The document provides information on drugs acting on the genitourinary system. It discusses several classes of drugs including antidiuretics, diuretics, 5-alpha reductase inhibitors, alpha blockers, anti-infectives, antigout agents, and spermicides. Specifically, it describes the mechanisms, indications, and side effects of antidiuretics like vasopressin and various classes of diuretics including loop diuretics, thiazide diuretics, and potassium-sparing diuretics. It also includes a section on research evidence regarding the use of terlipressin and albumin for hepatorenal syndrome.
Any environment in which a patient may unexpectedly experience a medical emergency needs to have the equipment to deal with that emergency efficiently. That’s the job of a crash cart emergency drugs. A crash cart contains the equipment and medications that would be required to treat a patient in the first thirty minutes or so of a medical emergency. Although crash carts drugs and equipment can differ somewhat depending upon their location. Drug dilutions may also vary according to hospital policy. It's important to know these life-saving drugs to all Nurses to handle the medical emergency scenarios.
Any environment in which a patient may unexpectedly experience a medical emergency needs to have the equipment to deal with that emergency efficiently. That’s the job of a crash cart emergency drugs. A crash cart contains the equipment and medications that would be required to treat a patient in the first thirty minutes or so of a medical emergency. Although crash carts drugs and equipment can differ somewhat depending upon their location. Drug dilutions may also vary according to hospital policy. It's important to know these life-saving drugs to all Nurses to handle the medical emergency scenarios.
Slides are prepared as per INC Syllabus Unit IX Drugs used in nervous system and it is most benefited for B sc Nursing students and faculty of the subject
Slides are prepared as per INC Syllabus Unit V Drugs used on Respiratory systems and it is most benefited for 2nd yr B sc Nursing students and faculty of the subject.
The intramuscular injection is most common type of drug administration. Because of a single mistake we can do harm to our patient. So, we should know about the right way to administer IM injection. Here, in this slides we discuss details about the topic. It will increase your skill proficiently.
Thanks
Slides are prepared as per INC Syllabus Unit IX Drugs used in nervous system and it is most benefited for B sc Nursing students and faculty of the subject
Slides are prepared as per INC Syllabus Unit V Drugs used on Respiratory systems and it is most benefited for 2nd yr B sc Nursing students and faculty of the subject.
The intramuscular injection is most common type of drug administration. Because of a single mistake we can do harm to our patient. So, we should know about the right way to administer IM injection. Here, in this slides we discuss details about the topic. It will increase your skill proficiently.
Thanks
Drug interactions (DIs) represent an important and widely under recognized source of medication errors. Interactions between food and drugs may inadvertently reduce or increase the drug effect. Some commonly used herbs, fruits as well as alcohol may cause failure of the therapy up a point of to serious alterations of the patient’s health. The majority of clinically relevant food-drug interactions are caused by food induced changes in the bioavailability of the drug. Major side-effects of some diet (food) on drugs include alteration in absorption by fatty, high protein and fiber diets.
Underlying factors:
Classification of drug-food interactions:
Pharmacodynamic interactions
Pharmacokinetic interactions
I. Absorption interactions
II. Transport and distribution interactions
III. Metabolism interactions
IV. Excretion interactions
Grapefruit juice
Alcohol and Medication Interactions
Common Alcohol-Medication Interactions
Specific Alcohol-Medication Interactions
INTRODUCTION
Cancer is a general term used to refer to a condition where the body’s cells begin to grow and reproduce in an uncontrollable way. Lung cancers are the fourth most common cancer reported in the Indian males.
DEFINITION
Lung carcinoma is a malignant lung tumor characterized by uncontrolled cell growth in tissues of the lung. If left untreated, this growth can spread beyond the lung by the process of metastasis into nearby tissue or other parts of the body.
CAUSES
The most common causes of fracture include,
I. Tobacco smoke
Tobacco use is responsible for more than one of every six deaths. The younger a person is when he or she starts smoking, the greater the risk of developing lung cancer.
II. Secondhand smoke
Passive smoking has been identified as a possible cause of lung cancer in nonsmokers. People who are involuntarily exposed to tobacco smoke in a closed environment (house, automobile, and building) have an increased risk of lung cancer when compared with unexposed nonsmokers.
