Renal/GU/F&E Drugs Flashcards
Oxybutynin class
antispasmodics/anticholinergics
Oxybutynin MoA
relax smooth muscle bladder; inhibits effects of acetylcholine (blocks PNS)
Oxybutynin indications
bladder spasm, overactive bladder
Oxybutynin route/dose
oral
Oxybutynin contraindications
GI obstruction, obstructive urinary tract problems (BPH), myasthenia gravis
Oxybutynin drug/drug
MANY; check drug reference before admin
Oxybutynin AE
related to blocking PNS; drowsiness, dizziness, blurred vision, tachycardia, dry mouth, nausea, urinary hesitancy, constipation, decreased sweating
Oxybutynin nursing considerations
assess urinary patterns, AE
renal functions
maintenance of volume and composition of body fluids (sodium regulation), blood pressure control (RAAS), regulation of red blood cell production (erythropoietin), regulation acid-base, electrolyte stability
diuretics general overview
MoA: act on kidneys to increase urine output
Indications: HTN, fluid overload/edema (HF, pulmonary edema, kidney/liver failure), glaucoma (decrease intra-occular pressure) hyper-kalemia (remove excess K)
diuretics general AE
GI effects: n/v/d
hypotension
dehydration (fluid volume deficit)
fluid and electrolyte disturbances- sodium and potassium
fluid rebound
fluid rebound
occurs with patients on diuretics do not take in adequate water (decrease fluid intake to decrease trips to the bathroom)
results in concentrated plasma of smaller volume
decreases volume is sensed by nephrons, which activates RAAs cycle
concentrated blood is sensed by osmotic center in brain, ADH is released to hold water and dilute the blood
results in rebound edema as fluid is retained
diuretics general contraindications
pregnancy/lactation, severe renal failure, hypotension, dehydration, drug-drug: Digoxin (increased potassium loss), Anticoags, anti-diabetic drugs (reduced effectiveness) and lithium (increased risk of toxicity)
Hydrochlorothiazide (HCTZ) class
thiazide diuretics
Hydrochlorothiazide (HCTZ) MoA
inhibits reabsorption of NaCl in distal tubule kidneys; remains in tubule for excretion (water follows Na)
Hydrochlorothiazide (HCTZ) indications
first line treatment for HTN
Hydrochlorothiazide (HCTZ) route/dose
oral
Hydrochlorothiazide (HCTZ) contraindications
allergy to sulfa drugs
Hydrochlorothiazide (HCTZ) AE
see general and photosensitivity
Hydrochlorothiazide (HCTZ) Nursing considerations
see general; use sunscreen
Furosemide (Lasix) class
loop diuretics
Furosemide (Lasix) MoA
inhibits reabsorption of NaCl in loop of Henle which causes a greater degree of diuresis than other diuretics (water follows Na)
Furosemide (Lasix) indications
conditions of fluid overload; hyperkalemia
Furosemide (Lasix) route/dose
oral, IVP (slow 20mg/min); may be given IM or as IV gtts
Furosemide (Lasix) contraindications
see general; ototoxic drugs; sulfa allergy
Furosemide (Lasix) AE
see general; hypokalemia; CNS effects: paresthesia, ototoxicity (IVP slowly)
Furosemide (Lasix) Nursing considerations
see general; potassium supplements; IV fall risk
Spironolactone class
Potassium sparing diuretic
Spironolactone MoA
aldosterone antagonist; blocks action of aldosterone in the distal tubule; loss of Na and retention of K
Spironolactone Indications
conditions of fluid overload (CHF and liver disease)
Spironolactone route/dose
oral
Spironolactone contraindications
see general
Spironolactone AE
hyperkalemia (weakness, cardiac arrhythmias, n/v/d); photosensitivity; androgen effects; impotence, hirsutism, irregular menses, gynecomastia
Spironolactone nursing considerations
see general: exceptions: monitor for high K, teach to avoid high K foods, use sunscreen
Mannitol class
osmotic diuretics
Mannitol MoA
increases osmolarity of glomerular filtrate (sugar molecule); inhibits reabsorption of water and electrolytes and increases urinary output; profound and rapid diuresis
Mannitol indications
reduce intracranial pressure of cerebral edema
Mannitol route/dose
IV only
Mannitol contraindications
can worsen edema; used with caution; pulm. edema, renal failure, CHF, stroke… exacerbated by the large shifts in fluid
Mannitol AE
hypovolemia (hypotension, light headedness, confusion, headache, electrolyte imbalance… cardiac decompensation and shock)
Mannitol nursing considerations
see general; monitor VS closely
Nursing assess and monitor
H&P: allergies, contraindications, kidney function
VS (hypotension=poor perfusion); rapid weight gain or loss (fluid balance)
I&O fluid overload and dehydration
Labs: decreased potassium (except K sparing), decreased sodium
nursing teaching
weigh daily on same scale, clothes, and time of day, monitor BP, take potassium supplements or avoid potassium as ordered, maintain fluid intake to prevent fluid rebound or dehydration, teach s/s of fluid loss and aggravating factors (d/v/excessive heat and sweating), take diuretics in AM, change positions slowly, AE and when to notify PCP
