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NR-NUR124 | Pharmacology > [9] FINALS | RENAL DRUGS > Flashcards

[9] FINALS | RENAL DRUGS Flashcards

1
Q

acts to increase flow of urine

A

DIURETICS

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2
Q

DIURETICS

Purpose:
* Decrease h____
* Decrease e____

A

Purpose:
* Decrease hypertension
* Decrease edema

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3
Q

DIURETICS

Drug Categories:
A. T____

B. L____

C. K____

D. C____

E. O____

A

Drug Categories:
A. Thiazides & Thiazide-like

B. Loop diuretics

C. K+ sparing diuretics

D. Carbonic Anhydrase inhibitor

E. Osmotic Diuretics

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4
Q

THIAZIDES & THIAZIDE-LIKE

EXAMPLES (2)

A

Chlorothiazide (Diuril), Hydrochlorothiazide (Hydrodiuril - most common)

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5
Q

THIAZIDES & THIAZIDE-LIKE

I: hypertension and p____

MOA: Acts on the ____ renal tubules to promote Na, Cl, and water excretion

S/E: h____ , hypomagnesemia, h____ , dizziness, headache, N&V, constipation, o____ , hyperglycemia, h____

A

I: hypertension and peripheral edema

MOA: Acts on the distal convoluted renal tubules to promote Na, Cl, and water excretion

S/E: Hypokalemia, hypomagnesemia, hypercalcemia, dizziness, headache, N&V, constipation, orthostatic hypotension, hyperglycemia, hyperuricemia

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6
Q

THIAZIDES

Nursing Considerations:
Assessment:

  • VS, Weight, u____, e____

Check:

  • Peripheral extremities – e____
  • History of drugs and herbal supplements taken daily
  • Review drug to drug interactions (d____, corticosteroids, antidiabetics, g____, l____)
A

Nursing Considerations:
Assessment:

  • VS, Weight, Urine Output, Electrolyte values

Check:

  • Peripheral extremities – Edema
  • History of drugs and herbal supplements taken daily
  • Review drug to drug interactions (digoxin, corticosteroids, antidiabetics, gingko, licorice)
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7
Q

THIAZIDES

Nursing Considerations:

✓Monitor VS (BP & Pulse) and s____ levels- report changes

✓Watch out for d____ and h____
❑ (muscle weakness, leg cramps, and cardiac
dysrhythmias)

✓Monitor daily weight- weight gain of ____ lbs. is equivalent to 1 L of body fluids

✓Note urine output (fluid loss or retention)

A

Nursing Considerations:

✓Monitor VS and serum electrolyte levels- report changes

✓Watch out for digitalis toxicity and hypokalemia
❑ (muscle weakness, leg cramps, and cardiac
dysrhythmias)

✓Monitor daily weight- weight gain of 2.2 lbs. is equivalent to 1 L of body fluids

✓Note urine output (fluid loss or retention)

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8
Q

THIAZIDES

Patient teaching:

  • Emphasize adherence to the therapy plan
  • Take drug e____
  • Keep drugs out of reach of small children
  • Inform – certain h____ may interact with
    thiazide diuretics
  • Teach on how to take and record b____ (daily)
A

Patient teaching:

  • Emphasize adherence to the therapy plan
  • Take drug early in the morning
  • Keep drugs out of reach of small children
  • Inform – certain herbal products may interact with
    thiazide diuretics
  • Teach on how to take and record BP (daily)
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9
Q

THIAZIDES

Patient teaching:

  • Prevent o____ - by slowly changing position from lying to standing
  • Use sunblock – to prevent p____
  • Eat foods rich in p____ (e.g. avocado, banana) - supplements may be prescribed
  • Taken with f____ - to avoid GI upset (diarrhea, N/V, anorexia)
A

Patient teaching:

  • Prevent orthostatic hypotension - by slowly changing position from lying to standing
  • Use sunblock – to prevent photosensitivity
  • Eat foods rich in Potassium (e.g. avocado, banana) - supplements may be prescribed
  • Taken with FOOD- to avoid GI upset (diarrhea, N/V, anorexia)
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10
Q

LOOP DIURETICS/ HIGH CEILING

EXAMPLES (2)

A

Furosemide (Lasix - most common), Bumetanide (Bumex)

