Meds Flashcards
Phenazopyridine (Pyridium), UTA
Action
Local effect on urinary tract mucosa-relief of symptoms related to urinary tract irritation from infection, trauma, or surgery
Relieves pain, burning sensation, frequency, urgency
What are the Side Effects of Pyridium?
GI upset
Red-orange urine; UTA turns urine blue
Blood dyscrasia
Nephrotoxicity, hepatotoxicity-metabolized in the liver, excreted in the kidney
Bethanechol (Urecholine)
Treats hypotonic bladder
What is the Action of Bethanechol?
Increases bladder tone of detrusor muscle
When is Bethanechol contraindicated?
Peptic ulcer
Side effects of Bethanechol?
GI distress, dizziness, fainting
Examples of Alpha Adreenergic Blockers?
Uroxatral (alfuzosin)
Cardura (doxazosin)
Flomax (tamsulosin)
Hytrin (terazosin)
Oxybutynin/Ditropan, Hyoscyamine/Cytospaz, Tolterodine tartrate/Detrol, Flavoxate/Urispas, VESIcare (solifernacin)
Action-anticholinergic
Direct action on smooth muscles to relieve spasms by relaxing smooth muscles of the urinary tract-decrease bladder muscle spasms
Used to manage disorders of lower urinary tract associated with hypermobility “gotta go, gotta go”-dysuria, urgency, nocturia, suprapubic pain, frequency, and incontinence
What are the SE of antispasmotics?
Drowsiness, tachycardia, dizziness, fainting, blurred vision,dry mouth, constipation
What should you do for antispasmotics?
Administer 1 hour before antacids
What is the Pharmocokinetics fo antispasmotics?
Side effects/adverse reactions
Drowsiness, tachycardia, dizziness, fainting, blurred vision,dry mouth, constipation
Administer 1 hour before antacids
Pharmacokinetics
Rapidly absorbed and widely distributed
Metabolized in the liver and excreted in the urine
Contraindicated in narrow-angle glaucoma, obstructive breathing problems, severe Ulcerative colitis, and myasthenia gravis, hypersensitivity to anticholinergics
Caution-cardiac, renal, hepatic, prostate problems
For antispasmotics what should I monitor?
CNS manifestations
Monitor I&O
Education-drowsiness and blurred vision
Use hard candy for dry mouth
Tolterodine tartrate (Detrol)
Control overactive bladder
SE of Detrol?
Drowsiness, tachycardia, dizziness, fainting, blurred vision, dry mouth, constipation
What should be cautioned for Detrol?
To be avoided if client has narrow-angle glaucoma or cardiac, renal, hepatic, prostate problems
Loop Diuretics
Increase the amount of urine excreted, inhibit electrolyte reabsorption in loop of Henle, thereby promoting excretion of Na, H2O, Cl, and K
Thiazide Diuretics
Increase urinary excretion of Na and H2O by inhibiting Na reabsorption in cortical diluting tubule
Potassium-sparing Diuretics
act on distal convoluted tubule to increase Na excretion and decrease K excretion
Osmotic Diuretics
Increase osmotic pressure of Glomerular Filtrate in proximal tubule and loop of Henle inhibiting reabsorption of H2O and electrolytes
Bumex/Bumetanide, Lasix/Furosemide, Demadex/Torsemide
LOOP DIURETICS
Antihypertensive action-renal vasodilation: provides increase GFR and decrease in peripheral vascular resistance
More potent than thiazide diuretics-cause rapid diuresis resulting in decreased vascular fluid volume, decreased cardiac output, and decreased BP
Need to be taken early to avoid nocturia
IV doses need to be given SLOWLY to avoid hypotension and ototoxicity (hearing loss)
Lasix should be given slowly IV. Why?
Avoid hearing loss?
Why should Lasix be given early?
Avoid nocturia.
Loop diuretics with Aminoglycosides can cause?
Ototoxicity
Loop Diuretics with digoxin?
Arrhythiams
NSAIDS, LITHIUM, AND Salycylates may do what to loop diuretics?
Decrease the effectiveness.
Loop diuretics with sulfonyureas may?
May cause hypoglycemia
What should you monitor for loop diuretics?
Monitor electrolytes, especially Na & K Monitor H & H-hemoconcentration BUN, Cr, and LFT Glucose Lithium levels Monitor VS-BP & P, Weight, I&O Assess for dehydration
What should you educate regarding loop diuretics?
EDUCATE Patient to eat food rich in K, Weigh daily, Avoid orthostatic hypotension, report ringing in the ears
Thiazide Diuretics
Hypotensive effect may be due to direct arteriolar vasodilation and decreased peripheral resistance-used for edema and HTN
Not effective for immediate diuresis
Hydrochlorothiazide/HCTZ/Hydrodiuril, Lozol/Indapamide, Zaroxylin/Metolazone, Polythiazide/Minizide
What would happen if you combine Thiazide Diuretics with lithium?
