Renal Flashcards
Anti-infective
Trimethoprim/nitrofurantoin
Nurse considerations- drink 2-3ltr water, administer with food to prevent GI upset, observe kidney bloods, monitor skin irritations, monitor for pulmonary reactions, rinse mouth after oral suspension as may stain teeth
Contraindications- impaired renal function
Education- continue course until finished, avoid milk products with meds as reduce absorption, drink 2-3ltr water, contact DR of develop chest pain, breathing difficulties, nitro turns urine brown
Diuretics
Increase rate of urine formation by reducing reabsorption of sodium, chloride and water by renal tubules, either interfering with active transport mechanism or altering tubular permeability
Classified by site of action-
*Carbonic anhydrase- acetazolamide (block enzyme carbonic anhydrase increasing excretion of bicarb, sodium and water)
Adverse effects- parasthesia, fatigue, headache, dizziness, anorexia, polyuria, fever, depression/excitement, abnormal liver function,
Interactions- potentiate effects of anticoagulant, risk of digoxin toxicity, use with salicylates results in metabolic acidosis, decrease lithium levels, increase duration of amphetamines, effects BGL’s
*High celling/loop- bumetanide, etacrynic, frusemide (limit amount of sodium reabsorbed in peritubular capillaries surrounding loop of henle 15-25%, calcium and magnesium also blocked). Used in HT
Adverse effects- electrolyte imbalance, hypovolaemia, urinary retention, deafness, anorexia, malaise, hypotension, muscle cramps
Interactions- lithium, enhances antihypertensive, increased digoxin toxicity, reduced by NSAIDS, caution in hearing impairment (removes fluid in ear canal), gout (crystal deposits), diabetes (polyuria)
*thiazide- chlortalidone, hydrochlorothiazide (interfere with sodium chloride reabsorption in distal tubules, increased excretion of potassium, magnesium and bicarb ions). Increase aldosterone. Act as antihypertensive.
Used in heart failure, liver failure, kidney failure
Adverse effects- hyperglycaemia, impaired glucose, affects lipid profile, can cause gout
*potassium sparing- epelerenone, spitonolactone (does not antagonise aldosterone so doesn’t need it to be effective, reduces sodium reabsorption and potassium excretion at end of distal tubule and collecting duct, mild antihypertensive action)
Used in HT, cirrhosis liver, swelling due to heart failure
Adverse effects- same as loop
Avoid foods high in potassium
*osmotic- glucose (affect proximal tubule and descending loop of henle and strong osmotic pressure in nephron prevents water reabsorption into peritubular capillaries)
Adverse effects- fever, thrombosis, flushing, precipitate Vit B deficiency, exacerbation of diabetes
Nursing points- monitor for dehydration, electrolyte imbalance, monitor hypoglycaemia, don’t administer with blood products
General nursing points- monitor FBC, daily wt, observe dehydration, monitor oedema, observe electrolyte imbalance
Sodium bicarbonate
Bolus 100mmol over 3-5min
Infusion- 150mmol in 1ltr glucose 5% or water (remove 150mls)
150mmol/ltr
0.15mmol/hr
Dose range 37.5-75mmol/hr
Furosemide
Loop diuretic
Inhibits reasorption of sodium and chloride in proximal and distal tubules in loop of henle
Side effects- hypokalaemia, hypomagnesia, metabolic alkalosis
Onset IV 5min peak 30min duration 2hrs
Metabolised by liver, excreted in kidneys
Nursing considerations- monitor hypotension, electrolytes,
