Renal Drugs Review
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hydrochloridethiazide [Microzide, Oretic] is given to pt. w/ ESRD [final stage of kidney failure marked by complete/nearly complete irreversible loss of renal function] what assessments would you find that would indicate the need for the drug?
- pt. has a urinary output of 90 mL over last 8 hrs [output should be at least 240 mL].
- pt. has good skin turgor, mucous membranes pink & moist.
- pt. has sacral & 2+ pitting edema.
- pt's BP is 90/60.
- pt's BP is 120/80.
what are common side effects of furosemide [Lasix]?
- electrolyte & hematologic imbalances.
- orthostatic hypotension.
- + ototoxicity.
MD ordered 80 mEq of furosemide [Lasix] x2/day, pt's potassium level is 2.5 (low). what should you do?
hold meds--don't give, notify MD.
MD ordered 250 mg of acetazolamide [Diamox] Q6hrs, comes in 500 mg tablets. how many tablets should you give?
250/500 = 0.5 x 4 (# of times drug will be given) = 2 tablets.
which meds are ok to give & which ones are not?
- pt. who has a BP of 168/84 & pitting edema, ok to give torsemide [Demadex].
- pt. given bumetadine [Bumex] c/o headache, ok to give (normal side effect).
- pt. taking furosemide [Lasix] now c/o leg cramps, hold meds & notify (pt. is losing too much potassium).
pt. given furosemide [Lasix] b/c of edema, UAP reports that pt. lost 1 lb. should you be concerned?
no, it's normal.
pt. is c/o GI upset after taking meds, what advice should you give?
take meds w/ milk, full glass of water, or w/ food.
pt. is prescribed hydrochlorothiazide [Microzide, Oretic], what kind of juice should pt. drink when taking meds?
delegation question: what kind of tasks can you delegate to UAP [unlicensed assistant personnel]?
- nothing that requires assessments (except for VS)/tx.
- can measure I&O.
- can help feed pt.
- can helpt pt. ambulate.
- can help bathe pt.
MD orders: potassium 40 mEq PO daily. you have 10 mEq/5 mL, how many mL should you give?
40/10 = 4 x 5 = 20 mL.
what kind of drug is mannitol [Osmitrol]?
- osmotic diuretic given for:
- ARF [acute renal failure] to decrease IOP [intraocular pressure].
- cerebral edema.
- irrigation solution in prostate sx.
how do you know if mannitol [Osmitrol] its effective?
increase in hourly urine output.
what are the side effects of spironolactone [Aldactone]?
- erectile dysfunction.
pt. is prescribed triamterene [Dyrenium], what kind of drug is it?
what should you monitor pt. for?
when should med be taken?
- potassium sparing diuretic.
- monitor for nausea, vomiting, hyperkalemia & photosensitivity.
- med should be taken in the morning.
pt. has been dx w/ glomerulonephritis [inflammation of the capillaries of the renal glomeruli] & is taking trimethoprim & sulfamethoxazole [Bactrim], what kind of drug is it?
how do you know if trimethoprim & sulfamethoxazole [Bactrim] is effective?
CBC--leukocytes not present (in urine too).
pt. is taking nitrofurantoin [Macrodantin] for UTI, she calls & says her urine is dark in color (coca-cola colored), what should you tell pt.?
harmless side effect of med.
what color does methenamine [Mandelamine] turn urine to?
may cause urine to turn blue.
color of urine for pt. on phenazopyridine hydrochloride [Pyridium] (urinary analgesic)?
may discolor the urine reddish-orange & may stain contacts.
-for pt. who has glaucoma [a disease of the eye marked by increased pressure w/in eyeball that can result in damage to optic disk & gradual loss of vision], is it ok to prescribe trimethoprim & sulfamethoxazole [Bactrim]?
-is it ok for pt. to take methenamine [Mandelamine] (anti-infective) w/ has cirrhosis [widespread disruption of normal liver structure by fibrosis & formation of regenerative nodules caused by any of various chronic progressive conditions affecting liver]?
-pt. who has hyperlipidemia [presence of excess fat/lipids in blood], is it ok to give cipro [Ciprofloxacin]?
