Renal meds Flashcards
Hydrochlorothiazide (Hydrodiuril)
Thiazide diuretic -> Acts on the early distal tubule -> increasing excretion of sodium, water, chloride, and potassium
USES:
Edema, hypertension, diuresis, HF; idiopathic lower extremity edema therapy
Contact prescriber immediately if muscle cramps, weakness, nausea, dizziness, or numbness occurs; rash
spironolactone (Aldactone)
Potassium-sparing -> acts on late distal tubule -> in excretion of sodium chloride, water, retention of potassium, phosphate
USES:
Edema of HF, hypertension, diuretic-induced hypokalemia, primary hyperaldosteronism (diagnosis, short-term treatment, long-term treatment), edema of nephrotic syndrome, cirrhosis of the liver with ascites
Watch:
Hypokalemia: assess for polyuria, polydipsia (excessive thirst), dysrhythmias including a U wave, depressed T wave on ECG
• Hyperkalemia: assess for weakness, fatigue, dyspnea, dysrhythmias, confusion, peak T wave.
Furosemide (Lasix)
Loop diuretic -> Acts on thick ascending limb of Henle’s loop -> inhibiting reabsorption of sodium and chloride & causing excretion of sodium, calcium, magnesium, chloride, water, and some potassium
Watch:
Ototoxicity: Assess patient for tinnitus, hearing loss, ear pain
Hypokalemia: assess for polyuria, polydipsia (excessive thirst), dysrhythmias including a U wave, depressed T wave on ECG
Orthostatic hypotension can occur rapidly
Captopril
Angiotensin-converting enzyme (ACE) inhibitor -> Selectively suppresses renin-angiotensin-aldosterone system; inhibits ACE; prevents conversion of angiotensin I to angiotensin II
Therapeutic outcome:
Decreased B/P in hypertension; decreased preload, afterload in HF
NO pregnancy
Watch: decreased platelets, orthostatic hypotension, syncope, allergic reactions (angioedema - difficulty breathing/swallowing)
EPINEPHrine
ACTION:
β1- and β2-agonist causing increased levels of cyclic AMP producing bronchodilatation, cardiac and CNS stimulation; large doses cause vasoconstriction via α-receptors; small doses can cause vasodilation via β2-vascular receptors
USES:
Acute asthmatic attacks, hemostasis, bronchospasm, anaphylaxis, allergic reactions, cardiac arrest, adjunct in anesthesia, shock
Diphenhydramine (Benadryl)
ACTION:
Acts on blood vessels, GI, respiratory system by competing with histamine for H1-receptor site; decreases allergic response by blocking histamine
Therapeutic outcome:
Absence of allergy symptoms and rhinitis, decreased dystonic symptoms, absence of motion sickness, absence of cough, ability to sleep
Teach patient product should be discontinued 4 days prior to skin allergy tests (cause false-positive result)
methylPREDNISolone
Corticosteroid
ACTION:
Decreases inflammation by suppression of migration of polymorphonuclear leukocytes, fibroblasts; reverses increased capillary permeability and lysosomal stabilization
Therapeutic outcome: Decreased inflammation
USES:
Severe inflammation, shock, adrenal insufficiency, collagen disorders, management of acute spinal cord injury, multiple sclerosis
Albuterol
Bronchodilator, Adrenergic β2-agonist
ACTION:
Causes bronchodilation by action on β2 (pulmonary) receptors by increasing levels of cyclic AMP, which relaxes smooth muscle; produces bronchodilatation; CNS, cardiac stimulation, increased diuresis, and increased gastric acid secretion; longer acting than isoproterenol
Therapeutic outcome: Increased ability to breathe because of bronchodilation
USES:
Prevention of exercise-induced asthma, acute bronchospasm, bronchitis, emphysema, bronchiectasis, reversible airway obstruction
Aluminum, Magnesium with simethicone (Mylanta)
Antacid - neutralizes acid, quick relief, short duration
NO renal failure pt
Take 2hrs before another oral med
Take 1-3 hrs after meal & before bedtime
Shake well before use - liquid form is better
Decreased absorption: digoxin, tetracycline, aspirin, iron, Propranolol (Inderal) - beta blocker to Decrease B/P, heart rate
mycophenolate (Cellcept)
Immunosuppressant
ACTION:
Inhibits inflammatory responses that are mediated by the immune system - suppress Tcells, Bcells => pt not supposed to have fever & increased BP (fluid retention)
USES:
Organ transplants to prevent rejection (renal); prophylaxis of rejection in allogenic cardiac, hepatic, renal transplants
Polyethylene glycol (GoLytely)
Act thru osmotic effect -> retaining water in colon and produces a watery stool.
to clean the colon before a colonoscopy or barium enema X-ray examination.
