Urinary/Renal System Drugs: Diuretics

Drugs for Urinary/Renal System

• Diuretics decrease fluid volume by increasing urine output
• They are used for high blood pressure (HBP) and heart failure (HF)
• Common side effects include dry mouth, fluid and electrolyte imbalance, and increased thirst
• Diuretics should be taken during the day and weight should be checked daily
• Adverse effects include:
• Dehydration
• Hyperkalemia, specifically with potassium-sparing diuretics. The patient should report numbness of hands or feet or irregular heartbeat
• Low blood pressure is also an adverse effect. Patients should stand slowly to avoid orthostatic hypotension
• Hypokalemia is an adverse effect only with loop diuretics and thiazides and patients should report muscle spasms and abnormal heart rhythm

Loop Diuretics & Thiazides

• Furosemide has a suffix of -mide or -nide
• Hydrochlorothiazide (HCTZ) causes potassium wasting
• Interventions include increasing patient fluid intake, monitoring for low potassium (muscle spasms, weakness, fatigue) with normal potassium levels between 3.5-5.0, eating potassium-rich foods, and avoiding use with patients who have gout, due to increased uric acid

Potassium Sparing Diuretics

• Spironolactone (Aldactone) is an example and patients should avoid salt substitutes, potassium supplements, and potassium-rich foods as an intervention

Drugs for Benign Prostatic Hyperplasia (BPH)

• Common side effects include reduced libido and ejaculation volume and reduced prostate-specific antigen (PSA) levels. Patients should be taught to expect these.
• Tamsulosin requires avoiding use with patients who have a sulfa allergy and can cause orthostatic hypotension so patients need to change positions slowly
• With Finasteride, patients should report breast enlargement

Drugs for Overactive Bladder

• These drugs improve symptoms and reduce incontinence by relaxing the bladder muscle
• Common side effects include urinary urgency, dry mouth and teaching patients to keep hard candy to suck on, but no gum, blurred vision and patients should get regular eye exams, and constipation and patients should intake more water and fiber
• Oxybutynin (Ditropan)
• Bethanechol's adverse effects include bronchoconstriction, fecal incontinence, excessive gastric acid, and bradycardia
• Mirabegron requires monitoring for hypotension, teaching patients to report undesirable changes in urinary elimination, and has a possible adverse effect of nasopharyngitis

Antihyperlipidemics Drugs

• These drugs will lower LDL, treat coronary artery disease, and prevent myocardial infarction (MI)
• They are not safe for pregnancy
• Alcohol, aspirin, and grapefruit juice should be avoided
• Common side effects include
• Myopathy
• Rhabdomyolysis, which is muscle breakdown
• Patients should report muscle aches, changes in urine color (brown), or decreased urine output
• Hepatotoxicity and patients should be monitored for signs of liver issues
• Atorvastatin and Lovastatin (-statin) are examples
• Gemfibrozil can cause liver toxicity and cholelithiasis (gallstones) and patients should report inability to eat fried foods or bloating
• Alirocumab requires reporting hypersensitivity reactions and rotating subq injection sites
• Colesevelam should be avoided 4 hours before or after taking other medications, has to be mixed with 240 ml (8oz), and it can cause vitamin deficiency

Antihypertensive Drugs

• These drugs lower blood pressure and patient should avoid alcohol
• Common side effects include hypotension
• Vasodilators like Hydralazine treat angina. Stop if BP is below 100 or drops by 30. Normal side effects include hypotension, headache, and hot flushing
• Alpha 2 Agonists like clonidine require monitoring the patient for CNS effects and teaching the patient normal side effects. Do not stop suddenly due to rebound HBP
• Alpha 1 Blockers like doxazosin requires monitoring for side effects
• Calcium Channel Blockers (Nifedipine, Verapamil) lower BP & HR; Hold if HR is below 60 or BP under 100 systolic or big drop in either
• Common side effect: fluid retention Patients should report rapid heartbeat, increased angina, dizziness, syncope
• Beta Blockers (Atenolol, Metoprolol, Propranolol) lower BP & HR, check pulse daily before giving/taking med, nonselective agents affect both heart and lung receptors
• Hold for HF, asthma, & COPD Patients.
• The first sign of HF is lower extremity edema
• Side effects may include: breathing problems, blood sugar masking equal or less than 70, and bradycardia & low BP less than 60 HR or less than 100 Systolic
• ACE (Captopril) (-pril) & ARB (Losartan) (-startan) lowers BP
• Adverse effects include: birth defects, angioedema, and cough

