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drugs affecting renal system

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Drugs Affecting the
Renal System
GROUP 6
Objectives:
• Understand the necessary patient monitoring and assessment
parameters when patients are prescribed drugs affecting the
renal system
• Recognize the medical conditions and indications for which
renal system drugs are prescribed
• Continuously assess and improve your knowledge and
practice related to drugs affecting the renal system to
provide the highest quality of care to patients
DIURETICS DRUG
Are medicines that help reduce fluid buildup in the
body. A diuretic is any substance that promotes
diuresis, the increased production of urine. This
includes forced diuresis. A diuretic tablet is sometimes
colloquially called a water tablet. There are several
categories of diuretics. All diuretics increase the
excretion of water from the body, through the
kidneys
There are five types of Diuretics
• LOOP OR HIGH DIURETICS
• THIAZIDE DIURETICS
• POTASSIUM SPARING DIURETICS
• OSMOTIC DIURETICS
• CARBONIC ANHYDRASE INHIBITORS
LOOP OR HIGH DIURETICS
Drug names:
1.
GENERIC NAME
• Bumetanide
• Furosemide
• Torsemide
2.
BRAND NAME
• Bumex
• Lasix
• Soaanz
Drug Dosage
Bumetanide
Injectable solution
•
•
•
•
Torsemide
Tablet
0.25mg/mL tablet
0.5mg
1mg
2mg
• 5mg
• 10mg
• 20mg
Furosemide
Oral solution or Tablets
• Adults - 20 to 80 mg
• Children - 2 mg
For high blood pressure
• 40 mg
Mechanism of action
• high ceiling diuretics may cause
a substantial diureses up to 20%
• this a large in comparison to
normal renal sodium
reabsorption which leaves only
about 0.4 %
• They act by diminishing sodium
reabsorption at different sites
in the nephron, thereby
increasing urinary sodium and
water losses
Indications
• HYPERTENSION
• EDEMA
ASSOCIATED
• RENAL CALCIUM
• CEREBRAL EDEMA
• HYPERCALCEMIA
Contraindicati
on
• ELECTROLYTE IMBALANCE
• SEVERE RENAL FAILURE
• HEPATIC COMA
Side Effects/
Adverse effects
• Hypokalemic metabolic alkalosis (hypokalemia)
• Ototoxicity
• Hyperuricemia
• Hypomagnesemia
• Allergic reactions
• Dizziness
• Postural hypotension
• Syncope
Nursing
Intervention
• Monitor urinary output to determine body fluid gain or loss. Urinary output should be
at least 30 mL/h or 600 mL/24 h.
• Notify a health care provider if urine output does not increase; a severe renal
disorder may be present.
• Weigh the patient to determine fluid loss or gain. A loss of 2.2 lb is equivalent to a
fluid loss of 1L.
• Monitor vital signs, and be alert for marked decreases in blood pressure.
• Administer IV furosemide slowly; hearing loss may occur if it is rapidly injected.
• Observe for signs and symptoms of hypokalemia (< 3.5 mEq/L), such as muscle
weakness, abdominal distension, leg cramps, and/or cardiac dysrhythmias.
• Monitor serum potassium levels, especially when a patient is taking digoxin.
Hypokalemia enhances the action of digitalis, causing digitalis toxicity.
THIAZIDE
DIURETICS
Generic Name
• Chlorthalidone
• Indapamide
• Metolazone
Brand Name
• Hygroton
• Lozol
• Mykrox
Drug Dosage
Metolazone
Tablet
• 2.5mg
• 5mg
• 10mg
Hypertension
• 2.5mg
Edema
• 2. 5 - 10mg PO
Chlorthalidine
Tablets
• Adults- 50 - 100 mg
For high blood pressure
• Adults- 25 mg
Indapamide
Tablets
• 1.25mg
• 2.5mg
Edema
2.5 mg PO
Hypertension
1.25 mg PO
Mechanism of Action
• T h i az i de di u r e t i c s e x e r t t h e i r di u r e t i c e ff e c t
vi a b l o c k a g e o f t h e s o d i u m - c h l o r i d e ( N a / C l )
channel in the proximal segment of the distal
c o nvo l u t e d t u b u l e ( D C T ) .