-pt. who has a hx of gastritis [inflammation of mucous membrane of stomach], is it ok to take nitrofurantoin [Macrodantine] (anti-infective)?
- yes, med doesn't affect glaucoma.
- no, med can be toxic to pt. due to cirrhosis.
if pt. has UTI [urinary tract infection], in addition to anti-infectives, what else should you encourage what?
lots of fluid (particularly cranberry juice to acidify urine b/c bacteria doesn't grow in acidic environment)
nitrofurantoin [Macrobid] (anti-infective) can cause which pulmonary side effects?
- chest pain.
- alveolar infiltrates.
- pulmonary fibrosis (Macrodantin lung).
nalidixic acid [NegGram] is contraindicated w/ pts who have what disorders?
contraindicated in pts w/ hx of seizures.
what is aluminum carbonate gel [Basaljel] given for?
- used to bind intestinal phospate eliminated in feces.
- used in pts w/ ESRD to reduce serum phosporus levels (hyperphophatemia > 4.5 mg/dL).
- also used as an antacid.
if sevelamer hydrochloride [Renagel] is given to balance elexctrolytes & fluids for pts on dialysis, how do you if its effective?
pt. has normal levels of fluid & electrolytes.
sodium polystyrene sulfonate [Kayexelate], how do you know if its effective?
potassium level is WNR.
pt. has potassium of 5.9, MD ordered sodium polystyrene sulfonate [Kayexelate] enema, nursing actions after enema?
- retain for 30-60 min.
- irrigate colon w. non-sodium containing fluid after Kayexelate is expelled.
what is the best way to give oral potassium supplements?
should be given w. at least 4 oz. of liquid [orange juice].
expected side effects of magnesium supplements?
- hypersomnolence (sleepy).
- hot flashes.
what kind of drug is tacrolimus [Prograf] & what is it used for?
- used for tx of autoimmune disorders, prevent organ rejection--life long therapy,
pt. taking tacrolimus [Prograf] is c/o sore throat, what should you do?
notify MD b/c drug increases risk of infection such as fever &/sore throat.
what side effects does azathioprine [Imuran] (immunosuppressant) have?
- bone marrow suppression.
- *monitor for neutropenia, thrombocytopenia, & take precautionary measures.
immunosuppressants are usually taken & how often are labs done?
why would immunosuppressants drugs & prednisone (glucocorticoid) given together?
to prevent organ rejection.
what are the diff. types of immunosuppresant drugs?
- calcineurin inhibitors: cyclosporine [Sandimmune, Genegraf, Neoral]
- glucocorticoid: [Prednisone]
- cytotoxics: azathioprine [Imuran]
- other: tacrolimus [Prograf], methotrexate [Rheumatrex, Trexall]
pt. w/ neurogenic bladder [nerve damage--spasm, flaccidity] given bethanechol chloride [Urecholine)], what precautions are done?
advise pt. to rise slowly b/c drug causes hypotension.
3 yr. old weighs 33 lbs is given 25 mg/kg of medication divided in 3 doses, you have 150 mg/mL. how many mL do you give in each dose?
- 1 kg = 2.2 lbs.
- 33/2.2 = 15 x 25 = 375/3 = 125/150 = 0.8 mL.
tolterodine [Detrol] is given for what?
- overactive bladder.
- *may cause dry mouth, constipation, headache, dizziness.
darvocet (non-opioid analgesic--synthetic drug) is given for what?
flavoxate [Urispas] is given for?
- used to relieve symptoms/dysuria.
- urinary urgency.
- suprapubic pain & frequency (spasms).
- urge incontinence.
adverse reactions of urinary anti-spasmodics?
- dry mouth.
- decreased tears & sweating.
- GI disturbances.
- blurry vision.
- urinary hesitancy.
what does bethanechol chloride [Uricholine] do?
- used to increase bladder tone & function.
- used to tx urinary retention & speed up peristalsis for urogernic bladder.
MD ordered potassium chloride 30 mL daily, how many teaspoons is given?
- 5 mL = 1 teaspoon
- 30/5 = 6 teaspoons.
- *1 Tablespoon = 3 teaspoons.
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