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PCC renal pharm
| Question | Answer |
|---|---|
| Hydrochlorothiazide (HydroDIURIL) Indications | increase urine output, treat HTN, edema for HF (p. 642) |
| Hydrochlorothiazide (HydroDIURIL) Pharmacokinetics | Readily absorbed in the GI tract. t½: 6 |
| Hydrochlorothiazide (HydroDIURIL) Administration | administer in the morning to avoid nocturia. Take with food to avoid GI upset. |
| Hydrochlorothiazide (HydroDIURIL) Side effects | electrolyte imbalances, hyperglycemia, dizziness, N/V, photosensitivity, |
| Hydrochlorothiazide (HydroDIURIL) Adverse reactions | severe dehydration, hypotension, Life threatening: aplastic anemia,thrombocytopenia , agranulocytosis |
| Hydrochlorothiazide (HydroDIURIL) Contraindications | renal failure, electrolyte depletion |
| Hydrochlorothiazide (HydroDIURIL) Interactions | Digoxin, Decrease effectiveness of antidiabetics, potentiate the action of other antihypertensives |
| Hydrochlorothiazide (HydroDIURIL) is a – | thiazide |
| Main purposes of diuretics | ↓ B/P & ↓ edema in HF and renal or liver disorders. |
| Diuretics produce ↑ urine output by | inhibiting sodium and water reabsorption from the kidney tubules. |
| Diuretics may cause loss of | electrolytes |
| Two main types of diuretics | Potassium sparing and potassium wasting |
| Four major types of Potassium wasting diuretics | Thiazide(thiazide like), Loop(high-ceiling), Diuretics, Carbonic-anhydrase inhibitor |
| Thiazides are primarily used for clients with | normal renal function. |
| Thiazides can cause | multiple electrolyte imbalances. |
| Loop diuretic: Action | Inhibit sodium and water reabsorption. |
| Loop diuretic | Excretes calcium so can be used with end stage renal disease or a creatinine clearance less than 30/min. |
| Loop diuretic can cause | multiple lab value changes |
| Osmotic (diuretic): Action | increase the osmolality (or the concentration ) and sodium reabsorption. |
| Osmotic(diuretic) Excretes | sodium, Chloride, potassium, & water. |
| Osmotic(diuretic) used in emergency situations with | ICP and IOP. |
| Carbonic anhydrase inhibitor: Action | Increases sodium, potassium, and bicarbonate excretion. Carbonic anhydrase inhibitor primarily used to |
| Potassium sparing diuretic: Action | promote sodium and water excretion and potassium. |
| Potassium sparing diuretics can cause | Hyperkalemia. |
| Potassium sparing are | weaker diuretics than thiazides and loops. |
| When potassium sparing diuretics are given with ACE inhibitors they can cause | increased serum potassium levels to life threatening levels. (p. 647) |
| Furosemide (Lasix) – indications: | fluid retention/fluid overload (p. 645) |
| Furosemide (Lasix) Pharmacokinetics | – rapidly absorbed in the GI tract. t½: 30-50min. Excretion in urine, some in feces. |
| When do you give Furosemide (Lasix) | in morning or afternoon but not after 5 pm |
| Furosemide (Lasix) Administration – | Take in the morning or afternoon no later than 5pm to avoid nocturia. Take with food to avoid nausea. |
| Furosemide (Lasix) Side effects | electrolye imbalance, Nausea, diarrhea, blurred vision, ECG changes, photosensitivity, vertigo |
| Furosemide (Lasix) Adverse reactions | severe dehydration, marked hypotension, Life threatening: Renal Failure, thrombocytopenia |
| Furosemide (Lasix) Contraindications | severe electrolyte imbalance, hepatic coma |
| Furosemide (Lasix) Interactions | Digoxin can cause toxicity |
| Osmotic Diuretics indications | prevent kidney failure, ↓ intracranial Pressure (ICP), and ↓ Intraocular pressure (IOP). (p. 645) |
| Osmotic Diuretics Administration | Diuresis occurs within 1-3 hours after IV administration. Administer over 3 to 5 minutes. |