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11
Q

LOOP DIURETICS/ HIGH CEILING

I: E____ and hypertension

MOA: Acts on the a____ by inhibiting Na reabsorption

S/E: H____, Na, Ca, Mg, Cl, dizziness, headache, N&V, o____

A

I: Edema and hypertension

MOA: Acts on the ascending loop of Henle by inhibiting Na reabsorption

S/E: Hypokalemia, Na, Ca, Mg, Cl, dizziness, headache, N&V, orthostatic hypotension

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12
Q

LOOP DIURETICS/ HIGH CEILING

Assessment:

  • Check for drugs that may cause drug interaction (e.g. alcohol, a____, anticoagulants, corticosteroids, l____, a____, digitalis)
  • VS, serum electrolytes, weight, and UO
  • Note hypersensitivity to s____
A

Assessment:

  • Check for drugs that may cause drug interaction (e.g. alcohol, aminoglycosides, anticoagulants, corticosteroids, lithium, amphotericin B, digitalis)
  • VS, serum electrolytes, weight, and UO
  • Note hypersensitivity to sulfonamides
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13
Q

LOOP DIURETICS/ HIGH CEILING

Nursing Considerations:

  • Monitor VS (decrease B____) and UO (should be at least ____ mL/h or ____ mL/24 hr)
  • Notify doctor – if UO does not increase (s____ may be present)
  • Weigh the patient - A loss of ____ lbs is equivalent to a fluid loss of 1 L
A

Nursing Considerations:

  • Monitor VS (decrease BP) and UO (should be at least 30 mL/h or 600 mL/24 hr)
  • Notify doctor – if UO does not increase (severe renal disorder may be present)
  • Weigh the patient - A loss of 2.2 lbs is equivalent to a fluid loss of 1 L
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14
Q

LOOP DIURETICS/ HIGH CEILING

Nursing Considerations:

  • Administer IV f____ SLOWLY
  • h____ may occur if it is rapidly injected
  • Check for signs of h____ (< 3.5 mEq/L) - Muscles weakness, abdominal distention, leg cramps, or cardiac dysrhythmias
  • Taken in the m____
  • Rise slowly from lying to standing (dizziness resulting from fluid loss)
A

Nursing Considerations:

  • Administer IV furosemide SLOWLY
  • Hearing loss may occur if it is rapidly injected
  • Check for signs of hypokalemia (< 3.5 mEq/L) - Muscles weakness, abdominal distention, leg cramps, or cardiac dysrhythmias
  • Taken in the morning
  • Rise slowly from lying to standing (dizziness resulting from fluid loss)
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15
Q

OSMOTIC DIURETIC

EXAMPLES (2)

A

Mannitol (Osmitrol - most common), Urea (Ureaphil)

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16
Q

OSMOTIC DIURETIC

I: Increased i____, i____ and prevent k____

MOA: Increases p____ and b____ concentration in renal tubules

S/E:
✓ F____ imbalance
✓ Pulmonary Edema
✓ N&V
✓ T____
✓ A____

A

I: Increased IOP, ICP and prevent kidney failure

MOA: Increases plasma and blood concentration in renal tubules

S/E:
✓ F&E imbalance
✓ Pulmonary Edema
✓ N&V
✓ Tachycardia
✓ Acidosis

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17
Q

OSMOTIC DIURETIC

Nursing Consideration for Mannitol

  • Mannitol c____ at low temperature
    -use i____
    -may be warmed
    -f____ drip
    -give with extreme caution if with h____
A

Nursing Consideration for Mannitol

  • Mannitol CRYSTALLIZES at low temperature
    -use in-line filter
    -may be warmed
    -fast drip
    -give with extreme caution if with heart condition/ heart failure
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18
Q

CARBONIC ANHYDRASE INHIBITORS

EXAMPLE (1)

A

Acetazolamide (Diamox)

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19
Q

CARBONIC ANHYDRASE INHIBITORS

I: increased IOP in o____ only, epilepsy, high altitude or a____; r____

MOA: Blocks the action of the enzyme c____ = increased NA, K, HCO3 excretion

S/E: f____ imbalance, Metabolic acidosis, c____, Orthostatic Hypotension, N/V, a____, confusion

A

I: increased IOP in open angle glaucoma only, epilepsy, high altitude or acute mountain sickness; respiratory acidosis

MOA: Blocks the action of the enzyme Carbonic Anhydrase = increased NA, K, HCO3 excretion

S/E: F&E imbalance, Metabolic acidosis, Crystalluria, Orthostatic Hypotension, N/V, anorexia, confusion

20
Q

POTASSIUM- SPARING DIURETICS

EXAMPLES (2)

A

Spinorolactone (Aldactone)
Amiloride (Midamor)