III. Environmental and occupational exposure
Various carcinogens have been identified in the atmosphere, including motor vehicle emissions and pollutants fromrefineries and manufacturing plants. High levels of radon have been associated with the development of lung cancer, especially when combined with cigarette smoking. Chronic exposure to industrial carcinogens, such as arsenic, asbestos, mustard gas, chromates, coke oven fumes, nickel, oil, and radiation has been associated with the development of lung cancer.
IV. Genetics
Some familial predisposition to lung cancer seems apparent, because the incidence of lung cancer in close relatives of patients with lung cancer appears to be two to three times that in the general population regardless of smoking status.
TYPES OF LUNG CANCER:
1. Small cell lung carcinoma
• Accounts for 15%-25% of lung cancers
• It is most malignant form
• Tends to spread early via lymphatic and bloodstream
• Is frequently associated with endocrine disturbances
• Predominantly central and can cause bronchial obstruction and pneumonia.
2. Non-small cell lung carcinoma
Is further classified by cell type,
Adenocarcinoma
• Most common type
• Accounts for approximately 30%-40% of lung cancers
• More common in women
• Often gas no clinical manifestations until widespread metastasis is present
• Usually begins in mucous glandular tissue, is most commonly located in peripheral portions of lungs.
Squamous cell carcinoma
• Second most common type of lung cancer
• Accounts for 30%-35% of lung cancers
• Is more common in men
• Arises from the bronchial epithelium of the lungs or bronchus, slow-growing cancer that usually begins in the bronchial tubes.
Large cell carcinoma
• The least common form
• Accounts for 5%-15% of lung cancers
• Composed of large sized cells that are anaplastic and often arise in the bronchi, commonly causes cavitation
• Is highly metastatic via lymphatic and blood.
STAGING OF NON-SMALL CELL LUNG C
The urinary system, also known as the renal system or urinary tract, consists of the kidneys, ureters, bladder, and the urethra. The purpose of the urinary system is to eliminate waste from the body, regulate blood volume and blood pressure, control levels of electrolytes and metabolites, and regulate blood pH.
Drugs using for GI system(pharmacology)varsha surkar
INC Syllabus • Antiemetics • Emetics • Purgatives • Antacids • Cholinergic • Anticholinergics • Fluid and Electrolyte therapy • Antidiarrheals • Histamines Composition, Action, Dosage, Route, Indications, Contraindications, Drug Interactions, Side effects, Adverse effects, Toxicity & Role of nurse Proton pump inhibitors
3. Antiemetics •Antiemetics are the Drugs which prevent or control the Vomiting/Nausea.
4. Antiemetics • Antiemetic are the drugs which prevent or control the vomiting/nausea. Classification Ondansetron 5HT3 AntagonistsGranisetron Dolasetron Domperidone Prokinetics / Dopamine AntagonistsOlanzapine Metoclopramide Cyclizine Antihistamines Diphenhydramine Meclozine Promethazine Hydroxyzine Hyoscine & Dicyclomine Anticholinergics
5. Mechanism of action • 5HT3 Antagonists: They block serotonin receptors in CNS and Gastrointestinal tract So they can be used to treat post operative and cytotoxic (Chemotherapy) drugs nausea/ vomiting. • Prokinetics (Dopamine Antagonists): They block the dopamine neurotransmitter also they promote gastrointestinal motility & quicken gastric emptying. • Antihistamines: They block the histamine neurotransmitter and they act by an effect on vomiting center and by producing sedation. • Anticholinergics: An Anticholinergic agents block the neurotransmitter Acetyl choline in central and peripheral nervous system.
6. Drug example and doses S. No. Drugs Doses 1 Hyoscine 200-600mg (SC) 2 Diclomine 40mg 6hourly 3 Cyclizine 50mg 4-6 hour 4 Meclizine 25mg/day. 5 Metoclopramide 10mg 6 Domperidone 10-20 mg 4-6hours 7 Ondansetron 8-16mg
7. Indications / Uses •5HT3 antagonists are used in management of nausea vomiting associated with chemotherapy. •Antihistamine such as diphen hydramine is used for motion sickness and morning sickness. •Metoclopramide is used for gastric emptying in patient’s receiving tube feeding. •Anticholinergic such as hyoscine, Dicyclomine are useful in travel sickness.
