nurs 317 final extra Flashcards
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Prototype Summary: Spironolactone
Potassium-Sparing Diuretics
Indications: Primary hyperaldosteronism, adjunctive therapy in the treatment of edema associated with HF, nephrotic syndrome, hepatic cirrhosis; treatment of hypokalemia or prevention of hypokalemia in patients at high risk if hypokalemia occurs; essential hypertension.
Prototype Summary: Spironolactone-actions
Actions: Competitively blocks the effects of aldosterone in the renal tubule, causing loss of sodium and water and retention of potassium.
Prototype Summary: Spironolactone- contarindications
hyperkalemia, renal disease, or anuria, which could be exacerbated by the effects of these drugs. Routine use during pregnancy is not appropriate; these drugs should be reserved for situations in which the mother has pathological reasons for use, not pregnancy manifestations or complications, and only if the benefit to the mother clearly outweighs the risk to the fetus.
oxybutynin (Ditropan XL),
Urinary Tract Antispasmodics
oxybutynin (Ditropan XL),
Indications: Relief of symptoms of bladder instability associated with uninhibited neurogenic and reflex neurogenic bladder; treatment of signs and symptoms of overactive bladder.
oxybutynin (Ditropan XL),
Actions: Acts directly to relax smooth muscle in the bladder; inhibits the effects of acetylcholine at muscarinic receptors.
Pharmacokinetics:
oxybutynin (Ditropan XL)
Monitor the results of laboratory tests, such as urinalysis and urine culture and sensitivity, to evaluate the effectiveness if UTI is the problem, and renal and hepatic function tests to determine the need for possible dose adjustment and to evaluate for possible toxicity.
Assess urinary elimination pattern, including amount and frequency of episodes, and for any complaints of frequency, urgency, pain, or difficulty voiding to monitor for excessive parasympathetic blockade or development of underlying UTI
.Assess for contraindications or cautions: Any history of allergy to these drugs to prevent hypersensitivity reactions; pyloric or duodenal obstruction or other GI lesions or obstructions of the lower urinary tract (e.g., prostate hypertrophy), which could be dangerously exacerbated by these drugs and cause
gastrointestinal adverse reactions and/or urinary retention; glaucoma, which could increase intraocular pressure due to blockage of the parasympathetic nervous system; and current status of pregnancy or lactation, which would require cautious use.
dutasteride (Avodart)
Drugs for Treating Benign Prostatic Hyperplasia
Benign prostatic hyperplasia (BPH), also called benign prostatic hypertrophy or enlarged prostate, is a common problem in men, and it increases in incidence with age
Drugs for Treating Benign Prostatic Hyperplasia
Benign prostatic hyperplasia (BPH),
Focus on Herbal and Alternative Therapies
Saw palmetto is an herbal therapy that has been used successfully for the relief of symptoms associated with BPH. Patients with BPH should be cautioned not to combine saw palmetto with finasteride because serious toxicity can occur.
phenazopyridine
OTHER DRUGS USED THAT AFFECT THE URINARY TRACT AND BLADDER
Urinary Tract Analgesic:(burning, urgency, frequency, pain, discomfort)
phenazopyridine & cipro
Clinically Important Drug–Drug Interactions
The risk of toxic effects of this drug increases if it is combined with antibacterial agents used for treating UTIs. If this combination is used, the phenazopyridine should not be used for longer than 2 days.
phenazopyridine- adverse
Adverse Effects
Adverse effects associated with this drug include GI upset, headache, rash, and a reddish-orange coloring of the urine, and staining of contact lenses
antithyroid drug for pregnancy
PTU is the drug of choice because it is less likely to cross the placenta and cause problems for the fetus.
Bisphosphonates should be used during pregnancy only if the benefit
Antithyroid Agents
indications: PTU
Thioamides lower thyroid hormone levels by preventing the formation of thyroid hormone in the thyroid cells, which lowers the serum levels of thyroid hormone. They also partially inhibit the conversion of T4 to T3 at the cellular level. These drugs are indicated for the treatment of hyperthyroidism. Thioamides include propylthiouracil (PTU) and methimazole (Tapazole).
menopause S&S
Menopause is associated with loss of many of the effects of these two hormones on the body, including retention of calcium in the bones,
lowered serum lipid levels,
and maintenance of secondary sex characteristics. As estrogen leaves the blood vessels, many women experience “hot flashes” or vasospasm. Drying vaginal tissue can lead to painful intercourse and more frequent urinary tract infections (UTIs).