Antianginals

• These drugs prevent angina and reduce the severity and frequency of angina attacks and treat HF after acute MI
• Adverse side effects include orthostatic hypotension, rapid heartbeat, weakness, vertigo, and paradoxical bradycardia
• Patient education: Teach male patients to avoid erectile dysfunction drugs while taking, to not drive or drink, keep tablets in a dark glass container
• Ranolazine requires monitoring for electrolytes imbalance, creatinine, BUN, and urine output, and no grapefruit
• Nitroglycerin/Isosorbide can be administered PO or transdermally

Antidysrhythmics

• These drugs make heart rhythm more regular, treat tachycardia, HF PTs, and reduces serious dysrhythmias
• Patients should monitor pulse rate & BP and report any new or distressing symptoms
• Patient should take drug exactly as needed, get regular checkups, and take with food
• Common side effects include GI manifestation as well as bradycardia & hypotension
• Epinephrine is used for cardiac dysfunction and anaphylaxis and patients should report any chest pains and to add Potassium+ foods to diet
• Digoxin, Dobutamine use is short term
• It is a second-line medication for HF and it decreases HR
• Side effects include anorexia and visual disturbance
• If digoxin is prescribed, be aware that it is a calcium blocker
• Take apical pulse for 1 full minute before giving this drug
• Monitor potassium levels and GI and CNS manifestations of toxicity
• Amiodarone is a potassium blocker and may cause photosensitivity, so patients need to get regular eye checks
• Quinidine (short term), Procainamide is a SODIUM blocker
• This drug makes the heart less excitable
• Patients should report fever, dry cough, and shortness of breath because the respiratory manifestation is ARDS
• There is a potential for adverse effects such as arterial embolism

Drugs for the Ears

• Debrox is used for ear wax removal and softens ear wax, but it is not for patients with an ear infection

Drugs for the Eyes

• These drugs are used for glaucoma
• Teach Patients not to rub eyes or drive at night
• • Betaxolol Ophthalmic drops cause stinging, burning, and eye discomforts
• Echothiophate decreases visual acuity and causes myopia
• Pilocarpine ophthalmic drops can cause urinary urgency and bradycardia. Patients should report this symptoms

Anticoagulants

• These medications prevent new clots and the growth of existing clots
• Used for patients recovering from MI heart attack and at risk for deep vein thrombosis
• DO NOT DISSOLVE CLOTS!
• Adverse effects
• Thrombocytopenia
• Bleeding and hemorrhage as well as bruising
• Allergic reactions
• GI manifestation
• Teach the patient to avoid OTC NSAIDs and aspirin and to use an electric razor for shaving and a soft toothbrush
• Clopidogrel should be taken with food and to report all adverse effects as it is a platelet inhibitor
• Diabigatran: a direct thrombin inhibitor for DVT, PE, and clotting
• Patients should not skip doses and report dark stool or hematoma to the healthcare provider
• Heparin (Enoxaparin) is an indirect thrombin inhibitor
• Adverse effects include shortness of breath
• It works fast
• Heparin is given IV or SubQ
• Warfarin (coumadin) works slowly but lasts longer than other anticoagulants
• May cause skin necrosis
• Patients should avoid green veggies due to increased vitamin K
• Requires PTT monitoring within the 46-70 range
• Normal INR ranges from 0.9-1.1, but is 2-3 when the patient needs anticoagulation

Thrombolytic Clot Busters

• These drugs dissolve and break down existing blood clots, so they are used for acute MI, PE, ischemic stroke, and arterial occlusion
• These are high-alert medications that are given via IV
• Adverse effects include shortness of breath, wheezing, chest tightness, and facial swelling

Hemorrhage

• This may include common side effects such as bleeding and hypotension

Erythropoietic Growth Factor

• These drugs make more red blood cells at a fast rate and are used for chemotherapy, HIV, and preoperative anemia
• Epoetin Alfa is given IV or subq
• Patients should teach PT: Reg BP checks and to Report headache, chest pain, vision changes as well as to check hematocrit / hemoglobin
• The medication should be held if hemoglobin is over 12 for a regular patient or 10 for a cancer patient
• Adverse effects may include hypertension, seizures, and heart problems like MI and HF

Drugs for Iron Deficiency Anemia

• Ferrous Sulfate causes dark stool
• Patients should increase fluids and fiber to avoid constipation and take with food
• Adverse effects include a metallic taste in the mouth and staining teeth
• Folic Acid is is usually given with iron and may cause yellowing of urine or increase risk for prostate cancer (long term use)
• Vitamin B12 requires reporting muscle weakness, palpitations, paresthesia, and nausea and to monitor K+ levels
• Adverse effects include erythema, hypertension, and hypokalemia