Vitamins and Renal Physiology Quiz

Vitamin K (AquaMEPHYTON)

• Used to produce red blood cells (RBCs) and synthesize clotting factors
• Treats neonatal hemorrhagic disease
• Chosen antidote for warfarin overdose
• Takes 3-8 hours to stop bleeding

Vitamin B6 (Pyridoxine)

• Caution with Parkinson's medications; decreases their effectiveness
• Drug interactions affect levodopa

Vitamin C (Ascorbic Acid)

• Enhances iron absorption
• Used to improve wound healing

Renal Physiology

• Kidneys are major organs for excretion and homeostasis
• Maintain:
  • Fluid balance (influencing heart rate/blood pressure)
  • Electrolyte balance (preventing arrhythmias)
  • Acid-base balance (regulating K+/H+ levels)
• Endocrine functions:
  • Renin production
  • Erythropoietin production
  • Calcitrol (Vitamin D) synthesis

Diuretic Therapy

• Desirable for: edema, hypertension, heart failure, renal failure, liver failure/cirrhosis, pulmonary edema
• Common adverse effects:
  • Electrolyte imbalances (especially potassium)
  • Dehydration
  • Hypotension (monitor blood pressure and heart rate)

Loop (High Ceiling) Diuretics

• Block sodium reabsorption at the loop of Henle
• Administered orally or parenterally
• Extensively bound to plasma proteins
• Indications include edema

Loop (High-Ceiling) Diuretics - Considerations

• Complete health history necessary
• Monitor vital signs (apical pulse, rhythm, blood pressure)
• Establish safety precautions
• Observe older adults carefully
• Ensure ready access to bathroom
• Administer early in the day
• Monitor potassium levels!

Loop (High-Ceiling) Diuretics - Drugs Similar to Furosemide (Lasix)

• Bumetanide (Bumex): for ascites and peripheral edema
• Ethacrynic Acid (Edecrin): alternative for sulfonamide allergies; can cause severe hearing loss
• Torsemide (Demadex): twice as potent as furosemide

Thiazide and Thiazide-Like Diuretics - Considerations

• Encourage water intake over alcohol or caffeinated drinks
• Caution with electrolyte drinks
• Baseline and periodic electrolyte measurement
• Measure blood pressure before and during therapy
• Monitor intake and output (I&O)
• Monitor for therapeutic effectiveness
• Monitor for adverse effects

Potassium-Sparing Diuretics - Drug Interactions

• Acidosis with ammonium chloride decreases diuretic effects
• Aspirin and salicylates decrease diuretic effects
• Digoxin effects are decreased
• Hyperkalemia with potassium supplements, ACE inhibitors, and ARBs
• Additive hypotensive effects with other antihypertensives

Principles of Fluid Imbalance

• Body fluids constantly exchange between intracellular and extracellular compartments (ICF, ECF)
• Imbalance between intake and output can cause fluid imbalance disorders (e.g., shock, dehydration)

Principles of Fluid Imbalance - Electrolytes

• Electrolytes (charged substances) are essential for homeostasis
• Imbalances signal underlying medical conditions; treatment focuses on correcting the cause.
• Important electrolytes: sodium (Na+), potassium (K+), magnesium (Mg2+), calcium (Ca2+)

Pharmacotherapy of Electrolyte Imbalances - Adverse Effects

• Hypernatremia: monitor neurological status/level of consciousness (LOC)
• Symptoms of hypernatremia include: lethargy, confusion, muscle tremor/rigidity, hypotension, restlessness, pulmonary edema

Pharmacotherapy of Electrolyte Imbalances - Potassium (K+)

• Most abundant intracellular cation

• Insulin is key for maintaining potassium balance.

• Hyperkalemia (serum > 5 mEq/L): caused by excessive consumption or renal problems

• Hypokalemia (serum < 3.5 mEq/L): usually due to diuretic therapy (loops and thiazides)

Pharmacotherapy of Electrolyte Imbalances - Potassium (K+) Indications for Admin

• Preventing hypokalemia
• Treating hypokalemia
• Treating mild alkalosis

Pharmacotherapy of Electrolyte Imbalances - Magnesium (Mg2+)

• Second most abundant intracellular cation

• Essential for neuromuscular function

• Kidney regulates magnesium levels

• Hypomagnesemia (serum < 0.65 mmol/L): caused by renal problems and diuretics

• Hypermagnesemia (serum > 1.05 mmol/L): mainly caused by advanced renal failure

Pharmacotherapy of Electrolyte Imbalances - Magnesium (Mg2+) Adverse Effects

• Adverse effects: diarrhea, magnesium overdose, skin flushing, sedation, confusion, intense thirst, muscle weakness
• Serious adverse effects: neuromuscular blockade, respiratory paralysis, heart block, circulatory collapse

Pharmacotherapy of Electrolyte Imbalances - Calcium (Ca2+)

• Most abundant mineral in the body

• Hypercalcemia (serum > 2.5 mmol/L): often from overactive parathyroid glands

• Hypocalcemia (serum < 2.1 mmol/L): signs of underlying pathology; caused by calcium/vitamin D deficiency, hypothyroidism, drug therapy

Pharmacotherapy of Electrolyte Imbalances - Calcium (Ca2+) Adverse Effects

• Adverse effects: constipation, nausea, vomiting, metallic taste
• Serious adverse effects: hypercalcemia, dysrhythmias, cardiac arrest, confusion, delirium, stupor, coma

Pharmacotherapy of Electrolyte Imbalances - Calcium (Ca2+) Contraindications/Precautions

