Week 3 - Meds Flashcards
what are the 3 categories of diuretics?
- loop
- thiazide
- K+ sparing
what is the prototype of loop diuretic
furosemide
what is the MOA of furosemide
- inhibits the reabsorption of sodium & chloride from the ascending loop of henle = prevents reabsorption of water
list some uses of furosemide (4)
- pulmonary edema associated w HF
- edema
- hypertension
- severe renal impairment
why is furosemide especially useful for patients with severe renal impairment?
- it can promote diuresis even when renal blood flow and GFR are low
- thiazides do not do this
list some adverse effects of furosemide (8)
- hypotension
- hypovolemia
- hyponatremia
- dehydration
- hypokalemia
- hypocholemia
- ototoxicity
- hyperglycemia
describe assessment for someone taking furosemide (7)
- weight
- I&O
- bp
- improvement of edema
- urine output
- electrolytes
- assess for hearing loss
describe patient education for someone taking furosemide (6)
- need high K+ diet
- rise slowly from sitting or lying
- use sunscreen to protect from photosensitivity
- take earlier in day to avoid nocturia
- monitor weight
- BG may be increased for diabetics = may need to increase insulin
what is the prototype of thiazide diuretics
hydroclorothiazide
what is the MOA of hydrochlorothiazide
- blocks reabsorption of Na and Cl at the early segment of the distal convoluted tubule
what is a con to hydrochlorothiazide
- only 10% of filtered sodium and chloride is normally absorbed at the site where thiazides act = not as potent as loop diuretics
note: pre much everything for loop & thiazide diuretics are the same so i did not make flashcards on this; one thing to note is thiazides do not cause ototoxicity & are less potent
…
what is the MOA of statins
- inhibits HMG-CoA reductase enzyme = decreased cholestrol synthesis
= lowered LDL, lowered total cholestrol, lower TG, increase HDL
what is the prototype for statins
- lovastatin
list some uses of statins (4)
- hypercholesteremia
- atherosclerosis
- prevention of CV events (MI, angina, stroke, etc.)
- diabetes –> to help reduce mortality by controlling HTN & cholestrol
list some adverse effects of statins (6)
- myopathy
- rhabdomyolysis
- hepatotoxicity
- GI symptoms
- blurred vision
- dizziness
describe assessment for someone taking stains (4)
- diet: fat, cholestrol
- fasting cholestrol, LDL, HDL, triglyceride levels
- hepatic studies
- renal function
what are some classes of antihypertensives (4)
- diuretics
- antiadrenergic drugs/sympatholytics
- calcium channel blockers
- drugs that suppress the RAAS
what is the MOA of beta-blockers
- blocks stimulation of beta1 adrenergic receptors
what effects do beta-blockers have (4)
- block cardiac beta1 receptors = decreased HR & contractility
- suppress reflex tachy
- block beta1 receptors on juxtaglomerular cells = reduced renin secretion = decreased RAAS effect
- long term use = reduced peripheral vascular resistance
what is the suffix for beta blockers
- olol
what are some adverse effects of beta blockers (5)
- bradycardia
- decreased AV conduction
- reduced contractility
- blockage of beta2 in lungs = bronchoconstriction
- hypotension
what is the MOA of alpha 1 blockers
- prevent stimulation of elpha1 receptors on arterioles & veins = prevent sympathetically mediated vasoconstriction = vasodilation = reduced peripheral resistance & venous return to heart
what is the main side effect of alpha1 blockers
- orthostatic hypotension
what is a significant side effect with vasodilators
- reflex tachy
what is the MOA of calcium channel blockers
- block calcium channels = dilation of arteries
what is the MOA of ACE inhibitors
- lower BP by preventing ACE which is responsible for the conversion of angiotensin 1 to angiotensin 2
= blocks all the effects of angio 2
what effects does angiotensin 2 have (3)
- stimulates the release of aldo (which says to keep Na and H2O
- increases bp by constricting the efferent arteriole