Compartments of Fluid in the Body
Continuous exchange across SPM;
intracellular: 70%
extracellular: 30%
- intravascular
- interstitial fluids
osmolarity
measure of solute concentration “pulling power”
solutes that determine osmolarity: sodium, glucose, urea
275-295 mOsm/kg
tonicity
ability of solution to cause change in water movement across membrane due to osmosis
reference point
plasma is isotonic- remains in intravascular space
isotonic
same concentration of particles as plasma
stays in intravascular space
hypertonic
greater concentration than plasma
water will move out of cells into solution (shrink)
hypotonic
lesser concentration than plasma
fluid moves from extracellular compartments into cells (swell)
H&H for fluid imbalance
increase: fluid volume deficit
decrease: fluid overload- massive blood loss
BUN for fluid imbalance (8-20 mg/dL)
increase: dehydration or impaired renal function
decrease: fluid overload
creatinine (0.6-1.2 mg/dL)
increase: renal failure
specific gravity (1.010-1.025)
increase: dehydration
decrease: fluid overload
infusions increase total fluid volume but…
compartment most expanded depends on solute (sodium) concentration
Isotonic: Normal Saline 0.9% NaCl
Hypertonic: 10% dextrose (D10W); 3% NaCl
Hypotonic: 0.45% NaCl (1/2 strength saline)
Isotonic IV Fluids
expands vascular fluid volume with no shifts in compartments
Isotonic IV Fluids uses
isotonic fluid volume deficient (hydration)
expands volume ECF to correct hypotension
Isotonic IV Fluids AE
fluid overload
Isotonic IV Fluids examples
Normal Saline 0.9% NaCl
Lactated Ringers (LR)
5% dextrose in water (D5W)
hypertonic IV fluids
expands plasma volume by drawing water away from cells and tissues
hypertonic IV fluids uses
hyponatremia
cerebral edema
hypertonic IV fluids AE
excessive expansions of intravascular compartment (plasma); fluid overload and hypertension
hypertonic IV fluids examples
3% normal saline
10% dextrose in water (or any greater than 10%)
D5W in 0.9% NaCl
D5W in 0.45% NaCl (the dextrose is rapidly metabolized and fluid becomes hypotonic)
hypotonic IV fluids
water moves out of vascular space to cells (ICF)
hypotonic IV fluids uses
hypernatremia and cellular dehydration
hypotonic IV fluids AE
depletion of intravascular compartment and consequential hypotension
too much expansion of intracellular compartment (peripheral edema)
hypotonic IV fluids example
0.45% NaCl (1/2NS)
IV Colloids
molecules too large to easily cross capillary membrane; stay in intravascular space &rapidly expand plasma volume; draw water from intracellular fluid and interstitial spaces into plasma; increase osmotic pressure
IV Colloids examples
5% albumin (trauma blood loss, ascites cirrhosis of liver)
dextran 40 in NS
dextran 40 in D5W
Sodium reference range
135-145 mEq/L
Potassium reference range
3.5-5.5 mEq/L
Calcium reference range
8.5-10.5 mg/dL
Magnesium reference range
1.5-2.5 mEq/L
Chloride reference range
97-107 mEq/L
Bicarbonate reference range
25-29 mEq/L
Phosphate reference range
1.8-2.6 mEq/L
Potassium chloride class
electrolyte replacement
Potassium chloride MoA
transmission of nerve impulses, cardiac contraction, renal function, intracellular ion maintenance
Potassium chloride indication
prevention and treatment of hypokalemia
Potassium chloride route
PO, IV
Potassium chloride AE
hyperkalemia, n/v/d, GI cramping, bradycardia, cardiac arrest
Potassium chloride nursing considerations
utilize electrolyte replacement protocol: oral admin preferred; follow dosing and lab draw times
throughout admin monitor for: cardiac abnormalities and vein phlebitis
teach patient: increase intake of high K= foods, do not break, crush, or chew ER caps or enteric capsules; report burning sensation at IV site
Potassium Administration Oral
do not break, crush, or chew ER caps or enteric capsules. With or after meals with full glass of water. Dissolve effervescent tabs in 8 oz cold water
Potassium Administration IV infusion
central line preferred- caustic to veins
admin rate- 10mEq/hour
Monitor IV site- phlebitis
Do not admin SQ or IM
Sodium polystyrene sulfonate (Kayexalate) class
potassium exchange resin
Sodium polystyrene sulfonate (Kayexalate) MoA
increases potassium excretion in intestines (exchange for sodium)
Sodium polystyrene sulfonate (Kayexalate) indication
hyperkalemia
Sodium polystyrene sulfonate (Kayexalate) route
oral or enema
Sodium polystyrene sulfonate (Kayexalate) contraindications
abnormal bowel function; constipation
Sodium polystyrene sulfonate (Kayexalate) Warning
GI bleeding, ischemic colitis, bowel perforation
Sodium polystyrene sulfonate (Kayexalate) AE
hypernatremia, hyperkalemia, n/v
Sodium polystyrene sulfonate (Kayexalate) nursing considerations
monitor electrolytes closely
Nursing Considerations for Fluid and Electrolytes
H&P
Monitor: fluid volume; HR, BP, heart , lungs
fluid intake and output (urine 30mL/hr)
daily weights (gain and loss)
laboratory studies