to walk to a computer station. For the second part, writing a SOAP (subjective, objective, assessment, and plan) note, 15 minutes were allotted. This was followed by 3 minutes for the SP to provide student feedback and 1 minute to rotate to the next station. In total, 35 minutes were allotted for each student to complete the case. Results All third-year medical students at our regional campus completed this activity at the midpoint of their academic year. Students were well prepared to gather necessary background information from the standardized patient. However, few made the connection between the patient's symptoms and the way in which her medications were contributing. Nor did they recommend an appropriate course of action for medications that required adjustment. Discussion From this activity, we gained insight into the student thought process with regard to medication management and have been able to develop new ways of revisiting basic science concepts in clinically relevant contexts to help bridge the gap between the basic and clinical components of pharmacology education.

Ajuste De Dose Dos Medicamentos De Acordo Com a Função Renal Em Um Hospital Universitário

“…Pacientes hospitalizados utilizam, geralmente, um grande número de medicamentos, em decorrência de suas complexas condições clínicas. Quando se trata de medicamentos excretados por via renal, sendo utilizados por pacientes que apresentam disfunção renal importante, podem ser necessários ajustes de dose para evitar-se toxicidade e eventos adversos relacionados a medicamentos (EAM) (1). O adequado ajuste de doses dos medicamentos depende da correta avaliação da função renal dos pacientes, especialmente quando são fármacos excretados na forma inalterada na urina, que possuem faixa terapêutica estreita, com metabólitos ativos excretados pelo rim ou que são nefrotóxicos (2).…”

“…Dessa forma, a avaliação da função renal dos pacientes por meio da estimativa da taxa de filtração glomerular (TFG) a partir da mensuração da creatinina sérica, é considerada de grande importância para a segurança da terapia medicamentosa. A creatinina sérica é o marcador de diagnóstico mais usualmente utilizado para análise da função renal na prática clínica, sendo utilizada para deter-minar a necessidade de ajuste de dose por meio de equações matemáticas (1). Tais equações são baseadas na dosagem da creatinina sérica, na idade, gênero, superfície corpórea e etnia.…”

Drug-Induced Acute Kidney Injury: A Standardized Patient Case for Clerkship Students

“…It should be noted that many of these educational modules have been previously published in MedEdPORTAL. 17–19…”

Ajuste de dose de antimicrobianos por função renal em Unidade de Terapia Intensiva adulto

“…A substantial number of antimicrobials used in the clinical practice have the peculiarity of being eliminated through the kidneys; therefore, renal function impairment can lead to reduced clearance of the drugs and to their consequent accumulation and/ or their metabolites in the body, resulting in clinical conditions of intoxication and Adverse Drug Events (ADEs) 2 . Therefore, adequate adjustment of the dose administered in these cases is necessary to guarantee a safe and effective antibiotic therapy and, in addition, it contributes to reducing treatment costs, hospitalization times and mortality 3 .…”