8. Contraindication / Precautions •Diphenhydramine is contraindicated in hypertensive patients. •Metoclopramide is contraindicated in suspected gastrointestinal problem. •Use cautiously and reduced dose in renal impairment conditions.
9. Adverse effects •Hypotension. •Constipation. •Dryness of mouth. •Blurred vision. •Pain in IM injection site. •Drowsiness. •Rectal irritation. •Photo sensitivity reaction.
10. Drug interactions •Use antihistamine, other CNS depressants including opioids and sedative – hypnotic drugs causes additive CNS depression. •Metoclopramide affects GI motility and alter GI absorption of other drugs such as salicylates, levodopa, diazepam, lithium, tetracycline.
11. Nursing Responsibilities •Assess the patient for nausea/vomiting and fluid and electrolyte imbalances. •Decrease metoclopramide dose 50% of usual recommended dose if creatinine clearance is less than 40ml/min. •Instruct the patient not to consume alcohol when taking an antiemetic drugs. •Advise the patient to take oral antiemetics 1hour.
Congenital anomalies of esophagus-Tracheoesophageal fistula, Esophageal atresia, esophageal stenosis, esophageal duplication cyst, esophageal webs or rings,, diverticulum of esophagus and congenital short esophagus
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
2. Genitourinary system
The genitourinary system or urogenital system is
the organ system of the reproductive organs and the urinar
system. These are grouped together because of their proximity
to each other, their common embryological origin and the use
of common pathways, like the male urethra
3. Drugs acting on Genitourinary
system
1. Antidiuretics
2. Diuretics
3. 5 alpha- reductase inhibitors for prostate enlargement
4. Alpha blockers for prostate enlargement
5. Antiinfectives in genitourinary medicines
6. Antigout agents
7. Ketoanalogues, amino acids
8. Spermicides
9. Urologicals
4. Anti- diuretics or Anti- Aquarectics
An antidiuretic is a substance that helps to control fluid balance
in a human body by reducing urination, opposing diuresis. Its
effects are opposite that of a diuretic.
Hormone (protein) secreted by posterior pituitary
(neurohypophysis)
The antidiuretic hormone class includes vasopressin (ADH),
argipressin, desmopressin, lypressin, ornipressin, oxytocin, and
terlipressin. Miscellaneous others include chlorpropamide and
carbamazepine.
Mechanism of action: It enhances water reabsorption from
the collecting ducts, it activates the V2 receptors on the cell
membrane thereby in creases the water permeability of the
cells.
5.
6.
7. Indications of Vasopressin
Diabetes Insipidus
Night time bed wetting
Hemophilia
Dehydration
Von Willebrand's Disease
Ventricular fibrillation
Gastrointestinal Hemorrhage
9. Side effects
Transient headache and flushing: frequent
Local Application: Nasal irritation, congestion, rhinitis,
ulceration, epistaxis
Systemic Side effects: belching, nausea, vomiting,
abdominal cramps, pallor, urge to defecate, backache
in females (uterine contraction)
Fluid retention, hyponatremia
Bradycardia, increased cardiac afterload, precipitate angina
10. Nursing Considerations
Monitor BP and weight throughout therapy. (Dose used to
stimulate diuresis has little effect on BP.) Report sudden
changes in pattern to prescriber.
Advise patient to drink 1– 2 glasses of water at time of
administration to minimize side effects (blanching of skin,
abdominal cramps, nausea).
Inform patient that these side effects are not serious and
usually disappear in a few minutes.
Caution patient to avoid concurrent use of alcohol while taking
vasopressin.
Patients with diabetes insipidus should carry identification at all
times describing disease process and medication regimen.
