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Unit 2 Meds
Renal Drugs
| Question | Answer |
|---|---|
| Antipyretics - Decreases temperature by acting on hypothalamus | Aspirin, Tylenol, Ibuprofen |
| Aspirin | Decreases platelet aggregation. S/E: bleeding, GI upset, renal impairment, tinnitus is sign of toxicity |
| Tylenol | 4 g in 24 hour max. Does not have anti-inflammatory, does not cause bleeding, hepatoxic - use sparingly in liver disease |
| Ibuprofen | Similiar to aspirin, first choice for fever, lower risk for GI upset |
| Vitamin A | Accelerated epithelialization |
| Vitamin B | Coenzyme |
| Vitamin C | Assist in synthesis of collagen for new capillaries |
| Vitamin D | Calcium |
| Antibiotics for UTI | trimethoprim/Sulfamethoxazole, macrobid, Cipro, Nitrofurantoin |
| Trimethoprim/sulfamethoxazole | Inhibits synthesis of folic acid. Patients may have photo sensitivity. Report rash immediately (Stevens-Johnson Syndrome), sulfa allergy |
| Macrobid | Long term/long acting Nitrofurantoin |
| Cipro | Causes yeast infections in mouth or vaginal canal. Use cautiously in elderly b/c may cause confusion and psychosis. Photosensitivity. Do not give with dairy or iron supplements. Pleural Quinolone |
| Nitrofurantoin | Urinary antiseptic. Activated by enzymes in bacteria, therapeutic levels are only in urine. If GI upset take w/ meals. Photosensitivity. *Acute alveolar infiltrates: chest pain, trouble breathing, crackles in lungs |
| Antifungal meds for UTI | Flagyl, Mycelex, Mycostatin, Diflucan |
| Flagyl | Treats protozoa infections, CDIFF. May change taste of things to metallic. Harmless darkening of urine. Avoid alcohol. Given PO or IV (po treats CDIFF) |
| Mycelex | Topical or antifungal. Tx yeast infection |
| Mycostatin | Swish and spit powder. Antifungal used to Tx yeast infections |
| Diflucan | Given po. Antifungal used to treat yeast infections (candidiasis) |
| Pyridium | Urinary analgesic, not an antibiotic, will alleviate symptoms but not treat infection. Stains urine reddish/orange. long term use may cause anemia |
| Antineoplastic (Chemotherapy) | Doxrubicin, Platinol, Methotrexate, 5 Fluorouracil, Floxuridine, Gemzar, Bacille Calmette |
| Doxrubicin | Tx invasive bladder cancer. S/E: Bone marrow suppression. Red color to urine and sweat. Cardiotoxic - do not give w/ heart disease. Only give thru central line cuz if it infiltrates will cause severe tissue damage |
| Platinol | Tx invasive bladder cancer. Watch for kidney damage, monitor BUN/Creatinine. Pre-medicate with Zofran b/c causes nausea and vomiting within an hour. S/E mild to moderate bone marrow suppression and ototoxic |
| 5 fluorouracil | Inhibits DNA synthesis. Only active on dividing cells. Given IV. S/E: Bone marrow suppression, neutropenia, oral/GI ulceration stomatitis (mouth gets bright red & swells), alopecia |
| Floxuridine | Similiar to 5 fluorouracil, same class different drug |
| Gemzar | Inhibits DNA synthesis (cells must be dividing). S/E: Nausea, vomiting, alopecia. Given IV, Can have infusion reaction (hypotension/flushing) if it happens decrease rate of infusion |
| Bacille Calmette | Live vaccine used for TB. Administered directly through bladder via foley. Produces local inflammatory response causing tumor regression. S/E: Dysuria, urgency/frequency, hematuria. Contraindications: Immune suppressed or active UTI |
| Bladder Agents | Ditropan, Detrol, Bentyl, Flomax, Proscar, Estrogen, Enablex, Urecholine, Vesicare |
| Anticholingeric | Ditropan, Detrol, Enablex, Urecholine, Vesicare |
| Muscarinic Receptor Antagonist | Bentyl, Enablex, Vesicare |
| Ditropan/Detrol | Used to treat urge incontinence. S/E: dry mouth, dry eyes, blurred vision, constipation. Anticholinergic |
| Bentyl | Reduces overactive bladder contraction in urge incontinence and overactive bladder. Muscarinic Receptor |
| Flomax | Reduces urethral sphincter resistance. Tx overflow incontinence. Alpha Adrenergenic Blocker |
| Proscar | Used to decrease prostate size, BPH |
| Estrogen | Local application (topical/cream) used to increase host defenses against UTI |
