Kidney Disease Medications PDF

(Ch. 24-26 Adams) Treating HTN ============ 1. **Diuretics**-Manage volume overload when urinary elimination is still present (CKD not ESKD) a. **Loop-**act on Loop of Henle; create the greatest diuresis; reserved for more serious cases of HTN. [Risks hypokalemia & dehyd...

(Ch. 24-26 Adams) Treating HTN ============ 1. **Diuretics**-Manage volume overload when urinary elimination is still present (CKD not ESKD) a. **Loop-**act on Loop of Henle; create the greatest diuresis; reserved for more serious cases of HTN. [Risks hypokalemia & dehydration and are ototoxic leading to deafness, especially in renal failure, dehydration, headache] i. Examples- \*furosem**ide** (Lasix), bumetan**ide** (Bumex), torsem**ide** (Demadex) b. **Thiazide**-act on distal tubule, create diuresis; most common diuretics for HTN; [main risk] [urinary potassium loss=hypokalemia, and fatigue, dehydration] ii. Examples-\*hydrochlorothiaz**ide** (HCTZ) (Microzide), chlorothiaz**ide** (Diuril), metolazone (Zaroxolyn), indapam**ide** (Lozol), methyclothiaz**ide** (Enduron) c. **Potassium sparing**-only modest diuresis, but benefit is not potassium loss; [Risk is] [hyperkalemia causing dysrhythmias, dehydration] iii. Examples-spironolactone (Aldactone), amilor**ide** (Midamor), eplerenone (Inspra) 2. **Angiotensin-Converting Enzyme (ACE) inhibitors**-stops angiotensin I from converting to angiotensin II, which is strong vasoconstrictor=peripheral resistance that causes increased blood pressure plus it stimulates secretion of Aldosterone which increases Na+ reabsorption= water retention and increased fluid volume; [Risks-persistent cough, headache, postural hypotension, hyperkalemia, and] [angioedema] d. Examples- \*enala**pril** (Vasotec), benaze**pril** (Lotensin), capto**pril** (Capoten), fosino**pril** (Monopril), Lisino**pril** (Prinivil, Zestril), quina**pril** (Accupril) 3. **Angiotensin II Receptor Blockers (ARBs**)-blocks angiotensin II after it is formed so stops the vasoconstriction. [Risks are hypotension, and headache (Rarely angioedema and cough)] e. Examples-val**sartan** (Diovan), lo**sartan** (Cozaar), azil**sartan** (Edarbi), cande**sartan** (Atacand), epro**sartan** (Teveten), irbe**sartan** ( Avapro) 4. **Block Aldosterone receptors**-block aldosterone receptors in the kidneys f. Examples- spironolactone (Aldactone) and eplerenone (Inspra) these two are also known as potassium sparing diuretics 5. **Block renin before it becomes angiotensin I or I**I. [Risks are diarrhea, cough, flulike s/s and rash] g. Example- aliskiren (Tekturna). Also, marketed in combination with HCTZ as Tekturna HCT, with amlodipine as Tekamlo, with HCTZ and amlodipine as Amturnide and with valsartan as Valturna. 6. **Calcium Channel Blockers**- blocks calcium ion channels in arterial smooth muscle (this is blood vessels) they relaxes them causing vasodilation which causes decreased blood pressure because peripheral resistance is decreased. [Risks are flushing, headaches, impotence, sexual dysfunction. Also, when used with macrolide antibiotics (erythromycin and clarithromycin) it greatly increases changes of hypotension and shock!] h. Examples- Selective for blood vessels- amlodi**pine** (Norvasc), felodi**pine** (Plendil), nicardi**pine** (Cardene), nifedi**pine** (Adalat CC, Procardia XL); for blood vessels and heart- diltiazem (Cardizem, Dilacor)-antianginal; and verapamil (Calan, Isoptin, Verelan)-antidysrhyhmic 7. **Adrenergic Antagonists** i. **Beta-Adrenergic** Antagonists-first line for HTN they decrease the HR and contractility, they reduce cardiac output and lower systemic BP. They also ease symptoms of angina pectoris and treat dysrhythmias, HF, MI and migraines. [Risks are bradycardia (check apical), fatigue, decreased libido, impotence, and cause *bronchoconstriction* so don't use with asthma or HR patients. ] iv. Examples -- metopro**lol** (Lopressor, Toprol), proprano**lol** (Inderal), ateno**lol** (Tenormin), bisopro**lol** (Zebeta) j. **Alpha 1 Adrenergic blockers** -- only work on receptors in smooth muscle so no bronchial involvement. v. Examples -- doxa**zosin** (Cardura), pra**zosin** (Minipress), tera**zosin** (hytrin) k. **Alpha 2 Adrenergic blockers**- act on Central Nervous system to the heart and arterioles and slows heart rate and dilates vessels. [Risks are CNS effects such as dizziness & sedation, severe effects are hemolytic anemia, leukopenia, thrombocytopenia and lupus.] vi. Examples-clonidine (Catapres) & methyldopa (Aldomet) l. **Alpha 1 and Beta blocker combo** vii. Examples- carvedi**lol** (Coreg), and labeta**lol** (Normodyne) 8. **Direct Vasodilators**- direct relaxation of vascular smooth muscle... [but work too well and cause lots of problems. Such as... 1. reflex tachycardia (heart trying to compensate for such a quick drop in BP) but can give with a beta blocker to prevent this, and 2. sodium and water retention because of the drop in BP and decrease in blood flow to kidneys renin is released and stimulates aldosterone which reabsorbs sodium and water, but can give with diuretic very cautiously! ] m. Example -- nitropusside (Nitropress) used in HTN emergencies Treating Heart Failure ====================== 9. Diuretics a. Loop b. Thiazide c. Potassium sparing 10. Angiotensin-Converting Enzyme (ACE) inhibitors 11. Angiotensin II Receptor Blockers (ARBs) 12. **Direct vasodilators- BiDil** is a combo of isosorbide dinitrate and hydralazine and is especially effective in treating HF in African Americanpatients 13. **Cardiac Glycoside**-cause the heart to beat more forcefully and more slowly thus increase the cardiac output. Now used mainly in advanced cases of HR since unlike ACE inhibitors it doesn't reduce mortality from HF. [Risks are dysrhythmias especially in renal patients, N/V, fatigue, anorexia, and visual disturbances such as halos that are yellow-green tinge or blurring. Serum digoxin levels should be taken while a patient is on this medication.] n. Example -- digoxin (Lanoxin, Lanoxicaps) 14. **Phosphodiesterase Inhibitors**-block the enzyme phosphodiesterase in the cardiac and smooth muscle thus increasing contractility and decreases left ventricular afterload. They also cause vasodilation. [They have very serious toxicity risks so therapy is limited to 2 to 3 days and patients must be continuously monitored for ventricular dysrhythmias. Potassium levels must be normal before starting this medication.] o. Example- milrinone (Primacor)