| Osmotic Diuretics Side effects | fluid & electrolyte imbalance, pulmonary edema, N/V, tachycardia, acidosis |
| Osmotic Diuretics Adverse reactions | renal failure, HF |
| Osmotic Diuretics Contraindications | Extreme caution must be used with clients who have HF and heart disease . |
| Osmotic Diuretics Interactions | Hypokalemia ↑ risk of digoxin toxicity. |
| Triamterene (Dyrenium) indications | ↑ urine output, treat fluid retention/overload (p. 648) |
| Triamterene (Dyrenium) Pharmacokinetics – | rapidly absorbed in the GI tract, t½: 1.5 to 2.5h, Excreted in urine. |
| Triamterene (Dyrenium) Administration – | Administer in am to avoid nocturia. Administer with food or milk to minimize GI distress. Can open capsules and mix with food if patient has difficulty swallowing. |
| Triamterene (Dyrenium) Side effects | electrolyte imbalance, N/V, diarrhea, dizziness, photosensitivity, dry mouth |
| Triamterene (Dyrenium) Adverse reactions | Life threatening: severe hyperkalemia, thrombocytopenia, megaloblastic anemia |
| Triamterene (Dyrenium) Contraindications | kidney or hepatic disease, severe hyperkalemia |
| Triamterene (Dyrenium) Interactions | potassium supplements, antihypertensives & lithium |
| Spironolactone (Aldactone) indications | treat edema and HTN (p. 649, Davis’s Drug Guide p. 456) |
| Spironolactone (Aldactone) Pharmacokinetics – | rapidly absorbed in the GI tract, t½: 1.5-2h, Excreted in urine. |
| Spironolactone (Aldactone) Administration – | Administer in AM to avoid nocturia. Administer with food or milk to minimize GI distress. |
| Spironolactone (Aldactone) Side effects | electrolyte imbalances, dizziness, N/V |
| Spironolactone (Aldactone) Adverse reactions | Life threatening:severe hyperkalemia |
| Spironolactone (Aldactone) Contraindications | Hyperkalemia, renal insufficiency, anuria |
| Spironolactone (Aldactone) Interactions | alcohol, antihypertensives, nitrates, digoxin |
| Urinary Antiseptics and Antibiotics | Prevent the growth of bacteria in the kidneys and the bladder only. (p. 471) |
| When Urinary Antiseptics and Antibiotics are given in lower doses they have a | bacteriostatic effect. |
| When Urinary Antiseptics and Antibiotics are given in larger doses they have a | bactericidal effect. |
| Acute Cystitis(lower UTI common use for urinary antiseptics/antibiotics) commonly occurs in | females because of short urethra. |
| Nitrofurantoin (Macrodantin) is a –urinary antiseptic & antibiotic | |
| Nitrofurantoin (Macrodantin) used to | treat acute or chronic UTIs (p. 472) |
| Nitrofurantoin (Macrodantin) Pharmacokinetics | Well absorbed in GI tract. t½: 20 min. Excreted in the urine. |
| Nitrofurantoin (Macrodantin) Administration – | Take with food to decrease GI distress. Do not crush or open capsules. Shake liquid suspension well. Rinse mouth after taking. |
| Nitrofurantoin (Macrodantin) Side effects | Dizziness, HA, drowsiness, Rust |
| Nitrofurantoin (Macrodantin) Adverse reactions | Superinfection, peripheral neuropathy, Life Threatening: hepatotoxicity, Stevens |
| Nitrofurantoin (Macrodantin) Contraindications | Hypersensitivity, renal impairment, oliguria , anuria |
| Nitrofurantoin (Macrodantin) Interactions | probenecid decreases effects of Macrodantin), Antacids(it decreases absorption of Macrodantin |
| Urinary Analgesics Action | relieves pain, burning sensation, frequency, urgency associated with urination. |
| Urinary Analgesics Only treats | the symptoms, not the underlying cause of the symptoms. |
| Urinary Analgesics May be taken concurrently with an | antibiotic. |
| Urinary Analgesics should not be used | long term for undiagnosed urinary tract pain. |
| Phenazopyridine hydrochloride (Pyridium): Indications | chronic cystitis to alleviate pain & burning with urination. (p. 476, Davis’s Drug Guide p. 1014) |
