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Unit 2 Meds

Renal Drugs

QuestionAnswer
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
Created by: kristyd02