NurseReview.Org Pharmacology - Kidney Drugs

Renal Pharmacology Drugs affecting the Kidney

Drug classification The nursing process applied to pharmacology Pharmacokinetics Pharmacodynamics

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

Diuretics
Agents that increase the amount of urine produced by the kidneys

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

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

Treatment of CHF
The sodium loss in the kidney is associated with water loss

Treatment of Hypertension
Diuretics will decrease the blood volume and serum sodium

Treatment of Glaucoma
Diuretics will provide osmotic pull to remove some of the fluid from the eye to decrease the IOP

time of administration of the diuretics
Usually in the morning!!

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

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

Thiazides
Prototype: Hydrochloro thiazide
1. Bendroflume thiazide
2. Ben thiazide
3. Chloro thiazide (Diuril)
4. Hydroflume thiazide
5. Methylclo thiazide
6. Trichlorme thiazide

Thiazide-like
1. Indapamide
2. Quinethazone
3. Metolazone
4. Chlorthalidone

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!!

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

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

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

Loop Diuretics

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

Potassium sparing diuretics
Prototype: Spironolactone
1. Amiloride
2. Triamterene

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

Pharmacokinetics: Side effects
HYPERkalemia!
Avoid high potassium foods:
Bananas
Potatoes
Spinach
Broccoli
Nuts
Prunes
Tomatoes
Oranges
Peaches

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

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

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

Carbonic Anhydrase Inhibitors
Prototype: Acetazolamide
1. Methazolamide

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

Pharmacokinetics: side effects
Metabolic ACIDOSIS happens when bicarbonate is lost
Hypokalemia

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

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

ASSESSMENT
Physical assessment
Vital signs
Special electrolyte and laboratory examination
Assess symptom of body weakness which may indicate hypokalemia

Nursing Diagnosis
Fluid volume deficit related to diuretic effect
Alteration in urinary pattern
Potential for injury (ototoxocity, hypotension)
Knowledge deficit

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

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!

EVALUATION: for effectiveness of therapy
Weight loss
Increased urine output
Resolution of edema
Decreased congestion
Normal BP

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NurseReview.Org Pharmacology - Kidney Drugs

by Nurse ReviewDotOrg on Nov 10, 2007

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