• Its effects on the nephron will be more
thoroughly discussed below and will be
r e fe r r e d t o i n t h e adve r s e e ffe c t s s e c t i o n .
INDICATIONS
• Indicated as adjunctive therapy to treat
edema associated with congestive heart
failure, hepatic cirrhosis, corticosteroid,
and estrogen therapy. ( FDA-approved)
CONTRAINDICATIONS
• Indicated to treat edema associated
with renal dysfunction. ( FDA-approved)
• Indicated to treat hypertension as a
sole agent or adjunct.
• Severe renal impairment
• Severe hepatic impairment
• hypersensitivity
• Pregnancy and Lactation
• Allergies
Side Effects/
Adverse effects
• dizziness and lightheadedness,
• Hypokalemia
• blurred vision,
• Hyponatremia
• loss of appetite,
• Metabolic alkalosis
• itching,
• Hypercalcemi
• stomach upset,
• Hyperglycemia
• headache, and
• Hyperuricemia
• weakness
• Hyperlipidemia
• Sulfonamide allergy
NURSING INTERVENTION
• Emphasize the need for adherence to the therapy plan. The patient may not
feel better for some time or may not feel worse if treatment is missed or
discontinued.
• Suggest that the patient take the drug early in the morning to avoid sleep
disturbance resulting from nocturia.
• Inform patients that certain herbal products may interact with thiazide
diuretics
• Monitor vital signs and serum electrolytes, especially potassium, glucose,
uric acid, and cholesterol levels. Report changes. If a patient is taking
digoxin and hypokalemia occurs, digitalis toxicity frequently results.
• Observe for signs and symptoms of hypokalemia such as muscle weakness,
leg cramps, and cardiac dysrhythmias.
• Monitor the patient’s weight daily. A weight gain of 2.2 lb is equivalent to 1 L
of body fluids.
• Note urine output to determine fluid loss or retention.
POTASSIUM SPARING DIURETICS
GENERIC NAME
BRAND NAME
• Spironoloctone
• Aldactone Carospic
• Amiloride
• Midamor
• Eplerenone
• Inspra
Drug Dosage
Spironolacton
e
Tablet
• 25 mg
• 50 mg
• 100 mg
Oral Suspension
• 5mg/ ml
Eplerenone
Tablet
• 25mg
• 50mg
Tablet
• 5mg
Amilorid
e
Congestive Heart Failure
• 5-10 mg
Hypertension
• 5-10 mg
Thiazide-Induced Hypokalemia
• 5-10 mg
Pediatric tablet
• 5 mg
Mechanism of Action
Potassium-sparing diuretics act to prevent sodium
reabsorption in the collecting tubule by either binding
ENaCs (amiloride, triamterene) or by inhibiting
aldosterone receptors (spironolactone, eplerenone). This
prevents excessive excretion of K+ in urine and
decreased retention of water, preventing hypokalemia.
Indications
• Hypertension ( High blood
pressure)
• Congestive heart failure
• Edematous conditions
• Hyperkalemia
• Anuria
• Acute renal insufficiency
Side effects/
Adverse effects
• Hyperkalemia
• Nausea and vomiting
• Abdominal discomfort
• Headache
• Drowsiness
• Confusion
• Ataxia ( loss of control on body movement)
• Kidney Stones
• Note the half-life of spironolactone. With a long half -life, the drug is
usually administered once a day, sometimes twice a day.
• Monitor urinary output; it should increase. Report if urine output is less
than 30 mL/h or less than 600 mL/day.
• Record vital signs and report any abnormal changes.
• Observe for signs and symptoms of hyperkalemia (serum potassium
>5.0 mEq/L). Nausea, diarrhea, abdominal cramps, numbness and
tingling of the hands and feet, leg cramps, tachycardia and later
bradycardia, peaked narrow T wave on electrocardiogram, or oliguria
may signal hyperkalemia.
• Administer spironolactone in the morning and not in the evening to
avoid nocturia.
Generic Name
• Mannitol
Brand Name
• Osmitrol
DRUG
DOSAGE
50 to 100 gm by a IV
Mechanism of Action
1.
inhibit water reabsorption in the proximal
convoluted tubule and the thin descending
loop of Henle and collecting duct, regions
of the kidney that are highly permeable to
water.