11. Research evidence
The role of oxytocin and vasopressin in central nervous system activity and mental disorders
Oxytocin and vasopressin, "peptides of love and fear", except for their classic role in control
of labor and breastfeeding and blood pressure regulation, are also implicated in various
processes like sexual behaviours, social recognition and stress response. These hormones
seems to be essential for appropriate and beneficial social interactions, play a very
important role in maternal care and closeness, promote general trust and cooperation and
prolong social memory. They also play a very important role in modulating fear and anxiety
response, especially by regulating the hypothalamic-pituitary-adrenal axis and amygdala
activity by its projections to the brain stem and hypothalamic structures. Both hormones,
particularly oxytocin, appears to be activating sexual behaviour or is responsible for
increased sexual arousal. Evidence from clinical trials suggests their potential role in
pathogenesis of schizophrenia, depression, autism and addiction together with possible
therapeutic use in the above conditions. In schizophrenia, patients with higher peripheral
oxytocin levels showed less severe positive, general and social symptoms and better
prosocial behaviours. Literature suggests that exogenous oxytocin may be effective as an
adjunctive therapy for that illness. Some data suggest that naturally occurring
autoantibodies reacting with oxytocin and vasopressin are involved in depression, eating
disorders and conduct disorder genesis.
12. Research Evidence
Terlipressin and albumin in patients with cirrhosis and type I
hepatorenal syndrome.
PURPOSE:Hepatorenal syndrome (HRS) is a pre-renal-like dysfunction that
generally onsets in cirrhotic patients presenting ascites. We investigated the
improvement of renal function in subjects with hepatorenal syndrome after
terlipressin administration and the survival times after this treatment. Fifty-
two patients affected by cirrhosis, with diagnosis of hepatorenal syndrome
were treated with intravenous terlipressin plus albumin (group A) or with
albumin alone (group B). Liver and renal function, plasma renin activity, and
aldosterone plasma levels were monitored. RESULTS:Patients from group A
showed a significant improvement (p < 0.001) of renal function valued by
creatinine rate compared with the results obtained in group B. The probability
of survival was higher in the group A (p < 0.0001).CONCLUSIONS:Our
results seem to confirm that the administration of terlipressin plus albumin
improves renal function in patients with cirrhosis and type I HRS and that a
reversal of hepatorenal syndrome is strongly associated with improved
survival.
14. Classes of Diuretics
Thiazide and Thiazide-like Diuretics
Loop Diuretics
Carbonic Anhydrase Inhibitors
Potassium-Sparing Diuretics
Osmotic Diuretics
Function of diuretic agent
Increase the amount of urine produced by the kidneys
Increase sodium excretion
15. Indications for Diuretic
Edema associated with congestive heart failure
Acute pulmonary edema
Liver disease (including cirrhosis)
Renal disease
Hypertension
Conditions that cause hyperkalemia
18. Contd..
Actions
Action is to block the chloride pump
Keeps chloride and the sodium in the tubule to beexcreted in
the urine, thus preventing the reabsorption of both in the
vascular system
Indications
Treatment of edema associated with CHF, liver, orrenal
disease
Monotherapy or adjuncts for the treatment ofhypertension
19. Contd…
Pharmacokinetics
• Well absorbed for the GI tract, metabolized in the
liver and excreted in the urine.
Contraindications
• Allergy to thiazides or sulphonamides
• Fluid and electrolyte imbalances, and renal and liver disease
• Bipolar disorders
• Pregnancy and lactation
21. Question
What is the action of thiazide diuretics?
A. Blocks the chloride pump
B. Blocks the sodium pump
C. Blocks the potassium pump
D. Blocks the carbonic anhydrase pump
22. Answer
A. Blocks the chloride pump
Rationale: Thiazide and thiazide-like diuretics act to block
the chloride pump. Chloride is actively pumped out of the
tubule by cells lining the ascending limb of the loop of
Henle and the distal tubule.
23. Loop Diuretics
Furosemide (Lasix)
– Most commonly used
Bumetanide (Bumex) and Torsemide (Demadex)
– New drugs,more powerful than Lasix
Ethacrynic acid (Edecrin)
– First loop diuretic introduced, used less frequently in
the clinical setting
24. Contd…
Action- Block the chloride pump in the ascending loop of
Henle. This causes reabsorption of sodium and chloride
Indications
• Acute CHF
• Acute pulmonary edema
• Edema associated with CHF
• Edema associated with renal or liver disease
• Hypertension
25. Contd..
Pharmacokinetics- Metabolized and excreted primarily
through the urine
Contraindications
• Allergy
• Electrolyte depletion
• Anuria
• Severe renal failure
• Hepatic coma
• Pregnancy and lactation
27. Carbonic Anhydrase Inhibitors
Action
– Block the effects of carbonic anhydrase; slow down the
movement of hydrogen ions
– More sodium and bicarbonate are lost in the urine
Indications
• Adjuncts to other diuretics
• Glaucoma
28. Contd..
Pharmacokinetics
• Rapidly absorbed and widely distributed
• Excreted in the urine
Contraindications
• Allergy
• Angle closure glaucoma
Adverse Effects
• Metabolic acidosis
• Hypokalemia
• Paresthesias of extremities, confusion, drowsiness
29. Question
Please answer the following statement as true or false.