HRT containg progesterone
Wild yam: 1 to 6 g/d PO; contains progesterone—do not use with HRT; may cause increased blood glucose and other toxic effects; do not combine with disulfiram or metronidazole—severe reaction may occur
herb caution for estrogen and progesterone
False unicorn root: 1 to 2 mL PO three times a day; do not use with estrogen or progestins—may alter uterine effects
progesterone - Vaginal gel adverse
use is associated with headache, nervousness, constipation, breast enlargement, and perineal pain.
progesterone intrauterine systems
are associated with abdominal pain, intensifying endometriosis symptoms, abortion, PID, and expulsion of the intrauterine device.
ranitidine (Zantac)- OTC
Histamine-2 Antagonists
H2 antagonists
block the release of hydrochloric acid in response to gastrin ,inhibiting gastric acid secretion and reducing total pepsin output.
cimetidine (Tagamet HB) dosage
H2 antagonists
300mg qid (with meals)or 800mg at bedtime
ranitidine - H2 antagonist adverse
-diarrhea or constipation;
-CNS effects of dizziness, headache, somnolence, confusion, or even hallucinations (thought to be related to possible H2 receptor effects in the CNS);
- cardiac arrhythmias and hypotension (related to H2 cardiac receptor blocking, more commonly seen with IV or IM administration or with prolonged use);
- gynecomastia (more common with long-term use of cimetidine) and impotence.
suppression of hydrochloric acid
Proton Pump Inhibitors
- suppress the secretion of hydrochloric acid into the lumen of the stomach
high potassium foods
Potassium-Rich Foods
Dried fruits (raisins, apricots)
Beans, lentils
Potatoes
Winter squash (acorn, butternut)
Spinach, broccoli
Beet greens
Avocado
Bananas
Cantaloupe
Oranges, orange juice
Coconut water
Tomatoes
Dairy and plant milks (soy, almond)
Yogurt
Cashews, almonds
Chicken
Salmon
Potassium-Sparing Diuretics - not powerful but retain k+
amiloride (Midamor),
eplerenone (Inspra),
spironolactone (Aldactone),
triamterene (Dyrenium)
Carbonic Anhydrase Inhibitors
Are relatively mild diuretics.
Available agents include acetazolamide (Diamox),
dichlorphenamide (Keveyis),
methazolamide (generic)
Carbonic Anhydrase Inhibitors
Clinically Important Drug–Drug Interactions
There may be an increased excretion of salicylates and lithium
Loop Diuretics
they work in the loop of Henle. Loop diuretics are also referred to as high-ceiling diuretics because they cause a greater degree of diuresis than other diuretics.
Loop Diuretics
ethacrynic acid (Edecrin),
the first loop diuretic introduced,
bumetanide (generic),
furosemide (Lasix),
torsemide (Demadex)
Loop Diuretics
furosemide (Lasix)
treatment of acute HF, acute pulmonary edema, edema associated with HF or with renal or liver disease, and hypertension.
Loop Diuretics
furosemide (Lasix)
Evaluation
Evaluate drug effects: urinary output, weight changes, status of edema, blood pressure changes.
Monitor for adverse effects: hypotension, hypokalemia, hyperkalemia, hypocalcemia, hypercalcemia, hyperglycemia, increased uric acid levels.
Alpha1-selective adrenergic blocking agents
are drugs that have a specific affinity for alpha1-receptors. These drugs include alfuzosin (Uroxatral), doxazosin (Cardura), prazosin (Minipress), silodosin (Rapaflo), tamsulosin (Flomax), and terazosin (generic)
Alpha1-selective adrenergic blocking agents
terazosin: 1-5 mg/day at bedtime
BPH: 10mg/day
Alpha1-selective adrenergic blocking agents
This causes a decrease in vascular tone and vasodilation, which leads to a fall in blood pressure. Because these drugs do not block the presynaptic alpha2-receptor sites, the reflex tachycardia that accompanies a fall in blood pressure does not occur. They also block smooth muscle receptors in the prostate, prostatic capsule, prostatic urethra, and urinary bladder neck, which leads to a relaxation of the bladder and prostate and improved flow of urine in male patients with benign prostatic hyperplasia (BPH).