21
Q

POTASSIUM- SPARING DIURETICS

I: Edema and h____

MOA: Acts primarily in the c____ renal
tubules to promote Na, H2O excretion & K
retention

S/E:
* H____
* Caution with poor renal functioning
* A____, N/V, diarrhea

A

I: Edema and HF

MOA: Acts primarily in the collecting duct renal
tubules to promote Na,H20 excretion & K
retention

S/E:
* Hyperkalemia
* Caution with poor renal functioning
* Anorexia, N/V, diarrhea

22
Q

POTASSIUM- SPARING DIURETICS

Assessment:

  • Check history of drugs taken daily
  • VS, s____, weight, and UO
  • UO should increase - report if UO is less than ____ mL/hr or less than ____ mL/day
  • Check for ____ (>5.0 mEq/L; give potassium chloride) - Nausea, diarrhea, abdominal cramps, numbness and tingling of the hands and feet, leg cramps, tachycardia and later bradycardia, peaked narrow T wave on ECG, oliguria
A

Assessment:

  • Check history of drugs taken daily
  • VS, serum electrolytes, weight, and UO
  • UO should increase - report if UO is less than 30 mL/hr or less than 600 mL/day
  • Check for hyperkalemia (>5.0 mEq/L; give potassium chloride) - Nausea, diarrhea, abdominal cramps, numbness and tingling of the hands and feet, leg cramps, tachycardia and later bradycardia, peaked narrow T wave on ECG, oliguria
23
Q

POTASSIUM- SPARING DIURETICS

Patient Teaching:

  • Take s____ with or after meals
  • Do not discontinue without consulting the Doctor
  • Spironolactone- can cause p____ - Use sunblock
  • Report r____, dizziness, w____ and GI upset
  • Advise patients with hyperkalemia to avoid foods rich in p____ - when taking potassium-sparing diuretics
A

Patient Teaching:

  • Take spironolactone with or after meals
  • Do not discontinue without consulting the Doctor
  • Spironolactone- can cause photosensitivity - Use sunblock
  • Report rash, dizziness, weakness and GI upset
  • Advise patients with hyperkalemia to avoid foods rich in potassium - when taking potassium-sparing diuretics
24
Q

BODY FLUIDS

Osmolality of body fluids - concentration of body fluids

  • Normal serum osmolality: ____ mOsm/kg
A

Osmolality of body fluids - concentration of body fluids

  • Normal serum osmolality: 275 to 295 mOsm/kg
25
Q

BODY FLUIDS

  • Three (3) Types of fluid concentration (based on the osmolality of body fluids):
    1. I____
    2. H____
    3. H____
A
  • Three (3) Types of fluid concentration (based on the osmolality of body fluids):
    1. Isoosmolar
    2. Hypoosmolar
    3. Hyperosmolar
26
Q

TYPES OF INTRAVENOUS SOLUTIONS

A. C____
1. Isotonic
2. Hypotonic
3. Hypertonic

B. C____
C. B____

A

A. Crystalloids
1. Isotonic
2. Hypotonic
3. Hypertonic

B. Colloids
C. Blood and blood products

27
Q

CRYSTALLOIDS - ISOTONIC SOLUTION

Example:

  • LR, R____, 0____, 5____ in water

Uses:

  • Corrects D____ and Na depletion
  • Replace GI losses
  • D____ provide some calories
A

Example:

  • LR, Ringer’s solution, 0.9% NaCl, 5% Dextrose in water

Uses:

  • Corrects DHN and Na depletion
  • Replace GI losses
  • Dextrose provide some calories
28
Q

CRYSTALLOIDS - ISOTONIC SOLUTION

Cautions for use:

  • LR should be used cautiously to patients with: r____ (contains K+), a____, l____
  • Isotonic solutions should be used cautiously in
    patients with: c____ or r____ disease (risk of FVE)

Note: DO NOT administer Isotonic solutions to patients with known or suspected I____

A

Cautions for use:

  • LR should be used cautiously to patients with: renal failure (contains K+), alkalosis, liver disease
  • Isotonic solutions should be used cautiously in
    patients with: Cardiac or renal disease (risk of FVE)

Note: DO NOT administer Isotonic solutions to patients with known or suspected ICP

29
Q

CRYSTALLOIDS - HYPOTONIC SOLUTION

Examples:

  • ____% NaCl, ____% NaCl, ____% NaCl

Uses:

