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Monday, November 12, 2007

Pharmacology - Kidney Drugs :: Nursing Pharmacology :: Review For Nursing Licensure Examination

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Pharmacology - Kidney Drugs :: Nursing Pharmacology :: Review For Nursing Licensure Examination Slide Transcript
Slide 1: Renal Pharmacology Drugs affecting the Kidney

Slide 2: Drug classification Pharmacodynamic s The nursing process Pharmacokinetics applied to pharmacology

Slide 3: Outline of review • Recall the anatomy of the urinary system • Recall the physiology of the urinary system • Review- drugs of the following categories: – 1. Diuretics – 2. Drug for BPH

Slide 5: Diuretics • Agents that increase the amount of urine produced by the kidneys

Slide 6: Classes of Diuretics Five major classes • 1. Thiazides and thiazide-like • 2. Loop diuretics • 3. Potassium-sparing • 4. Carbonic anhydrase inhibitors • 5. Osmotic diuretics

Slide 7: General indications for the use of the diuretics • Treatment of edema – Urine output will increase and excess fluid is flushed out of the body

Slide 8: General indications for the use of the diuretics • Treatment of CHF – The sodium loss in the kidney is associated with water loss

Slide 9: General indications for the use of the diuretics • Treatment of Hypertension – Diuretics will decrease the blood volume and serum sodium

Slide 10: General indications for the use of the diuretics • Treatment of Glaucoma – Diuretics will provide osmotic pull to remove some of the fluid from the eye to decrease the IOP

Slide 11: time of administration of the diuretics • Usually in the morning!!

Slide 13: Diuretics Comparison Diuretic class Major site of Special Side action effect (s) 1. Carbonic Proximal tubule Acidosis anhydrase inhibitor Proximal tubule Hyperuricemia 2. Thiazide and thiazide like Hypokalemia Hypokalemia 3. Loop diuretics Loop of Henle Ototoxicity 4. Potassium Distal tubule Hyperkalemia sparing 5. Osmotic diuretic Glomerulus Hypovolemia & hypotension

Slide 14: Diuretics Comparison Diuretic class Special Uses 1. Carbonic Mountain sickness anhydrase inhibitor Meniere’s disease Nephrolithiasis due to calcium stones 2. Thiazide and thiazide like Hypocalcemia Hypercalcemia 3. Loop diuretics 4. Potassium CHF taking digoxin sparing 5. Osmotic diuretic Increased ICP LITHIUM TOXICITY

Slide 15: Thiazides Prototype: Hydrochlorothiazide • 1. Bendroflumethiazide • 2. Benthiazide • 3. Chlorothiazide (Diuril) • 4. Hydroflumethiazide • 5. Methylclothiazide • 6. Trichlormethiazide

Slide 16: Thiazide-like • 1. Indapamide • 2. Quinethazone • 3. Metolazone • 4. Chlorthalidone

Slide 17: Thiazides Pharmacodynamics • These drugs BLOCK the chloride pump • This will keep the Chloride and Sodium in the distal tubule to be excreted into the urine • Potassium is also flushed out!!

Slide 18: Thiazide • Special Pharmacodynamics: Side effects – Hypokalemia – DECREASED calcium excretion hypercalcemia – DECREASED uric acid secretion hyperuricemia – Hyperglycemia

Slide 19: Loop Diuretics Prototype: Furosemide • 1. Bumetanide • 2. Ethacrynic acid • 3. Torsemide

Slide 20: Loop Diuretics Pharmacodynamics • High-ceiling diuretics • BLOCK the chloride pump in the ascending loop of Henle • SODIUM and CHLORIDE reabsorption is prevented • Potassium is also excreted together with Na and Cl

Slide 21: Loop Diuretics

Slide 22: Loop Diuretics • Special Pharmacodynamics: side-effects – Hypokalemia – Bicarbonate is lost in the urine – INCREASED calcium excretion Hypocalcemia – Ototoxicity- due to the electrolyte imbalances

Slide 23: Potassium sparing diuretics Prototype: Spironolactone • 1. Amiloride • 2. Triamterene

Slide 24: Potassium sparing diuretics Pharmacodynamics • Spironolactone is an ALDOSTERONE antagonist • Triamterene and Amiloride BLOCK the potassium secretion in the distal tubule • Diuretic effect is achieved by the sodium loss to offset potassium retention

Slide 25: Potassium sparing diuretics

Slide 26: Potassium sparing diuretics Pharmacokinetics: Side effects – HYPERkalemia! – Avoid high potassium foods: • Bananas • Potatoes • Spinach • Broccoli • Nuts • Prunes • Tomatoes • Oranges • Peaches

Slide 27: Osmotic Diuretics Prototype: Mannitol • 1. Glycerin • 2. Isosorbide • 3. Urea

Slide 28: Osmotic Diuretics Pharmacodynamics • Mannitol is a sugar not well absorbed in the nephron osmotic pull of water diuresis

Slide 29: Osmotic Diuretics Pharmacokinetics: side effects – Sudden hypovolemia Important for the nurse to warm the solution to allow the crystals to DISSOLVE in the bottle!

Slide 30: Carbonic Anhydrase Inhibitors Prototype: Acetazolamide • 1. Methazolamide

Slide 31: Carbonic Anhydrase Inhibitors Pharmacodynamics • Carbonic Anhydrase forms sodium bicarbonate • BLOCK of the enzyme results to slow movement of hydrogen and bicarbonate into the tubules • plus sodium is lost in the urine

Slide 32: Carbonic Anhydrase Inhibitors Pharmacokinetics: side effects – Metabolic ACIDOSIS happens when bicarbonate is lost – Hypokalemia

Slide 33: The Nursing Process and the diuretics ASSESSMENT • Assess the REASON why the drug is given: ______ ______ ______ ______

Slide 34: The Nursing Process and the diuretics ASSESSMENT • The nurse must elicit history of allergy to the drugs – Allergy to sulfonamides may contraindicate the use of thiazides • Assess fluid and electrolyte balance • Assess other conditions like gout, diabetes, pregnancy and lactation

Slide 35: The Nursing Process and the diuretics ASSESSMENT • Physical assessment – Vital signs – Special electrolyte and laboratory examination • Assess symptom of body weakness which may indicate hypokalemia

Slide 36: The Nursing Process and the diuretics Nursing Diagnosis – Fluid volume deficit related to diuretic effect – Alteration in urinary pattern – Potential for injury (ototoxocity, hypotension) – Knowledge deficit

Slide 37: The Nursing Process and the diuretics IMPLEMENTATION • Administer IV drug slowly • Safety precaution for dizziness/hypotension • Provide potassium RICH foods for most diuretics, with the exception of spironolactone • Provide skin care, oral care and urinary care

Slide 38: The Nursing Process and the diuretics IMPLEMENTATION • Monitor DAILY WEIGHT- to evaluate the effectiveness of the therapy • Monitor urine output, cardiac rhythm. Serum electrolytes • ADMINISTER in the MORNING! • Administer with FOOD!

Slide 39: The Nursing Process and the diuretics EVALUATION: for effectiveness of therapy Weight loss Increased urine output Resolution of edema Decreased congestion Normal BP





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