Lewis 51 - AKI and CKD Flashcards
MOA/Class
Insulin (regular)
Facilitates transport of glucose and electrolytes across cell membrane and stimulates metabolic processes
Short-acting Insulin
Tucker 38
Side Effects
Insulin (regular)
hypoglycemia, lipodystrophy, hypokalemia
Tucker 38
Nursing Considerations
Insulin (regular)
Regular insulin is the only insulin that may be given IV (DKA or hyperkalemia).
Give with concurrent dose of dextrose if given for hyperkalemia to prevent hypoglycemia.
General insulin considerations: Check glucose levels before administering insulin. Beta blockers may decrease/mask s/s of hypoglycemia. Insulin needs may increase with corticosteroid therapy. May require double RN verification.
Onset: 30-60 minutes; Peak: 2-4 hours; Duration: 6-12 hours
Tucker 38
Indications
Insulin (regular)
Hyperglycemia; hyperkalemia
Tucker 38
MOA/Class
sodium bicarbonate
neutralizes acid; promotes shift of potassium into cells
Antacid/alkalinizing agent
Tucker 57
Side Effects
sodium bicarbonate
metabolic alkalosis, hypokalemia
Tucker 57
Nursing Considerations
sodium bicarbonate
Observe IV site closely; monitor EKG
Tucker 57
Indications
sodium bicarbonate
Acidosis; hyperkalemia
Tucker 57
MOA/Class
calcium gluconate
Regulates transmission of nerve impulses and contraction of cardiac, skeletal, and smooth muscle.
Raises threshold for cardiac excitation thus decreasing risk for dysrhythmias
Electrolyte supplement
Tucker 60
Side Effects
calcium gluconate
Phlebitis
Tucker 60
Nursing Considerations
calcium gluconate
Observe IV site closely; monitor EKG
Tucker 60
Indications
calcium gluconate
Hypocalcemia
Hyperkalemia, magnesium toxicity
Tucker 60
MOA/Class
sodium polystyrene sulfonate (Kayexalate)
Exchanges sodium for potassium in the intestine
cationic exchange resin
Side Effects
sodium polystyrene sulfonate (Kayexalate)
hypokalemia, constipation, fecal impaction, intestinal necrosis
Nursing Considerations
sodium polystyrene sulfonate (Kayexalate)
Not to be used in emergent situations due to delayed therapeutic effects
Given PO or via enema
Indications
sodium polystyrene sulfonate (Kayexalate)
Hyperkalemia
MOA/Class
patiromer (Veltassa)
Increases fecal excretion of potassium by binding to potassium in the GI tract
Side Effects
patiromer (Veltassa)
Hypokalemia, diarrhea
Nursing Considerations
patiromer (Veltassa)
Not to be used in emergent situations due to delayed therapeutic effects
Indications
patiromer (Veltassa)
hyperkalemia
MOA/Class
lisinopril, enalapril, captopril, etc.
Prevents conversion of angiotensin 1 to angiotensin 2 (causing vasodilation)
Angiotensin-Converting Enzyme (ACE) Inhibitor
Tucker 43
Side Effects
lisinopril, enalapril, captopril, etc.
Dry cough
Hyperkalemia
First-dose hypotension, orthostatic hypotension
Angioedema
Tucker 43
Nursing Considerations
lisinopril, enalapril, captopril, etc.
- NSAIDs may decrease therapeutic effect and contribute to kidney injury
- Monitor other medications that strongly depend on fluid/electrolyte balance (digoxin, lithium, etc.)
- Avoid potassium supplements
- Note: While ACE inhibitors have some effect on all portions of the cardiac system (“pump, pipes, and volume”), they are most effective on the “pipes” portion.
Tucker 43
Indications
lisinopril, enalapril, captopril, etc.
Hypertension; Decrease cardiac workload; Prevent/limit ventricular remodeling
Tucker 43
MOA/Class
losartan, valsartan, etc.
Blocks the binding of A2 to receptors
Angiotensin II Receptor Blocker (ARB)
Tucker 43
Side Effects
losartan, valsartan, etc.
Hypotension
Hyperkalemia (less common than ACEIs, but still need to monitor)
Less dry cough than ACEIs
Tucker 43
Nursing Considerations
losartan, valsartan, etc.
Avoid potassium supplements
Like ACEIs, most important to monitor BP
Tucker 43
Indications
losartan, valsartan, etc.
Hypertension; Decrease cardiac workload; Prevent/limit ventricular remodeling
Tucker 43
MOA/Class
calcium acetate; calcium carbonate (Tums)
Neutralize stomach acid
Control of hypophosphatemia (binds to phosphate within the GI tract for elimination)
Antacid/phosphate binder
Tucker 60
Side Effects
calcium acetate; calcium carbonate (Tums)
Constipation
Tucker 60
Nursing Considerations
calcium acetate; calcium carbonate (Tums)
Take with meals when used as a phosphate binder; monitor calcium and phosphate levels.