  • Treats intracellular d____ (DKA - Diabetes TYPE 1, Hyperosmolar hyperglycemic State - Diabetes TYPE 2)
  • Provides f____ to allow excretion of body wastes
  • D____ provides some calories
A

Examples:

  • 0.45% NaCl, 0.33% NaCl, 0.225% NaCl

Uses:

  • Treats intracellular dehydration (DKA - Diabetes TYPE 1, Hyperosmolar hyperglycemic State - Diabetes TYPE 2)
  • Provides free water to allow excretion of body wastes
  • Dextrose provides some calories
30
Q

CRYSTALLOIDS - HYPOTONIC SOLUTION

Contraindications:

  • Do not use in patients with: known or suspected
    i____, l____, shock, trauma, b____

Considerations:

  • Monitor for signs of F____ and worsening of
    h____ (due to decrease in vascular volume)
A

Contraindications:

  • Do not use in patients with: known or suspected
    ICP, liver disease, shock, trauma, burns

Considerations:

  • Monitor for signs of FVD and worsening of
    hypovolemia (due to decrease in vascular volume)
31
Q

CRYSTALLOIDS - HYPERTONIC SOLUTION

Example:

  • ____% NaCl; 5% Dextrose and ____% NaCl; 5%
    Dextrose and ____% NaCl; % Dextrose in LR; ____% Dextrose and water; ____% Dextrose and water

Uses:

  • Corrects severe h____
  • Decreases i____ (cerebral edema)
  • Dextrose provides some calories
A

Example:

  • 3% NaCl, 5% Dextrose and 0.45% NaCl, 5%
    Dextrose and 0.9% NaCl, % Dextrose in LR, 10% Dextrose and water, 50% Dextrose and water

Uses:

  • Corrects severe hyponatremia
  • Decreases ICP (cerebral edema)
  • Dextrose provides some calories
32
Q

CRYSTALLOIDS - HYPERTONIC SOLUTION

Considerations:

  • May cause i____ and pulmonary edema - Administer slowly and carefully with infusion control pump and constant monitoring
  • Avoid p____ use
  • Higher concentrations of dextrose (>____%) must be given through - Central venous access device
  • May be added to amino acid solutions as T____

Contraindications:

  • C____ or r____ disease
  • D____ or D____
A

Considerations:

  • May cause intravascular volume overload and pulmonary edema - Administer slowly and carefully with infusion control pump and constant monitoring
  • Avoid prolonged use
  • Higher concentrations of dextrose (>10%) must be given through - Central venous access device
  • May be added to amino acid solutions as TPN (total parenteral nutrition)

Contraindications:

  • Cardiac or renal disease
  • DHN or DKA
33
Q

used primarily as a measurement of the concentration of IV solutions compared with the osmolality of body fluids

A

TONICITY

34
Q

TONICITY OF INTRAVENOUS SOLUTIONS

  1. Hypotonic: <____ mOsm/kg
  2. Isotonic: ____ mOsm/kg
  3. Hypertonic: >____ mOsm/kg
    * IV solutions are used to replace body fluid loss
A
  1. Hypotonic: <280 mOsm/kg
  2. Isotonic: 280–300 mOsm/kg
  3. Hypertonic: >300 mOsm/kg
    * IV solutions are used to replace body fluid loss
35
Q

COLLOIDS

Volume expanders

  • D____
  • A____
  • H____
  • P____
  • C____
A

Volume expanders

  • Dextran solutions
  • Amino acids
  • Hetastarch
  • Plasmanate
  • Colloidal gelatin
36
Q

BLOOD AND BLOOD PRODUCTS

EXAMPLES (4)

A

Packed RBCs (PRBC), plasma, platelets, cryoprecipitate

37
Q

BLOOD AND BLOOD PRODUCTS

Considerations:

  • Proper products-to- patient identification
  • Maximum rate of infusion – ____ hours per unit
  • Pre-medications (e.g. d____)
  • Multiple Blood transfusions – check for serum ionized c____ levels
  • Never add medications to the unit of blood
A

Considerations:

  • Proper products-to- patient identification
  • Maximum rate of infusion – 4 hours per unit
  • Pre-medications (e.g. diphenhydramine)
  • Multiple Blood transfusions – check for serum ionized calcium levels
  • Never add medications to the unit of blood
38
Q

BLOOD AND BLOOD PRODUCTS

  • I____ - known as lipid emulsion
  • Patient must have c____ or p____ inserted vascular access device
  • N & V, elevated t____ - if given rapidly
A
  • IV Fat Emulsion - known as lipid emulsion
  • Patient must have centrally or peripherally inserted vascular access device
  • N & V, elevated temperature- if given rapidly
39
Q