- increase pressure in the afferent arteriole (increases systemic BP)
what is the suffix for ACE inhibitors
- pril
ex. captopril
what are some side effects of ACE inhibitors (5)
- tachycardia
- hypotension
- persistent cough , bronchospasm
- angioedema
- hyperkalemia
what is the MOA of angiotension 2 receptor blockers
- lower bp the same way ACE inhibitors do but it is done by blocking the action of angio 2, not preventing the formation
what is the suffix for ARBs
- sartan
what is the MOA of direct renin inhibitors
- suppression of the entire RAAS by acting directly on renin, inhibiting the formation of angiotensinogen to angio 1
what is the difference in side effects for ACEI vs ARBs`
- arbs do not cause angioedema
- and have lower risk of cough & significant hyperkalemia
what is the suffix of direct renin inhibitors
-ren
what is the MOA of aldo antgaonists
- lower BP by promoting release of Na and water (typically tells us to keep it)
what is a significant side effect of aldo antagonists
- promotes renal retention of K+ = risk of hyperkalemia
what is the suffix for aldo antagonists
- one
ex. spironolactone, eplerenone
what are 2 nursing considerations for ACEI
- have been shown to slow the progression of nephropathy
- GFR must be checks on initiation & with dose increase –> expect ~15% decrease
what is kayexelate
- sodium polystyrene sulfonate
- potassium binding agent
what is the MOA of kayexelate
- slower method to lower serum potassium
- removes potassium by exchanging sodium for potassium in the body, primarly in the large intestine
what is kayexelate used for
- for hyperkalemia
what are some adverse effects of kayexelate (3)
- hypokalemia
- sodium retention = hypernatremia
- GI effects –> NVD, constipation, anorexia, fecal impaction
describe assessment for someone of kayexelate (3)
- monitor electrolytes
- monitor bowel function
- monitor I&O, weight
describe patient education for someone of kayexelate (2)
- follow low-potassium diet
- avoid laxatives, electrolyte based products, antacids
how fast does kayexelate work? how is it administered?
- it is a slower method of lowering serum potassium
- administered oral or rectal route
what are 2 types of phosphate binders
- calcium carbonate (ApoCal, Tums)
- sevelamer carbonate (renagel)
what is the MOA of sevelamer carbonate
- prevents hyperphosphatemia by binding to dietary phosphate in the gut, preventing its absorption
- thus, decreases parathyroid hormones
list uses of sevelamer
- control of hyperphosphatemia in ESRD patients
what are some adverse effects of sevelamer (5)
- infection
- GI effects (NVD, constipation)
- obstruction
- peritonitis
- perforation
describe assessment for someone taking sevelamer
- asses GI status (signs of obstruction, perforation, NVD, bowel function)
- S&S of infection
- phosphorus levels
describe patient education for sevelamer
- not to chew, cut, or dissolve tabs
- swallow whole w water
does sevelamer contain calcium?
- no
what is erythropoietin
- a hematopoietic agent given to increase the production of RBCs
how is erythropoietin administered? how often for a pt in ESRD
- subcut
- 3 times/week
why is insulin/glucose used to treat hyperkalemia? how is it administered
- it is used to rapidly shift K+ into the cell
- administered IV
what are 2 types of vit D supplements
- calcitrol
2. alfacalcidol
what is the MOA of calcitrol (3)
- increases intestinal absorption of calcium
- provides calcium for bones
- increases renal tubular reabsorption of phosphate
what are the uses for calcitrol
- active form of vit D given when phosphate levels are controlled, but calcium remains low
- hypocalcemia
what is replavite
- a vitamin supplment for B, C, and folic acid
what is the use for replavite
- used to replace vitamin B & C and folic acid that is lost during dialysis
what is alfacalcidol? what does it do
type of vitamin D supplement
- helps regulate the amt of calcium and phosphate