| Enablex | Used for overactive bladder. Avoid w/ liver failure. S/E: dry mouth, dry eyes, blurred vision, constipation. Muscarinic Receptor, Anticholingeric |
| Urecholine | Used for urinary retention. Relaxes muscles and increases voiding pressure. S/E: rare |
| Vesicare | Tx: overactive bladder and urge incontinence. Avoid w/ liver failure. S/E: Dry mouth, dry eyes, blurred vision, constipation. Anticholinergic |
| Agents to treat Hyperkalemia | Kayexalate, calcium gluconate, sodium bicarbonate, Insulin & D50 |
| Kayexalate | Can give orally or thru retention enema. Liquid given in grams. Will cause diarrhea and Na+ & H2O retention. Do not give orally if bowel issues. Watch for constipation. Don't give if CHF |
| Calcium Gluconate | Ca+ given IV push or IV piggyback. 10 acc amp. Cardioprotective, if given to quickly BP will rise |
| Sodium Bicarbonate | Given in large vein and pushes K+ back into cell. Thick and hard to push(costic) |
| Insulin & D50 | Given first b/c insulin drops blood sugar. Does not treat hyperkalemia, Dextrose 50 g glucose. Treats hyperkalemia, pushes K+ back into cell |
| Meds for Renal Failure | Mucomyst, Renagel, Phoslo, Sensipar, Calcitrol, Fosrenol, Magnesium Oxide, Midodrine |
| Mucomyst | Kidney protector. Protects kidneys from IV dye |
| Renagel | Ca+ free phospate binder. Does not increase Ca+ levels. Expensive. Give to patients with cardiovascular risks. Binds to biosalts in intestine and decreases cholesterol |
| Phoslo | Ca+ based phosphate binder, "giving Ca+". Cheap. Give to patients who do not have cardiovascular risks. Decrease Phos Increase Ca+ |
| Sensipar | Works in parathyroid gland. Prevents hyperparathyroidism in end stage renal disease. Only used on patients on dialysis |
| Calcitrol | Active form of Vit D. Give in addition to Renagel, Phoslo, and Sensipar if Ca+ level decrease |
| Fosrenol | Ca+ free phosphate binder. Expensive give to patients with cardiovascular risks |
| Magnesium Oxide | Replaces magnesium and alleviates constipation |
| Midodrine | Increases BP during dialysis |
| Lasix/Bumex | Work in loop of henle to secrete excess fluid (potassium), causes hypokalemia |
| Epogen/Procrit | Stimulates RBC production. Given subcut on days of dialysis. Natural replacement of erythorpoietin that kidneys make. Will not see increase in hgb for 2-3 weeks |
| Aranesp | Longer acting so it isn't given as frequently, depends on hemoglobin level |
| Iron Sucrose | Can be given with or without erythorpoietin. Watch for hypotension. Iron supplement given IV |
| Sodium Ferric Gluconate | Must give with erythorpoietin. Can have severe allergic reaction so give test dose. Watch for hypotension, flushing, chest/back pain. If test dose goes okay can give full dose. Iron supplement given IV |
| Isotonic Solutions | 0.9 NS, Ringers Solution, Lactated Ringers |
| Hypertonic Solutions | 3% NaCl |
| Hypotonic Solutions | 0.45, D5W |
| 0.9 NS | Only fluid you can use w/ blood products. Used to keep fluid in vascular space |
| 0.45 NaCl | Fluid goes into tissue (rehydrates tissue) |
| 3% NaCl | Used to treat severe hyponatremia. Given slowly on IV pump, watch patient carefully |
| Ringers Solution | Has some electrolytes. Stays in vascular space |
| Lactated Ringers | Has some bicarbonate, no free water or calories, just replaces vascular volume loss |
| D5W | Has 170 cal/L. Will not stay in vascular space, rarely given |
| Albumin | Protein, not given as a nutrition supplement but to pull fluids into vascular space which will maintain BP. Comes in 5% (250 mL) or 25% (50mL). Some will see this as blood product. Given during dialysis and to maintain BP |
| Potassium Chloride po | Large white pill that is hard on stomach (GI upset) so give with food. Enteric coated yellow pill protects stomach |
| Potassium Chloride IV | Add to IV fluid. 40 meq/L = maintenance fluid. Peripheral IV = 10 meq/hr. Burns peripherally, get doctors order for lidocaine. Central line = 20 meq/hr b/c there is more blood flow |
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kristyd02
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