BLOOD AND BLOOD PRODUCTS

Cautions for use:

  • At risk for fat e____ (fractured femur)
  • With allergy to e____ or soybeans
  • P____
  • Bleeding disorders
  • L____ failure
  • R____ disease
A

Cautions for use:

  • At risk for fat embolism (fractured femur)
  • With allergy to eggs or soybeans
  • Pancreatitis
  • Bleeding disorders
  • Liver failure
  • Respiratory disease
40
Q

FLUID IMBALANCE

Fluid Volume Deficit

  • Strict I and O h____
  • O____ Care
  • Encourage increase O____
  • Monitor for s____ and pressure
  • Monitor for s/sx of F____ due to h____ - thirst, restlessness, HA, inability to concentrate, dry mucous membranes, poor skin turgor, tachycardia, changes in mental status, slightly decrease BP
A

Fluid Volume Deficit

  • Strict I and O hourly
  • Oral Care
  • Encourage increase OFI
  • Monitor for skin breakdown and pressure
  • Monitor for s/sx of FVD due to hypovolemia - thirst, restlessness, HA, inability to concentrate, dry mucous membranes, poor skin turgor, tachycardia, changes in mental status, slightly decrease BP
41
Q

FLUID IMBALANCE

Fluid Volume Deficit

  • Recognize late symptoms of hypovolemia: c____, cold clammy skins, w____, confusion and o____
  • Assess for o____ - safety in transferring and changing of positions
  • Monitor lab results: H____ and H____, urine s____; increase NA, BUN, crea, electrolyte levels & serum osmolality
A

Fluid Volume Deficit

  • Recognize late symptoms of hypovolemia: Cyanosis, cold clammy skins, weak thread pulse, confusion and oliguria
  • Assess for orthostatic hypotension- safety in transferring and changing of positions
  • Monitor lab results: Hgb and Hct, urine specific gravity (increased - concentrated urine); increase NA, BUN, crea, electrolyte levels & serum osmolality
42
Q

FLUID IMBALANCE

Fluid Volume Excess

  • Monitor for F____
  • T____, bounding pulse, t____, increase BP and pulse pressure
  • Altered m____, generalized edema, a____,
  • Constant, irritated cough; dyspnea, o____, crackles, pulmonary congestion, muffled heart sounds
  • F____
  • Increased ICP, j____ vein distention; increased UO
  • Monitor lab results - elevated BUN, Hgb and Hct, Na, Serum osmolality, urine specific gravity)
A

Fluid Volume Excess

  • Monitor for FVE
  • Tachycardia, bounding pulse, tachypnea, increase BP and pulse pressure
  • Altered mental status, generalized edema, anasarca,
  • Constant, irritated cough; dyspnea, orthopnea, crackles, pulmonary congestion, muffled heart sounds
  • Fatigue
  • Increased ICP, jugular vein distention; increased UO
  • Monitor lab results - elevated BUN, Hgb and Hct, Na, Serum osmolality, urine specific gravity)
43
Q

FLUID IMBALANCE

Fluid Volume Excess

  • Daily weight- sudden ____
  • Administer d____ as ordered
  • Fluid and s____ restrictions
  • Head of the bed elevated ____ to ____ degrees - facilitate respiration
A

Fluid Volume Excess

  • Daily weight- sudden increases
  • Administer diuretics as ordered
  • Fluid and sodium restrictions
  • Head of the bed elevated 30 to 40 degrees - facilitate respiration
44
Q

FLUID IMBALANCE

Fluid Volume Excess

  • Monitor e____ areas for signs of pressure and altered skin integrity
  • Meticulous s____
  • R____
A

Fluid Volume Excess

  • Monitor edematous areas for signs of pressure and altered skin integrity
  • Meticulous skin care
  • Repositioning
45
Q

ELECTROLYTES

A. P____

B. S____

C. C____

D. M____

E. C____

F. P____

A

A. Potassium

B. Sodium

C. Calcium

D. Magnesium

E. Chloride

F. Phosphorus (phosphate

46
Q

Transmission and conduction of nerve impulses and for the contraction of skeletal, cardiac and smooth muscles

A

POTASSIUM (3.5-5.0 mEq/L)

47
Q

POTASSIUM (3.5-5.0 mEq/L)

A

NR-NUR124 | Pharmacology (10 decks)

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