The loop diuretics cause the body to excrete a copious
amount of potassium-rich urine.
30. Answer
False
Rationale: The loop diuretics have a similar effect in the
descending loop of Henle and in the distal convoluted
tubule, resulting in the production of a copious amount of
sodium-rich urine.
31. Potassium Sparing Diuretics
Action
• Cause a loss of sodium while retaining potassium
• Block the actions of aldosterone in the distal tubule
Indications
• Adjuncts with thiazide or loop diuretics
• Patients who are at risk for hypokalemia
Pharmacokinetics
• Well absorbed, protein bound, and widely distributed
• Metabolized in the liver and excreted in the urine
33. Osmotic Diuretics
Action – Pull water into the renal tubule without sodium loss
Indications
• Increased cranial pressure or acute renal failure due to
shock, drug overdose, or trauma
Pharmacokinetics
1. Freely filtered at the renal glomerulus, poorly reabsorbed
by the renal tubule
2. Not secreted by the tubule
3. Resistant to metabolism
35. Question
How do carbonic anhydrase inhibitors work?
A. Slow down the reabsorption of sodium
B. Speeds up creation of sodium bicarbonate
C. Balances acidic and alkaline solutes in urine
D. Slows down the movement of hydrogen ions
36. Answer
D. Slows down the movement of hydrogen ions
Rationale: Diuretics that block the effects of carbonic
anhydrase slow down the movement of hydrogen ions.
As a result, more sodium and bicarbonate are lost in the
urine.
37. Nursing Considerations
Monitor BP often and assess for orthostatic hypotension;
periodically assess weight as an index of fluid retention.
Lab tests: Monitor serum electrolytes, uric acid, blood glucose,
BUN, and creatinine periodically throughout the course of
therapy.
Monitor coagulation parameters and lithium levels in patients on
concurrent anticoagulant and/or lithium therapy.
Check weight at least weekly and report abrupt gains or losses to
physician.
Understand the risk of orthostatic hypotension.
Report symptoms of hypokalemia (see Appendix F) or hearing
loss immediately to physician.
Monitor blood glucose for loss of glycemic control if diabetic.
Do not breast feed while taking this drug without consulting
physician
40. Ketosteril
Mechanism of Action-It can provide essential amino acids
and reduce the intake of amino nitrogen. It can utilize the
nitrogen in non-essential amino and turn them into amino
acids so as to reduce the production of urea nitrogen. It can
reduce building up of uremic toxins in blood significantly.
Dosage / Direction for Use-Adults (70 kg/body
weight): 4-8 tablets 3 times daily during meals
41. Indications- Prevention and therapy of damages due to faulty
or deficient protein metabolism in chronic renal insufficiency in
connection with limited protein food of ≤40 g/day. Amino acid
deficiency, Incontinence, Asthma, Paracetamol poisoning,
Allergies, Radiation side effects, Alcohol, Copper poisoning,
Diaper rashes, Paracetamol over dosage, Depression
Contraindications
Hypercalcemia
Disturbed amino acid metabolism.
In case of hereditary phenylketonuria, it has to be taken into
account that Ketolog contains phenylalanine.
Adverse Reactions
Hypercalcemia may develop.
42. Nursing Considerations
Protein intake to be reduced
A protein-restricted diet can prevent/reduce waste load on
the kidneys so kidney function can be maintained. However,if
you do not have enough consumption of protein, you may
develop malnutrition.
The keto acids in ketosteril are amino acids without nitrogen,
inside the body they bind with body’s nitrogen and forms
proteins,so you are less prone to develop malnutrition.
Assess the serum creatinine and BUN levels. High creatinine
and BUN levels result from impaired kidney structure and
reduced renal function. Ketosteril only can reduce the
production of wastes in body to lower levels of creatinine and
BUN.