Lithium-if used concomitant, will increase lithium levels
What do you look for if Thiazide Diuretics are with sulfonylureas and insulin?
Increase potential for hypoglycemia
What does NSAIDS do to thiazide diuretics?
Decrease
What happens when you add loop and thiazide diuretics?
Increases
What should you monitor when given thiazide diuretics?
VS, I&O, Weight
What are the SE of Thiazide Diuretics?
Dehydration, N/V, orthostatic hypotension, diarrhea, constipation
Potassium-sparing Diuretics
Act on distal convoluted tubule to increase Na excretion and increase K secretion
Used for HTN and edema associated with heart failure
Amiloride hydrochloride, Spironalactone/Aldactone, Triamterene/Dyrenium
What are the drug interecation of pottasium sparing diuretics?
Potentiate effect of hypertensive medications
Increased risk of hyperkalemia
Reduced effect of Digoxin when used with Amiloride
Aspirin may slightly decrease effect
Food increases absorption
What should you look for in Pottasium Sparing DIuretics?
Monitor VS, I&O D/C K supplements Do not use with salt substitutes Monitor serum electrolytes May take 3 days to achieve maximum effect of diuresis
What are the SE of Pottasium Sparing Diuretics?
CNS
GI
Impotence, muscle cramps, gynecomastia and breast tenderness
Hyperkalemia (containdicated with K> 5.5
Osmotic Diuretics
Increase osmotic pressure of Glomerular filtrate inhibiting reabsorption of H2O and electrolytes
Used to prevent and manage ARF and oliguria
Used to decrease intracranial pressure
Mannitol-used with Chemo to induce diuresis
Mannitol/Osmitrol, Urea/Ureaphil
What Drug Interactions do you look for in Osmotic Diuretics?
Decrease serum Lithium levels
with Cardiac Glycosides, may cause Digitalis toxicity
Increased effects with other diuretics
What implications should you look for when given osmotic diuretics?
Monitor electrolytes
Strict I&O, daily weights
Maintain hydration
Monitor lung and heart sounds for pulmonary edema
What are the SE of Osmotic Diuretics?
Headache, syncope, hypotension
Dry mouth, N/V, urinary retention, electrolyte imbalance
What are the AE of Osmotic DIuretics?
Adverse effects: seizures, thrombophlebitis, CHF, CV collapse
What are ACE inhibitors?
Angiotensin Converting Enzyme inhibitors: inhibit the renin-angiotensin-aldosterone mechanism by blocking conversion of angiotensin I to angiotensin II and prevent vasoconstriction
Used to treat HTN
Used to prevent kidney failure in patients with diabetes
What is ACE inhibitors?
Angiotensin Converting Enzyme inhibitors: inhibit the renin-angiotensin-aldosterone mechanism by blocking conversion of angiotensin I to angiotensin II and prevent vasoconstriction
Used to treat HTN
Used to prevent kidney failure in patients with diabetes
Ace Inhibitors are effective to white’s how?
Are effective ALONE in Caucasians, but require adjunct diuretic in African Americans
Common ACE end it what?
Pril
What happens if Pottasium and ACE inhibitors are taken together?
May cause Hyperkalemia
Should you take ACE inhibitors with pregnancy?
HELL NO. DISCONTINUE
What will happen if you take ACE inhibitors with Digoxin?
May increase Digoxin concentration
Antacids do what to Ace Inhibitors?
Decrease Absorption
Foods high in fat may do what do Ace Inhibitors?
Impair Drug Absorption
What are SE of Ace Inhibitors?
Dry, hacking cough
May increase BUN and Cr, LFT, bilirubin, uric acid and blood glucose
Headache, dizziness, fatigue, hypotension
What is the Adverse effect of angioedema?
angioedema
What should you do for ACE inhibtors.
Monitor labs
Administer 1 hour BEFORE meals to increase absorption
DO NOT GIVE to pregnant or lactating women
Take BP before giving and check periodically
Labs
Education
Hematopoietic Growth Factor
Used to stimulate RBC production
Reverses anemia associated with Chronic Renal/Kidney Disease
Epoetin alfa/Epogen/Procrit subQ or IV 3 times weekly
SE: HTN, headache, iron deficiency, sweating
May cause bone pain, arthralgias
Monitor CBC, BUN, Cr, phosphorus, and K
What is dopamine used for regarding renal failure?
Dopamine-restore and maintain renal perfusion and eliminate drugs that are directly nephrotoxic
Must assess IV site frequently for extravasation
Increase urine flow
Dopamine/Intropin-dosage to increase renal perfusion 2-5 mcg/kg/min increase to 50mcg/kg/min to increase BP
What medications do you use to prevent rejection?
Cyclosporine/Neoral Azathioprine/Imuran Muromonab-CD3 Anti-rejection medications following renal transplant—lifelong treatment Immunosuppressant N/V