| Phenazopyridine hydrochloride (Pyridium) Pharmacokinetics | Rapidly absorbed in GI tract. Excreted in urine. |
| Phenazopyridine hydrochloride (Pyridium): Administration – | Take after meals. Do not crush, break or chew tablet. |
| Phenazopyridine hydrochloride (Pyridium): Side effects | GI upset, red orange urine |
| Phenazopyridine hydrochloride (Pyridium): Adverse reactions | Blood dyscrasia, nephrotoxicity , hepatotoxicity |
| Phenazopyridine hydrochloride (Pyridium): Contraindications | severe hepatitis, renal failure |
| Urinary Stimulants Action | Increases bladder tone of detrusor muscle. The detrusor muscle produces the contraction of the bladder and with the increased tone will produce a contraction strong enough to stimulate micturition |
| Bethanechol Chloride (Urecholine) is a | – urinary stimulant |
| Bethanechol Chloride (Urecholine): Indications | treat urinary retention (p. 273, 474, 476) |
| Bethanechol Chloride (Urecholine): Pharmacokinetics | action: promote bladder contractions, ↑ GI peristalsis, ↑ GI secretion, ↑ pupil constriction, ↑ bronchoconstriction, t½: UK |
| Bethanechol Chloride (Urecholine): Administration | PO: 10 to50 mg b.i.d. or q.i.d., max: 120mg/d; take this med on an empty stomach, Can be given SubQ but not IM or IV. |
| Bethanechol Chloride (Urecholine) can be given _____ but not ___ or ___ | can be given SubQ but not IM or IV |
| Bethanechol Chloride (Urecholine) should be given on an | – empty stomach |
| Bethanechol Chloride (Urecholine): Side Effects | GI distress, dizziness, fainting |
| Bethanechol Chloride (Urecholine): Adverse Reactions | orthostatic hypotension, bradycardia, muscle weakness; (Life Threatening): acute asthmatic attack, heart block, circulatory collapse, cardiac arrest. |
| Bethanechol Chloride (Urecholine): Contraindications | intestinal or urinary tract obstruction, severe bradycardia,active asthma , hypotension , Peptic ulcer |
| Bethanechol Chloride (Urecholine):Interactions | antidysrhythmics |
| Urinary Antispasmodics/Antimuscarinics Action | Direct action on smooth muscles to relieve spasms of the bladder. |
| Oxybutynin (Ditropan): Indications: | treat spasms and overactive bladder (p. 476) |
| Oxybutynin (Ditropan): is a | urinary antispasmodic/antimuscarinics |
| Oxybutynin (Ditropan): Administration | Immediate release tablets must be given on empty stomach while extended release can be given with or without food. |
| Oxybutynin (Ditropan): Side effects | Drowsiness, tachycardia , dizziness, fainting, blurred vision, dry mouth, constipation |
| Oxybutynin (Ditropan): Adverse reactions | hyperthermia |
| Oxybutynin (Ditropan): Contraindications | Avoid in narrow-angle glaucoma,cardiac, renal , hepatic, prostate problems |
| Oxybutynin (Ditropan): Interactions | antidepressants, haloperidol, alcohol, antihistamines, opioids. |
| Tolterodine tartrate (Detrol): Indications | decrease urinary frequency, urgency, & incontinence (p. 280, 475 |
| Tolterodine tartrate (Detrol): Pharmacokinetics | Absorbed in GI tract. t½: 2 |
| Tolterodine tartrate (Detrol): Administration – | do NOT crush or break extended release tabs. |
| Tolterodine tartrate (Detrol): Side effects | N/V, dizziness, vertigo, dry mouth , constipation, wt gain |
| Tolterodine tartrate (Detrol): Adverse reactions | bronchitis, visual abnormalities, chest pain, HTN |
| Tolterodine tartrate (Detrol): Contraindications | in client’s with narrow angle glaucoma or cardiac, renal, hepatic, prostate problems |
| Tolterodine tartrate (Detrol): Interactions | tricyclic antidepressants, azole antifungals, cyclosporine |
| antispasmodics has the same effects as | antimuscarinics(agents that block parasympathetic nerve impulses), parasympatholytics, and anticholinergics |
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