Indications
• Acute renal failure
during a prolonged
surgery or trauma
• Glaucoma
Contraindications
•
•
•
•
•
Intracranial bleeding
Urinary tract obstruction
Pulmonary congestion
Edema
Heart failure
Side Effects/ Adverse effects
•
•
•
•
•
•
•
•
Chest pain
Congestive heart failure
Phlebitis ( inflammation of the vein )
Convulsions
Chills
Dizzziness
Headache
Electrolyte imbalance
Nursing Interventions
• Assess neurologic status: LOC, ICP reading, pupil size and reaction when
product is given for increased ICP
• Assess for vision changes or eye discomfort or pain before, during
treatment (increases intraocular pressure); neurologic checks, ICP
during treatment (increased ICP)
• Assess patient for tinnitus, hearing loss, ear pain; periodic testing of
hearing is needed when high doses of this product are given by IV route
• Assess fluid volume status: check I&O ratios and record hourly urine
values, breath sounds,
• weight, distended red veins, crackles in lungs, color, quality, and
specific gravity of urine, skin turgor, adequacy of pulses, moist mucous
membranes (provide adequate fluids), bilateral lung sounds, peripheral
pitting edema
ANTIDIURETICS
Generic Name
• Vasopressin
• Desmopressin
Brand Name
• Antidiuretic
Hormone
• Minirin
Drug Dosage
Vasopressin
• 5-10 units IM/ SC
Diabetes insipidus
• Adult: IM/SUBCUT 5-10 units bid-qid prn;
CONT IV INF 0.0005 units/kg/hr, (0.5
milliunit/kg/hr), double dose q30min as needed
• Child: IM/SUBCUT 2.5-10 units bid-qid prn
Desmopressin
• 100 - 400 mcg orally
• 1 -4 mcg IV
Mechanism of Action
Reduces urine flow by acting reabsorption of water by kidney tubales
Indication
• Cranial Diabetes insipidus
• Primary nocturnal enuresis
• Nocturia associated with
multiple selerosis
Contraindication
• Hypersensitivity
• impaired renal function
• With ongoing diuretic
treatment
• Edema
• hypertension
• fluid and electrolyte
imbalance
• pregnancy and lactation
Side Effects/ Adverse effects
• Nasal Irritation
• Rhinitis
• Abdominal Cramp
• Urge defecate
• Fluid retention
• Congestion
• Ulceration
• Nausea
Nursing Intervention
• Monitor I&O ratio, urine osmolality, specific gravity, weight daily; check for
edema in extremities; if water retention is severe, diuretic may be
prescribed; check pulse, B/P when giving product IV or SUBCUT
• Assess for water intoxication: lethargy, behavioral changes, disorientation,
neuromuscular excitability, dehydration, poor skin turgor, severe thirst, dry
skin, tachycardia
• Assess intranasal use: nausea, congestion, cramps, headache; usually
decreased with decreased dosage
• Pregnancy/breastfeeding: No wellcontrolled studies, use only if benefit
outweighs fetal risk, cautious use in breastfeeding, excretion is unknown
• Use demonstration, return demonstration to teach technique for nasal
instillation, clear nasal passage before use
• Caution patient to avoid OTC products (cough, hay fever), since these
preparations may contain EPINEPHrine and decrease product response; do
not use with alcohol
Urinary Antiseptic
Generic Name
Brand Name
• Methenamine hippurate
• Hiprex
• Sulfamethoxazole
• Bactrim
• Nitrofurantoin
• Furadantin
• Fosfomycin
• Manurol
• Trimethoprim
• Proloprim
• Ertapenem
• Invanz
• Ketorolac Tromethamine
• Toradol
• Ciprofloxacin
• Cipro
Drug Dosage
Methenamine
hippurate
Oral Solution
• 500 mg/ml
Tablet
• 1 gram
Sulfamethoxazole
Injected Solution
• (16mg/ 80mg)/ml
Oral Suspension
• (40mg/200mg)5ml
Tablet
• 80mg/400mg
• 160mg/800mg
Nitrofurantoin
Capsule, macrocrystals
• 25 mg
• 50 mg
• 100 mg
Capsule, monohydrate/
macrocystal
• 100 mg
Oral Suspension
• 25mg/5ml
Trimethoprim
Injected solution
• (16mg/80mg)ml
Ertapenem
Powder for Injection
• 1gram/vial
Oral suspension
• (40mg/80mg)ml
Tablet
• 80mg/400mg
• 160mg/800mg
Fosfomycin
• 3 gram/ packet
Ketorolac Tromethamine
Tablet
• 10mg
Injectable solution
• 15mg/ml
• 30mg/ml
Prefilled syringe
• 15mg/ml
• 30mmg/ml
• 60mg/2ml
Ciprofloxacin
Infusion solution
• 200mg/100ml
• 200mg/20ml
• 400mg/40ml
• 400mg/200ml
Oral Suspension
• 250mg/5ml
• 500mg/5ml
Tablet
• 100mg
• 500mg
• 750mg
Tablet, extended
release
• 500mg
• 1000mg
Mechanism of
Action
There are bacteriostic drug. They
inhibit the growth of different
sepcies of bacteria in urine.
