GU Medication Flashcards
Reasons to give IV fluid to Pt’s
- NPO
- Hypovolemia
- Dehydration
- Certain Medications – certain dye’s for angiograms
Where is most fluid located?
In the cells
Oncotic Pressure
Pressure that a protein will exert to pull fluids towards them
Hydrostatic pressure
Pressure that pulls fluid out and puts it into the interstitial space
Normal Osmolality in blood
275 - 295 mOsm/kg
Hypertonic IV fluid
-Does what?
- Water moves from interstitial space to plasma
Hypotonic IV fluid
-does what?
- Water moves from plasma to interstitial space
Isotonic IV fluid
-Does what?
- No fluid shift
2. Don’t give to someone with with HTN
0.9 normal Saline and Lactated Ringer
Isotonic Solution
-Stays in the vessel
D5.9
- Hypertonic Solution
- Fluid is going to leave cell and interstitial space into the plasma
- Cells will shrink from loss of fluid
D5W
- Hypotonic solution
2. Fluid will move out of plasma and into interstitial and cellular space.
Crystalloids
- Contain Electrolytes (Lactated ringer, Saline)
- Used to replace fluids and promote urine output
- Compartment entered depends on tonicity of IV fluid
Colloids
- Molecules to large to easily cross capillary membrane
- Stays in IV space
- Rapidly expand plasma volume - Draw water from intracellular fluid and interstitial spaces into plasma
- –ULTIMATE Hypertonic solution
Diuretics
-Used for
- High potassium
- Kidney failure (Don’t work when kidneys have failed)
- Fluid overload
Pharmacotherapy considerations for Renal Failure
-Adjustments
- Reduce medications because they are excreted in the kidneys
- Call pharmacy to properly adjust the dose
Pharmacotherapy considerations for Renal Failure
-Labs and tests to see Renal Failure
- GFR
- Creatinine clearance
- BUN
- Urine output 30ml/hr test
- Person w/ kidney failure will have high potassium levels
- Calcium will be low and phosphorus will be high
- Sodium can be low
- Early signs of renal failure is HTN
Sings of liver failure
- Person w/ kidney failure will have high potassium levels
- Calcium will be low and phosphorus will be high
- Sodium can be low
- Early signs of renal failure is HTN
Loop diuretics
-Examples
- Lasix
2. Bumex
Thiazide type diuretics
-Examples
- Hydrochlorothiazide
2. Metolazone (Zaroxolyn)
Potassium sparing diuretics
-Examples
- Triamterene (Dyrenium)
2. Spirolactone (Aldactone)
Combination of diuretics
-Examples
- Maxide
2. Diazide
Diuretic Uses
- Hypertension
- Hyperkalemia
- CHF
- Fluid Overload
- Primary Aldosteronism
Diuretic Contraindications
- Electrolyte depletion (especially potassium)
- Pregnancy
- Anuria or progressive oliguria
- Anuria is <400 ml/24hr - Hypokalemia (Loop and thiazide) (check lab electrolytes)
- Hyperkalemia (w/ K+ sparing)
- Renal dysfunction
Prednisone (glucocorticoid)
-Interaction
Prednisone decreases potassium
Also can decrease calcium and magnesium
Hypokalemia and Digoxin
Hypokalemia can cause digoxin toxicity
Hyperkalemia and ACE inhibitor & ARB
don’t give together.
Diuretic
-Drug interactions
- ACE Inhibitors
- NSAID’s
- Can decrease the effectiveness of diuretics and ACE inhibitors - Digoxin Toxicity (with hypokalemia)
- Corticosteroids (K will decrease)
Digoxin Toxicity
-Signs
- Light halo’s
- Visual disturbances
- Severe N/V
Diuretics
-Adverse Effects
- Hypotension
- Electrolyte Imbalance
- Hearing Changes (LASIX) **TEXT
- Photosensitivity (hydrochlorothyozide) –turns urine blue **TEST
- Dehydration – If BUN is high but everything is normal cut back on diuretics.
Hydrochlorothyozides
- turns urine blue
2. Photosensitivity
Lasix
-Implications
Can cause uric acid levels and gout
Hydrochlorothyozide
-Implications
Limit Sun Exposure
Lasix IV push
-How fast does it work?
- 5 minutes to take effect
Diuretics
-How to know they are working
- Lowered BP
- Potassium levels are good
- CHF is good
- They are urinating
Antispasmodics
- Parasympatholitic action to relax bladder muscle and increase holding capacity
Antispasmodics
-Examples
- Urispas
Antispasmodics
-Contraindications
- Narrow-angle glaucoma
- myasthenia gravis
- CAD
- GI bleeding or issues w/ motility
Antispasmodics
-Pyridium (phenazopyridine)
- Pyridium turns the urine blood orange and it stains.
2. Anesthetic effect on the urinary mucosa
Antispasmodics
-Used for
- Dysuria
- Urgency
- Nocturia
- Pain
- Frequency
- Relief after transurethral surgery // Neurogenic bladder
Antispasmodics
-Adverse effects
- Headache, dizziness, restlessness
- N/V, dry mouth
- Heart palpitations and tachycardia
- Urinary retention
Antispasmodics
-Implications
- Watch for GI distress cause anti-cholinergic slow digestive process
- Watch symptoms of liver and kidney damage
- Urine can stain while on Pyridium
- Watch I/O
ACE Inhibitors
-Overview
- Causes dry cough
- Increases potassium
- Contraindicated with renal stenosis
- Don’t use with pregnancy
Phosphate-Binding Agent
- Corrects the calcium/phosphorus imbalance from renal failure
- Binds w/ phosphorus in the GI tract
Phosphate-Binding Agent
-When to give
- Give right before meal time
Phosphate-Binding Agent
-Contraindication
- Hypercalcemia
2. Hypophosphatemia
Potassium
-can it be given IV push?
potassium cannot be given IV push.
It is never safe to push potassium
Cation-Exchange Resin
- It will give a sodium molecule and take away a potassium molecule
- Works in the stomach as well as the intestine (oral and enema)
Cation-Exchange Resin
-Contraindications
- Potassium is exchanged for Sodium so fluid follows sodium.
- HTN
- CHF
- Marked Edema
Cation-Exchange Resin
-Interactions
- Cation-donating antacids/laxatives
Cation-Exchange Resin
-Adverse Effects
- Hypokalemia
- Hypocalcemia
- Hypomagnesemia
1, 2, and 3 work together / if one goes down, look at the others - Sodium retention