Neomycin
Antibiotic
Works by stopping the growth of bacteria in the intestines.
Neomycin may also be used along with a special diet to treat a certain serious brain problem (hepatic encephalopathy)
Calci-Chew
prevent or treat low blood calcium levels
treat conditions caused by low calcium levels such as bone loss (osteoporosis), weak bones (osteomalacia/rickets), decreased activity of the parathyroid gland (hypoparathyroidism), and certain muscle disease (latent tetany)
Lanthanum carbonate (Fosrenol)
Aluminum-free, calcium-free phosphate binder -> bind to dietary phosphorus in GI tract -> lower phosphorus level thru stools
Calcium salts (Tums)
Antacids, calcium supplement
ACTION:
Neutralizes gastric acidity
Assess for milk-alkali syndrome (due to hypercal): nausea, vomiting, disorientation, headache
Diphenoxylate w/ Atropine (Lomotil)
Antidiarrheal
Diphenoxylate is similar to opioid pain relievers, but it acts mainly to slow the gut. Atropine belongs to a class of drugs known as anticholinergics, which help to dry up body fluids and also slow gut movement
NO treating diarrhea w/ C.diff, kid <6 yo
Propantheline bromide (Pro-Banthine) discontinued in US
Anticholinergics (antispasmatics)
Function: inhibits gastric acid secretion in large doses
NO pt w/ glaucoma, prostate hypertrophy, paralytic ileus, hiatal hernia, GERD
Loperamide (Imodium)
Antidiarrheal
ACTION:
Direct action on intestinal muscles to decrease GI peristalsis; reduces volume, increases bulk; electrolytes are not lost
USES:
Diarrhea (cause undetermined), chronic diarrhea, to decrease amount of ileostomy discharge, traveler’s diarrhea
Do not break, crush, or chew caps
NO infectious diarrhea
Peri-Colace (sennoside & docusate combo)
Treat constipation
Sennosides are known as stimulant laxatives -> keeping water in the intestines -> cause movement of the intestines.
Docusate is known as a stool softener. -> increase the amount of water in the stool -> softer and easier to pass
Dopamine
low doses causes renal and mesenteric vasodilatation -> increase BP & cardiac output (.22mcg)
high dose kills kidney (50mg)
Antidote: Phentolamine (Regitine)
inFLIXimab (Remicade)
ACTION:
Monoclonal antibody that neutralizes the activity of tumor necrosis factor α (TNFα) that has been found in Crohn’s disease; decreased infiltration of inflammatory cells
Therapeutic outcome: Decreased cramping and blood in stools -> control bowel movement
USES:
Crohn’s disease, fistulizing, moderate to severe; rheumatoid arthritis given with methotrexate, plaque psoriasis, ankylosing spondylitis, ulcerative colitis, psoriatic arthritis, psoriasis
tamsulosin (Flomax)
α-adrenergic blocker
ACTION: decrease smooth muscle tone of prostate gland & bladder neck, increase urine flow, not affecting libido
USES:
Symptoms of BPH, renal stones
Watch: hypotension, dizziness, postural hypotension
Finasteride (Proscar)
5α-Reductase inhibitor
Inhibits conversion of testosterone to dihydrotestosterone (DHT) -> decreased amounts of DHT => reduce size of prostate, increase urine flow, help w/ hair growth on crown & eyelashes
Decrease libido, erection + increase breast size (Gynecomastia)
Oxybutynin (Ditropan)
urinary antispasmatic
ACTION:
Relaxes smooth muscles in urinary tract by inhibiting acetylcholine at postganglionic sites
Therapeutic outcome: Decreased symptoms of urgency, nocturia, incontinence
USES:
Antispasmodic for neurogenic bladder, overactive bladder in females (OTC), renal stones
