Week 10 CKD Kidney pharm Flashcards
How does medication slow progression of CKD?
- reduce damage to the kidney
- manage the consequences of reduced GFR
What are the 3 ways we reduce damage to the kidney in CKD?
1 Lower BP
2. control atherosclerosis
3. control blood sugar (DM)
What stage is reducing damage to the kidneys in CKD?
stage 3
What 3 ways do we manage the physical consequences of reduced GFR?
- diuretics for fluid overload
- rebalance electrolyte imbalances (Na+ K+ Cal phos)
- check hormone imbalance (epo) & give endogenous (blood transfusion) epo where needed
What are the CKD meds?
- Captopril
- Candesartan
- Atorvastatin (Lipitor)
- Furosimide
- Hydrochlorothiazide
- Spironolactone
- Ethropoeitin
- Calcium carbonate
- Sodium Polystyrene Sulfonate (Kayexalate)
- Ferrous Sulfate (Feosol)
- Calcitriol (Rocaltrol)
What drug class is captropril and why is it used?
ACE inhibitor
to stop angiotensin 1 converting to angiotensin II - RAAS so that Na+ will stop absorbing and stop fluid retention
What alternative is used if the cough from captopril can’t be tolerated?
candesartan
What does captopril do for the glomerulus?
stops afferent arteriole pressure
dilates efferent arteriole
What is captopril contraindicated in?
- pregnancy
- breastfeeding
- renal artery stenosis
- angioedema
What are the 3 adverse effects of captopril?
- first dose hypotension
- cough
- hyperkalemia
What should nurses monitor with people on captopril?
- BP - esp first dose and changes
- fluid volume/dehydration
- blood work - K+, Na+, Urea, creatinine
If blood pressure drops do we have hyperperfusion to the kidneys or hypoperfusion ?
hypoperfusion
What is the drug class of candesartan and what does it do?
ARB
angiotensin II receptor blocker
blocks angiotensin 2 from reaching the receptor on the adrenal cortex
are the contraindications of candesartan and captopril the same?
yes
Do ARBs or ACE inhibitors decrease cardiovascular morbitidy?
ACE inhibitors
Which medication causes cough?
Captopril
What should we always monitor for patients on atorvastatin?
LFTs
CK (creatine kinase - when there is muscle cell damage is releases this enzyme)
How long does it take to see the effects of Atorvastatin?
2 weeks
where does Furosemide work?
on the ascending limb (the fat part) of the loop of Henle
When GFR is low can we still use a diuretic?
yes! this is an advantage!
What is furosemide contraindicated in?
- someone who has no urine output - anuria <40ml
- hepatic coma - a coma from liver issues - can cause cerebra edema
What are the adverse effects of Furosemide?
- Hyponatremia
- Hypocholremia
- Dehydration
- hypotension
- hypokalemia
- Ototoxicity