IV therapy/Pharm Test Urinary drugs part 1

Kidney Function and Medication

• Kidneys filter medications from the blood.
• Renal disease impairs kidney function, leading to drug toxicity.
• BUN and creatinine levels assess kidney function.
• Renal disease, urine pH changes, and age can impair medication effectiveness.
• If a person has renal disease the doctor may chose to put them on reduced amounts of medication so it doesn’t damage the kidney further and prevent drug toxicity.
• Altered urinary PH affect the absorption rate of certain
• Normal creatinine levels range from 0.6 to 1.3 mg/dL.
• Normal BUN levels range from 10 to 20 mg/dL.

Carbonic Anhydrase Inhibitors

• This class of diuretics excretes sodium, potassium bicarbonate, and water.
• Used primarily for glaucoma, also for altitude sickness, seizures, and heart failure (as diuretics)
• Decreases aqueous humor production, reducing intraocular pressure resulting in glaucoma being treated.
• Side effects include rare but serious blood disorders, nausea, vomiting, diarrhea, electrolyte imbalances(sodium and potassium) glucose disturbances, flu-like symptoms, and paresthesias.
• Notify doctor if pain in eye doesn’t decrease

Loop Diuretics

• These drugs excrete sodium and chloride (salt).
• Sodium excretion leads to water excretion. (Sodium follow water)
• Work in the loop of Henle
• Used for nephrotic syndrome, heart failure, pulmonary edema, and hypertension.
• Decreasing the amount of fluid in the body can lead to these Adverse effects include dehydration(dry mucus membranes and weight loss) hyponatremia, hypokalemia, hypochloremia,hypocalcemia, hypomagnesemia, hypotension, ototoxicity, and hyperglycemia.
• If we lose to much potassium our heart can increase or decrease (Low potassium=Heart issues)
• Assess for hearing loss or tinnitus (ototoxicity)
• Watch blood glucose (hyperglycemia) especially in diabetic patient because it can result in issues
• Contraindications are pregnancy,(only use if necessary)anuria, and severe kidney failure.
• Precautions include cardiovascular disease, diabetes, dehydration, electrolyte imbalances, gout, digoxin, lithium, ototoxic medications, NSAIDs, and antihypertensives.
• Hypokalemia increases digoxin toxicity risk. VERY IMPORTANT
• Excessive potassium loss requires potassium supplements because potassium keeps dropping.
• Combining with other antihypertensives can cause hypotension.
• Hypoatremia increases lithium toxicity.
• NSAIDs reduce kidney blood flow, decreasing loop diuretic effectiveness.

Potassium-Sparing Diuretics

• Used for hypertension, edema, and heart failure.
• Blocks aldosterone action in hyperaldosteronism.
• Major side effect is hyperkalemia (high potassium) because it holds potassium
• Other side effects include endocrine effects (deepened voice, impotence in men; menstrual irregularities in women), drowsiness, and metabolic acidosis.
• Interactions include ACE inhibitors, angiotensin receptor blockers, and direct renin inhibitors.
• Contraindicated in hyperkalemia, anuria, and severe kidney failure.
• Avoid high-potassium foods, salt substitutes, and potassium supplements.

Osmotic Diuretics

• Used for systemic or critically ill patients.
• Increases osmotic pressure in the proximal convoluted tubule of the kidney.
• Fluid shifts from tissues to circulatory vessels.
• Used for edema, diuresis, cerebral edema, intraocular pressure reduction, and acute renal failure management.
• Mannitol is a common osmotic diuretic.
• Contraindications include active intracranial bleeding, aneurysm, severe pulmonary edema, severe dehydration, and kidney failure.
• Adverse effects include heart failure, pulmonary edema, rebound intracranial pressure increase, fluid and electrolyte imbalances, and metabolic acidosis.
• Increases lithium excretion.
• Causes hypokalemia, increasing digoxin toxicity risk.
• Monitor urine output, blood pressure, pulse, respiratory rate, and neurological status in patients with increased intracranial pressure.

Thiazide and Related Diuretics

• Used for systemic edema, mild to moderate hypertension, diabetes insipidus, and calcium reabsorption in postmenopausal osteoporosis.
• Diabetes insipidus-Rare disorder that causes the body to produce too much urine and feel thirsty all the time.
• Adverse effects include electrolyte imbalances, dehydration, hyperglycemia, hyperuricemia, and joint pain.
• Precautions include liver disease, diabetes, lupus erythematosus, and diarrhea.
• Contraindicated in pregnancy, breastfeeding, and kidney impairment.
• Interactions include ACE inhibitors, angiotensin receptor blockers, and direct renin inhibitors.
• No increased risk of hearing loss as with loop diuretics.
• Do not administer to patients allergic to sulfa.

Diuretic Assessments

• Baseline assessments: Vital signs, weight, and lab values.
• Ongoing assessments: Fluid intake/output, dehydration signs, electrolytes, heart rate, and orthostatic hypotension.
• Education: Full treatment course, dietary changes, and potential adverse effects.

Effectiveness of Diuretics

• Effectiveness: Decreased intracranial/intraocular pressure, increased urine output, decreased blood pressure.
• Monitoring: BUN and creatinine levels for renal function, uric acid levels for gout, and glucose levels for diabetes.

General Tips

• Avoid late-day dosing to prevent nighttime urination and falls.
• Potassium-wasting diuretics patients eat potassium-rich foods.
• Potassium-sparing diuretics patients avoid potassium-rich foods, salt substitutes, and potassium supplements.
• Adequate kidney function is essential.
• Urine output should be at least 30 ml/hour for effectiveness.

Diuretic Medications

• Proper timing is crucial for effective condition management.
• Avoid reducing fluid intake to prevent dehydration, especially in elderly patients.
• Optimal administration times are typically 8 am and 2 pm, with a maximum dosage before 4:30 pm.
• Take with food or milk to reduce adverse effects.
• Avoid alcohol, as it's a diuretic and can interfere with medication.
• Avoid non-prescription medication use without medical approval.
• Caution while driving or performing hazardous tasks due to potential hypotension and dizziness.
• Increase fluid intake if dizziness/weakness occurs; seek medical attention if symptoms persist.
• Monitor weight weekly (more frequently as needed).
• Closely monitor blood glucose in patients with diabetes or those taking loop or thiazide diuretics.

Nursing Interventions

• Monitor for fluid overload (increased pulse/respiration, fluid in lungs, edema, unwell feeling) and deficit (decreased urine output, dry membranes, thirst, confusion).
• Daily morning weight.
• Frequent vital signs until stable.
• Monitor electrolytes (potassium, creatinine), and urine output.
• Encourage prescribed fluid intake.
• Limit salt intake.
• Recommend potassium-rich foods for patients on potassium-wasting diuretics (baked potatoes, bananas, apricots, oranges, dates, tomatoes, tomato juice, sweet potatoes, kale, and raisins).

This quiz covers essential concepts related to kidney function, medication filtering, and various classes of diuretics. It discusses the implications of renal disease on medication effectiveness and the specific uses and side effects of carbonic anhydrase inhibitors and loop diuretics. Test your knowledge on how these concepts are intertwined in pharmacology.