43. Anti-Gout
Gout is a familial metabolic disease characterized by recurrent
episodes of acute arthritis due to deposits of monosodium urate
in joints and cartilage.
Formation of uric acid calculi in the kidneys may also occur.
Treatment of gout is aimed at relieving the acute gouty attack
and preventing recurrent gouty episodes and urate lithiasis.
Common drugs are- Colchicine, Allopurinol, Febuxostat,
Lesinurad, Pegloticase, Probenecid, Rasburicase.
Mechanism of Action- Inhibits reabsorption of uric acid at
the proximal convoluted tubule. Also, inhibits renal tubular
secretion of weak organic acids, such as penicillins.
44. Indications
• Acute gouty arthritis
• For the prophylaxis of recurrent episodes of gouty arthritis
Contraindications-Blood dyscrasias, concurrent high-dose
aspirin therapy, severe renal impairment, uric acid calculi
Adverse Effects : Nausea, vomiting, abdominal pain,
Headache, Anorexia, Lower back pain, rashes, flushed face and
gingivitis.
45. Nursing Responsibilities
Monitor Serum uric acid.
Encourage patient to maintain a high fluid intake
(3000ml/day).
Monitor I/O charting, Output should be at-least
2000ml/day.
Avoid Alcohol.
Avoid high purine foods like meats and sweet breads.
Encourage for low purine foods like peanut butter, egg,
fruits and vegetables, Potatoes, rice and pasta.
48. Alpha blockers
These drugs work by relaxing the muscle at the bladder neck
thereby improving the flow of urine.
Uses-Benign prostatic hypertrophy.
Contraindications-Hypersensitivity to tamsulosin; in
conjunction with another alpha1A-adrenergic blocking agent;
lactation, pediatric patients.
Side effects include dizziness, postural hypotension,
headache and retrograde ejaculation.
Dosage-Adult: PO 0.4 mg q.d. 30 min after a meal, may
increase up to 0.8 mg q.d.
49. 5 alpha reductase inhibitors-
These drugs inhibit the conversion of testosterone to
dihydrotestosterone, the most potent androgen in the prostate
gland. This causes a “shrinkage” in the size of the prostate gland
thus helping to improve lower urinary tract symptoms. These
drugs take some months to work and the urinary symptoms do
not improve straight away.
Uses-Benign prostatic hypertrophy, male pattern hair loss
(androgenetic alopecia).
Dosage- Benign Prostatic Hypertrophy Adult: PO 5 mg/d
and Male Pattern Hair Loss Adult: PO 1 mg q.d.
Contraindications-Hypersensitivity
Side effects include loss of libido, impotence, and a reduction in
the volume of the ejaculate.
50. Anti-Cholinergics
These drugs act to inhibit bladder contractions and increase
bladder capacity.
Uses-Neurogenic bladder, BPH, Bladder infections, Enuresis
Contraindications-Hypersensitivity, narrow angle glaucoma,
myasthenia gravis, partial or complete GI obstruction, gastric
retention, paralytic ileus, megacolon, severe colitis, GU
obstruction, urinary retention, unstable cardiovascular status.
Dosage- 5mg b.d.
Side effects include dry mouth, constipation, blurred vision,
and tachycardia.
51. Nursing Responsibilities
Monitor for signs of orthostatic hypotension; take BP lying
down, then upon standing.
Make position changes slowly to minimize orthostatic
hypotension.
Keep physician informed of expected responses to drug therapy
(e.g., effect on urinary frequency, urgency, urge incontinence,
nocturia, completeness of bladder emptying).
52. Anti-infectives
Used to prevent or treat urinary tract infections.
Methenamine -e.g.Methenamine mandelate andMethenamine
hippurate
Nitrofurans –e.g.Nitrofurantoin
Quinoline derivative- e.g. Norfloxacin , Ciprofloxacin
53. Methenamine
Actions-Tertiary amine liberates formaldehyde in an acid
medium.
Uses-Prophylactic treatment of recurrent urinary tract
infections (UTIs). Also long-term prophylaxis when residual
urine is present (e.g., neurogenic bladder).
