Exam 2: Pharmacotherapy Of Renal Failure

Question 1

Pharmacotherapy of Renal Failure includes

Answer 1

Attempts to cure cause of dysfunction:

• Diuretics - to increase urine output
• Cardiovascular drugs - to treat HTN or heart failure
• Dietary management: restriction of protein; reduction of Na, K, Phosphorus, Mg+

Question 2

Diuretics

Answer 2

Increases rate of urine flow.

Excretion of excess fluid.

Question 3

Side Effects of Diuretic Therapy

Answer 3

F&E disturbances:
Dehydration
Orthostatic Hypotension
Potassium and sodium imbalances

Question 4

Adverse Effects of Loop Diuretics

Answer 4

Rapid Excretion of large amounts of water
Dehydration
Electrolyte Imbalances
Ototoxicity

Question 5

Loop Diuretics include

Answer 5

• torsemide (demadex)

- bumetanide (bumex)

Question 6

Torsemide

Answer 6

Longer half life than furosemide: once a day dosing

Question 7

Bumetanide

Answer 7

40 times potency of furosemide

Shorter duration of action.

Question 8

Nursing Management: Loop Diuretics

Answer 8

• Obtain baseline and monitor periodically lab values, weight, current level of urine output.
• Monitor electrolytes: especially potassium, sodium and chloride.

Question 9

Loop Diuretics: Monitor for side effects such as

Answer 9

Orthostatic hypotension
Hypokalemia
Hyponatremia
Polyuria

Rash or pruritus

Question 10

Patient Teaching: Loop Diuretics

Answer 10

• Teach patients to take diuretics in the morning
• Change positions slowly
• Monitor Weight
• Take potassium supplements and consume potassium rich foods.

Question 11

Thiazide Diuretics: MOA

Answer 11

Blocks Na+ reabsorption and increases potassium and water excretion.

Question 12

Primary Use: Thiazide Diuretics

Answer 12

Used to treat mild to moderate HTN.

Also indicated to reduce edema associated with heart, hepatic and renal failure.

Question 13

Thiazide Diuretics

Answer 13

Largest, most commonly prescribed class of diuretics.
Less efficacious than loop diuretics.
Not effective in clients with severe renal failure.

Question 14

Prototype Drug: Thiazide Diuretic

Answer 14

Chlorothiazide (Diuril)

Question 15

Thiazide Diuretic: MOA

Answer 15

To block sodium absorption in distal tubule of nephron.

Question 16

Primary Use: Thiazide Diuretic

Answer 16

To treat mild to moderate HTN.
To treat severe HTN, in combination with other drugs.
To treat fluid retention from heart failure, liver disease and corticosteroid or estrogen therapy.

Question 17

Adverse Effects: Thiazide Diuretics

Answer 17

Dehydration
Orthostatic Hypotension
Hypokalemia

Question 18

Thiazide and Thiazide-like Diuretics: Patient Teaching

Answer 18

Teach patient to:

• Use sunscreen to decrease photosensitivity.
• Take K+ supplements, if ordered.
• Consume K+ rich foods.
• Report any tenderness or pain in joints (may cause hyperuricemia.. gout like conditions)

Question 19

Potassium-Sparing Diuretics Advantage

Answer 19

Diuresis without affecting blood potassium levels

Question 20

Potassium-Sparing Diuretics: MOA

Answer 20

Either by blocking sodium or by blocking aldosterone.

Question 21

Potassium-Sparing Diuretics are less effective than

Answer 21

Loop Diuretics but helps prevent hypokalemia.

Question 22

Potassium-Sparing Diuretics include

Answer 22

Spironolactone

Question 23

Potassium-Sparing Diuretic: MOA

Answer 23

To block action of aldosterone

Question 24

Primary Use: Potassium-Sparing Diuretics

Answer 24

To significantly reduce mortality in heart failure.

Question 25

Adverse Effects of Potassium-Sparing Diuretics

Answer 25

Hyperkalemia

Question 26

Nursing Considerations for Potassium Sparing Diuretics

Answer 26

- Spironolactone may decrease effectiveness of anticoagulants. - Clients taking lithium or digoxin may be at increased risk for toxicity. - Report S&S of hyperkalemia

Question 27

Triamterene (Dyrenium) is a potassium sparing diuretic that is contraindicated in

Answer 27

Lactating women

Question 28

Things to avoid when taking Potassium Sparing diuretics

Answer 28

- Avoid use of K+ based salt substitutes - When in direct sunlight, use sunscreen. - Avoid performing tasks that require mental alertness. - Do not eat excess amount of foods high in K+.

Question 29

Miscellaneous Diuretics

Answer 29

Cannot be classified as loop, thiazide or potassium-sparing agents.

Question 30

Two these miscellaneous diuretics inhibits

Answer 30

Carbonic anhydrase

Question 31

Carbonic Anhydrase

Answer 31

Enzyme that affects acid-base balance by its ability to form carbonic acid from water and carbon dioxide.

Question 32

Primary Use: Miscellaneous Diuretics

Answer 32

To maintain urine flow in times of hypoperfusion: for clients with acute renal failure or during prolonged surgery.

Question 33

Osmotic Diuretics include

Answer 33

Mannitol

Question 34

Mannitol: MOA

Answer 34

- Works along entire nephron: proximal tubule and descending loop on Henle (major site of action) - Increased osmotic pressure in glomerular filtrate d/t non-absorbability (pulls fluid into tubules around surrounding tissues - Inhibits reabsorption of H2O and solutes - rapid diuresis) - Induces vasodilation (excellent for preventing kidney damage - used in early AKI)

Question 35

Evaluation of the patient taking drug therapy for renal failure

Answer 35

- Experiences decrease in blood pressure - Free from or experiences minimal adverse effects - Verbalizes an understanding of the drug’s use, adverse effects and required precautions. - Demonstrates proper self-administration of medication (dose, timing, when to notify provider)