Tucker 60
Indications
calcium acetate; calcium carbonate (Tums)
Acid reflux, hyperphosphatemia
Tucker 60
MOA/Class
sevelamer
Increases fecal excretion of phosphate by binding to phosphate in the GI tract
Phosphate binder
Side Effects
sevelamer
Diarrhea, vomiting
Nursing Considerations
sevelamer
Used when calcium-based phosphate binders cannot be used.
Take with meals.
May not be taken with other medications as will impair absorption of those medications
Indications
sevelamer
Hyperphosphatemia
MOA/Class
cholecalciferol, calcitriol
Required for calcium absorption from the GI tract
Inactive form may be used when patient has some activating function left
Active form required if kidney can no longer activate vitamin D
cholecalciferol (Inactive form) calcitriol (Active form)
Vitamin D analog
Tucker 37
Side Effects
cholecalciferol, calcitriol
No significant concerns
Tucker 37
Nursing Considerations
cholecalciferol, calcitriol
Ensure adequate intake of calcium through diet or supplement
Tucker 37
Indications
cholecalciferol, calcitriol
Hypocalcemia
Tucker 37
MOA/Class
cinacalcet
Increases sensitivity of calcium-sensing receptors in the parathyroid gland
- Increase sensitivity decreases release of PTH in the presence of hypocalcemia
- Decreased release of PTH decreases bone degeneration in CKD-MBD
Calcimimetic agent
Tucker 37
Side Effects
cinacalcet
Nausea/vomiting
Dysrhythmias, prolonged QT interval
Tucker 37
Nursing Considerations
cinacalcet
Monitor calcium levels and EKG
Tucker 37
Indications
cinacalcet
Secondary hyperparathyroidism (often due to CKD)
Tucker 37
MOA/Class
epoetin alfa; darbapoetin alfa
Mimics effects of erythropoietin to stimulate bone marrow production of RBCs
Erythropoiesis Stimulating Agents
Tucker 49
Side Effects
epoetin alfa; darbapoetin alfa
Hypertension, thromboembolism, rash
Tucker 49
Nursing Considerations
epoetin alfa; darbapoetin alfa
Contraindicated when Hgb level >10 g/dL or with uncontrolled HTN
May require increased intake/supplement iron and/or folic acid
Tucker 49
Indications
epoetin alfa; darbapoetin alfa
anemia
Tucker 49
MOA/Class
Ferrous fumarate, ferrous sulfate (PO)
Iron dextran, ferrous gluconate, iron sucrose (IV or IM)
Required for RBC production
Supplement
Tucker 49
Side Effects
Ferrous fumarate, ferrous sulfate (PO)
Iron dextran, ferrous gluconate, iron sucrose (IV or IM)
Dark stool; constipation
Tucker 49
Nursing Considerations
Ferrous fumarate, ferrous sulfate (PO)
Iron dextran, ferrous gluconate, iron sucrose (IV or IM)
PO absorbed best with vitamin C; avoid giving with calcium products (causes decreased absorption)
Ingest PO liquid formulations with straw to prevent staining of teeth
Remain upright for 30 minutes after injection to prevent heartburn
IM given Z-track
Food sources: red meats, legumes, dark leafy green vegetables, whole-grain and enriched breads and cereals, beans
Tucker 49
Indications
Ferrous fumarate, ferrous sulfate (PO)
Iron dextran, ferrous gluconate, iron sucrose (IV or IM)
iron deficiency
Tucker 49
MOA/Class
atorvastatin, simvastatin, rosuvastatin
Decreased cholesterol production by the liver
HMG-Co-Enzyme A (HMG-CoA) Reductase Inhibitor (Statin)
Tucker 47
Side Effects
atorvastatin, simvastatin, rosuvastatin
Hepatotoxicity, myopathy/rhabdomyolysis, GI upset
Tucker 47
Nursing Considerations
atorvastatin, simvastatin, rosuvastatin
Avoid grapefruit juice
Monitor LFTs
May be most effective when taken at bedtime
Tucker 47
Indications
atorvastatin, simvastatin, rosuvastatin
Hypercholesterolemia
(may be part of stroke or MI prophyaxis regimen)
Tucker 47
MOA/Class
fenofibrate, gemfibrozil
Inhibits synthesis of triglycerides in the liver. Activates enzymes responsible for breaking down cholesterol.
Fibrate/Fibric acid derivative
Tucker 47
Side Effects
fenofibrate, gemfibrozil
GI upset, rash, increased PT, hepatotoxicity, myalgia/rhabdomyolysis
Tucker 47
Nursing Considerations
fenofibrate, gemfibrozil
May increase bleeding risk when used with anticoagulants
Tucker 47
Indications
fenofibrate, gemfibrozil
Hypercholesterolemia
Tucker 47