Dosage- 1g b d
Contraindications-Renal insufficiency, liver disease, gout,
severe dehydration
Adverse Effects -Nausea, vomiting, diarrhea, abdominal
cramps, anorexia, Bladder irritation, dysuria, frequency,
albuminuria and hematuria.
54. Nitrofurans
Actions-Synthetic nitrofuran derivative presumed to act by
interfering with several bacterial enzyme systems. Highly
soluble in urine and reportedly most active in acid urine.
Antimicrobial concentrations in urine exceed those in blood.
Uses-Pyelonephritis, pyelitis, and cystitis caused by susceptible
organisms.
Dosage- 50-100mg qid
Contraindications-Anuria, oliguria, significant impairment of
kidney function (creatinine clearance <40 mL/min); G6PD
deficiency; infants <3 mo. Safety during pregnancy (category
B), pregnancy at term, or lactation is not established
Adverse effects- Headache, Nausea, Anorexia, Arthralgia,
Pruritis and tooth staining.
55. Quinoline derivatives
Actions-Inhibits DNA-gyrase, an enzyme necessary for
bacterial DNA replication and some aspects of transcription,
repair, recombination, and transposition.
Uses-UTIs, lower respiratory tract infections, skin and skin
structure infections, bone and joint infections, GI infection
Contraindications-Known hypersensitivity to ciprofloxacin or
other quinolones and syphilis
Dosage- Adult: PO 500–750 mg q12h IV 200–400 mg q12h,
infused over 60 min
Side-effects- Nausea, vomiting, diarrhea, cramps, Transient
increase in eosinophilia count, Headache, vertigo, malaise,
peripheral neuropathy, seizures (especially with rapid IV
infusion), Pruritis, tendon pain and inflammation.
56. Nursing Responsibilities
Monitor urine pH; value of 5.5 or less is required for optimum
drug action.
Monitor I&O charting
Immediately report tendon inflammation or pain. Drug should
be discontinued.
Report sudden, unexplained joint pain.
Restrict caffeine due to the following effects (e.g., nervousness,
insomnia, anxiety, tachycardia).
57. Spermicides
Spermicide is an agent that kills spermatozoa (sperm).
Spermicide causes the sperm cell membrane to rupture, so the
sperm is unable to fertilize the egg. Creams, jellies, foams etc.,
containing chemical spermicides are used as contraceptives.
NONOXYNOL-9
Actions-Nonionic surfactant spermicidal incorporated into
foams, gels, jelly, or suppositories.
Therapeutic Effects-Applied over the cervix, blocks entrance
to uterus by sperm, traps and absorbs seminal fluid, then
releases the immediately available spermicide. Immobilizes
sperm by cell membrane disruption.
58. Uses-As barrier contraceptive alone or in conjunction with a
vaginal diaphragm or with a condom.
Topical Apply or insert 30–60 min before intercourse.
Contraindications-Cystocele, prolapsed uterus, sensitivity or
allergy to polyurethane or to nonoxynol-9; vaginitis; history of
TSS; pregnancy; immediately after delivery or abortion; during
menstruation.
Adverse effects-vaginal irritation and dryness; increase in
vaginal infections
59. Nursing responsibilities
Patient teaching
Stop using nonoxynol-9 if pregnancy is suspected.
Report symptoms of vaginal infection to physician: Burning,
inflammation, intense vaginal and vulvar itching, cheesy, curd-
like discharge, painful intercourse, dysuria. Nonoxynol-9
antifungal properties are weaker than its antibacterial potency,
thus vulvovaginal candidiasis frequently occurs.
Use spermicide before the first and every subsequent act of
intercourse.
60. Bibliography
Trounce’s Clinical pharmacology for nurses; Ben Greenstein;
Dinah gould; 18th ed;Elsevier publications;pg-161-190
Mosby’s Nursing Drug reference; Linda Skidmore; Roth;26th
ed;Elsevier publications;pg-33,40,129,1078,2045,97
http://www.pharmacologyeducation.org/drugs/genitourinary-
system
https://www.drugs.com/drug-class/genitourinary-tract-
agents.html
https://patient.info/in/medicine/the-genito-urinary-system-1272
http://www.mayoclinic.org/diseases-conditions/high-blood-
pressure/in-depth/diuretics/art-20048129
http://www.robholland.com/Nursing/Drug_Guide/data/monogra
phframes/T062.html