• Hypercalcemia, hyperparathyroidism, digoxin toxicity, renal/cardiac insufficiency
• Dysrhythmias, dehydration, diarrhea, sarcoidosis (metastatic bone disease), renal calculi, hyperphosphatemia

Neurodegenerative Diseases

• Progressive, irreversible loss of neurons
• Affects any age group
• Pharmacotherapy treats symptoms (no cure)
• Depression common

Pharmacotherapy of Parkinson's Disease

• Goal: balance dopamine and acetylcholine
• Treatment may take 2-3 weeks to see benefits

Parkinson's Disease - Dopamine Agonists

• Increase available dopamine by replacing, decreasing breakdown, increasing release, activating dopamine receptors

Parkinson's Disease - Anticholinergic Drugs

• Block acetylcholine's excitatory action, reducing abnormal muscle movements

Levodopa - Considerations

• Take on an empty stomach
• Avoid multivitamins/B6 and high-protein diets
• Safety precautions for ambulation due to potential dizziness; assist with activities of daily living (ADLs)
• Monitor liver and kidney function
• Avoid alcohol
• Watch for mood/behavioral changes (e.g., aggression, confusion)

Pramipexole - Considerations

• Assess baseline vital signs and Parkinson's Disease (PD) symptoms
• Monitor for orthostatic hypotension
• Monitor for tardive dyskinesia
• Assess mental status
• Alert patient/family about sleep attacks
• Ensure family understands that PD treatment is not a cure but might help symptoms for a time

Benztropine - Adverse Effects

• Adverse effects: sedation, constipation, blurred vision, dry mouth, decreased sweating, urinary retention, confusion
• Serious adverse effects: paralytic ileus

Benztropine - Contraindications/Precautions

• Closed-angle glaucoma, myasthenia gravis, tardive dyskinesia, GI/urinary obstructions, prostatic hypertrophy, peptic ulcers, tachycardia, alcohol

Benztropine - Drug Interactions

• Additive toxicity (antihistamines, tricyclic antidepressants, phenothiazines, MAOIs, quinidine)
• Additive sedative effect (alcohol, CNS depressants)
• Slow GI motility/decreased absorption (antidiarrheals)

Benztropine - Pregnancy Category C; Treatment of Overdose

• Treatment of overdose: physostigmine (1-2 mg subcutaneous or IV) to reverse anticholinergic intoxication

Pharmacotherapy of Alzheimer's Disease

• Modest results only; ineffective at stopping disease progression

Cholinesterase Inhibitors

• Tacrine, other reversible inhibitors
• Increase acetylcholine concentrations in the brain
• Goal: improve ADLs, behavior, cognition
• All drugs in this class are equally effective
• Gastrointestinal (GI) system most affected (nausea, vomiting, diarrhea)

Cholinesterase Inhibitors-Nursing Considerations

• Cognition, safety, independence, symptoms, baseline labs, vital signs (VS), vision, weight, liver and kidney function

Donepezil - Adverse Effects

• Adverse effects: Nausea, vomiting, diarrhea (N/V/D), anorexia, muscle cramps, syncope, ecchymosis, fatigue, arthralgia, abnormal dreams/hallucinations/confusion/depression, headache
• Serious adverse effects: life-threatening dysrhythmias, sinus bradycardia, seizures, renal failure, hepatotoxicity (monitor liver enzymes)

Donepezil - Treatment & Considerations

• Treatment of overdose: anticholinergic drugs to reverse
• Considerations: cognitive function/safety, baseline lab tests (especially liver/renal), symptoms, depression, agitation, anxiety, aggression/confusion
• Alert family to monitor for irregular heartbeat or chest discomfort.
• Evaluate alternative living arrangements, support groups (patient and family).
• Avoid alcohol

Multiple Sclerosis

• Unknown cause; characterized by demyelination secondary to inflammatory response (autoimmune)
• Leading cause of neurologic disability in 20-40 age group
• Symptoms include difficulty balancing, muscle weakness; exacerbation/remission pattern

Muscle Spasms

• NSAIDs and skeletal muscle relaxants used for treatment

Cyclobenzaprine - Considerations

• History and physical (including vital signs)
• Baseline neurologic status
• Assess for pain
• Protect from injuries (falls from drowsiness)
• Assess for skin reactions (urticaria, rash, pruritus)
• Inform patient not to drive.

Cyclobenzaprine - Similar Drugs

• Methocarbamol (Relaxin, Robaxin) - adjunct to physical therapy
• Metaxalone (Skelaxin) - ineffective against spasticity-related neurological disorders
• Orphenadrine (Banflex, Myophen, Norflex) - anticholinergic
• Tizanidine (Zanaflex) - for spasticity related to injury/MS

Muscle Spasticity

• Continuous contraction
• Pain more intense than spasms; causes greater impairment
• Irritable deep tendon reflexes, scissoring movements (lower extremities), fixed joint movement
• Caused by neuromuscular diseases, not a disorder itself

Dantrolene - Considerations

• History and physical (baseline neurologic/pain)
• Monitor VS during IV administration
• Assess for cardiopulmonary changes
• Watch liver function (liver function tests)
• Report jaundice
• Avoid alcohol
• Teach patient not to drive

Non-Pharmacologic Therapies

• Physical therapy (increases movement, prevents contractures)
• Herbal remedies (e.g., black cohosh, castor oil packs, capsaicin)

Test your knowledge on the important roles of Vitamin K, B6, and C, as well as their interactions and uses in medical contexts. Additionally, explore key concepts related to renal physiology and diuretic therapy. This quiz covers essential topics in pharmacology and body homeostasis.