• Methamine is used to prevent
recurrent urinary tract
infection
• Sulphonamide are used to
treat infections causes by
susceptible organism in
urinary tract
• Pregnant and breast feeding
women
• Hisotry of Steven johnson
Syndrome
• Hypersensitive
• Cautiously use in patient with mild
to moderate renal or hepatic
• disorder, severe allergies, blood
dysrasias urinary obstruction
Side Effects/
Adverse effects
• Fever
• Rash
• Crystalluria
• Nausea
• Vomiting
• Photosensitivity reaction
• Steven's Job Syndrome
• Monitor urinary output and urine specific gravity. Careful attention to output is required
when administering urinary antiseptics to patients with anuria and oliguria. Report
promptly any decrease in urine output.
• Obtain urine culture to identify infecting organism before initiation of drug therapy to
treat UTI.
• Observe the patient for side effects and adverse reactions to urinary antiseptic drugs.
Peripheral neuropathy (tingling, numbness of extremities) may result from renal
insufficiency (inability to excrete drug) or long-term use of nitrofurantoin. Peripheral
neuropathy may be irreversible
• Teach patients not to crush tablets or open capsules.
• Advise patients to rinse the mouth thoroughly after taking oral nitrofurantoin. The drug
can stain teeth.
• Teach patients to shake suspensions well before administration and to protect them from
freezing.
URINARY STIMULANT
Generic Name
Brand Name
Bethanechol chloride
Urecholine
Drug Dosage
• Adult: PO; 10-50 mg tid/qid 1 h or 2 h pc; max:
200mg/d
• Adult: Subcut: 5 mg tid/qid PRN; max: 40 mg/d
Mechanism of Action
• to increase bladder tone by increasing tone of the
detrusor urinal muscle, which produces a contraction
strong enough to stimulate urination
Indication
• Acute potoperative
urinary retention
• neurogenic atony of the
urinary bladder
Contraindication
• Hypersensitivity to bethanecol or to
any component of the injection
• Hyperthyroidism
• pregnancy
• lactation
• peptic ulcer
• latent or active bronchial asthma
• vasomotor instability
• coronary artery disease
• epilepsy
• parkinsonism
Side effects/ Adverse effects
• Dry mouth
• Urinary retention
• constipation
• blurred vision
Nursing Intervention
• Assessment of urinary symptoms, and monitoring for side
effects and therapeutic effects
• Before taking bethanechol, tell your doctor if you have or
have ever had asthma, a bladder infection, epilepsy, high
blood pressure, heart disease, Parkinson's disease, an
overactive thyroid gland, or ulcers. tell your doctor if you
are pregnant, plan to become pregnant, or are breast feeding
REFERENCES:
McCuistion, L. E., Vuljoin-DiMaggio, K., Winton, M. B., Yeager, J. J. (2018). Pharmacology: A Patientcentered Nursing Process Approach. United States: Elsevier.
Skidmore-Roth, L. (2018). Mosby's 2019 Nursing Drug Reference E-Book. United States: Elsevier
Health Sciences.
https://go.drugbank.com/
https://www.sciencedirect.com/
https://www.rxlist.com/how_do_osmotic_diuretics_work/drug-class.htm
https://www.drugs.com/drug-class
https://www.slideshare.net/diptisorte/drugs-used-on-urinary-system
https://drive.google.com/file/d/1wpocbw8JNuwJIfkjl8JKhh8TtGbr8MDy/view?usp=sharing
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