(pyelonephritis)
Blockage anywhere in the urinary tract can lead to backflow problems and the spread of bladder infections into the kidney
cystitis
Females, with shorter urethras, are particularly vulnerable to repeated urinary tract, bladder, and even kidney infections. Children may also have frequent urinary tract problems. Patients with indwelling catheters or intermittent catheterizations often develop bladder infections or cystitis
Correlation between Hemoglobin A1C Level and Mean Plasma Glucose Levels
Hemoglobin A1C (%) Mean Plasma Glucose
In mg/dL In mmol/L
6 126 (100–152)
7.0 (5.5–8.5)
7 154 (123–185)
8.6 (6.8–10.3)
8 183 (147–217)
10.2 (8.1–12.1)
9 212 (170–249)
11.8 (9.4–13.9)
10 240 (193–282)
13.4 (10.7–15.7)
11 269 (217–314)
14.9 (12.0–17.5)
12 298 (240–347)
16.5 (13.3–19.3)
Adapted from American Diabetes Association. (2018). Glycemic targets: Standards of medical care in diabetes—2018. Diabetes Care 48 (Suppl 1), S55–S64.
Chronic Bacterial Prostatitis
Long-term therapy (3 to 4 months) with a low-dose oral antimicrobial agent is often used for treatment.38 Transurethral resection of the prostrate (TURP) has been used to treat males with refractory disease.
Diverticulosis
This suggests that factors such as lack of fiber in the diet, a decrease in physical activity, and poor bowel habits, along with the effects of aging, contribute to the development of the disease.
Types of Glomerular Disease
The clinical manifestations of glomerular disorders generally fall into one of five categories:
Nephritic syndromes
Rapidly progressive glomerulonephritis
The nephrotic syndrome
Asymptomatic disorders of urinary sediment (i.e., -hematuria, prote inuria)
Chronic glomerulonephritis5
Nephritic syndromes: hallmark- edema
is characterized by massive proteinuria (>3.5 g/day) and lipiduria (e.g., free fat, oval bodies, fatty casts) along with an associated hypoalbuminemia (<3 g/dL), generalized edema, and hyperlipidemia (cholesterol > 300 mg/dL).
Acute pyelonephritis upper UTI
represents an infection of the renal parenchyma and renal pelvis. Improperly treated, it can lead to sepsis, renal abscesses, chronic pyelonephritis, and chronic renal failure.
nonpituitary ACTH-secreting tumor.
Cushing syndrome can also result from long-term therapy with one of the potent pharmacologic preparations of glucocorticoids; this form is called iatrogenic Cushing syndrome.1
liver inflammation
The key enzymes are alanine aminotransferase (ALT) and aspartate aminotransferase (AST), which are present in liver cells. ALT is a more specific indicator
portal hypertension- complications
Complications of portal hypertension arise from the increased pressure and dilation of the venous channels behind the obstruction. In addition, collateral channels that connect the portal circulation with the systemic circulation open. The major complications of the increased portal vein pressure and the opening of collateral channels are ascites, splenomegaly, hepatic encephalopathy, and the formation of portosystemic shunts with bleeding from esophageal varices
Thyroid storm, or thyrotoxic crisis
manifestations:
is manifested by a very high fever, extreme cardiovascular effects (i.e., tachycardia, congestive failure, and angina), and severe CNS effects (i.e., agitation, restlessness, and delirium). The mortality rate is high
Buclizine- antihistamine and antiemetic drug
for the treatment of allergy symptoms and prevention of nausea and vomiting
Primary Adrenal Cortical Insufficiency
Addison disease- life long drug therapy
Fludrocortisone mineralocorticoid
corticosteroid Hydrocortisone
Glucocorticoid Hormone Excess
Cushing Syndrome-hypercortisolism
surgery, irradiation, or pharmacologic treatment is determined largely by the cause of the hypercortisolism
CRH stimulation test, high-dose dexamethasone suppression test, radiologic imaging of the pituitary and adrenal glands, and petrosal sinus sampling.
Chronic disease
GFR of less than 60 mL/min/1.73 m2 for 3 months or more
kidney failure
GFR of less than 15 mL/min/1.73 m2, usually accompanied by most of the signs and symptoms of uremia, or a need to start renal replacement therapy.
Ondansetron
antiemetic medication that prevents and treats nausea and vomiting. It’s used to treat nausea caused by chemotherapy, radiation, surgery, migraines, or gastroenteritis.
Mumps complications
Primary hypogonadism
Encephalitis
Infections—mumps orchitis (gonadal failure is a much more common manifestation when mumps occurs after puberty
The prodromal phase of viral hepatitis
a stage before jaundice appears is characterized by nonspecific symptoms like fatigue, malaise, loss of appetite, nausea, vomiting, and sometimes fever or joint pain.
