Sweet Glomerulus: A Case of Diabetic Nephropathy

DRUG SITAGLIPTIN (JANUVIA) 25 mg OD

CLASSIFICATION MECHANISM INDICATION CONTRINDICATION/ ADVERSE
OF ACTION SPECIAL EFFECTS
PRECAUTION
Antidiabetic Agent Elevates the Adjunct C: Type I DM Headache
Incretin Modifier level of treatment of Diabetic Ketoacidosis Nasopharyngitis
incretin Type 2 SP: Moderate to URTI
hormones, Diabetis severe renal Peripheral edema
thus Mellitus in impairment Osteoarthritis
increasing combination Renal impairment Anorexia
insulin with exercise Renal failure Dizziness
secretion and and diet. Hemodialysis Hypoglycemia
reducing PREGNANCY
glucagon CATEGORY B
secretion.

NURSING CONSIDERATIONS

Assessment:
Monitor for s/sx of hypoglycemia
Monitor baseline and periodic creatinine clearance, FBS and RBS level
Assess for history of combined medication with insulin or metformin which could have addictive effect.

Pt. and Family Teachings:

Tech pt. that diet and exercise regimen must be followed.
Educate pt regarding Type2 diabetes and its management.
Emphasize that regular daily blood glucose monitoring amd periodic glycosylated hgb test must be done.
Instruct pt. to immediately notify physician if hypoglycemic or hyperglycemic episode occur.
Can be taken with food or meal or an empty stomach

Chapter 7
DRUG STUDY

25
 Sweet Glomerulus: A Case of Diabetic Nephropathy

DRUG SIMVASTATIN 10mg/tab OD

CLASSIFICATION MECHANISM INDICATION CONTRINDICATION/ ADVERSE
OF ACTION SPECIAL EFFECTS
PRECAUTION
Lipid regulating Inhibits To reduce LDL, C: Hypersensitivity to Abdominal
drug HMG- COA cholesterol and simvastatin pain
Antihyperlipidemic reductase triglycerides. Active liver disease Constipation
enzyme To increase HDL Hepatic Flatulence
which cholesterol in the encephalopathy Nausea
reduces treatment of Hepatitis Acid
cholesterol hyperlipidemia Jaundice Vomiting
synthesis; including Rhabdomyolysis Diarrhea
this enzyme hypercholesterole SP: History of liver Dyspepsia
is needed for mia disease Headache
cholesterol As prophylaxis to Alcoholic Insomnia
production hypercholesterole Renal Disease/ Rashes
mic pts with impairment Pruritus
ischemic heart Seizure disorder Dizziness
disease PREGNANCY Muscle
Coronary Heart CATEGORY X Cramps
Disease

NURSING CONSIDERATIONS

Assessment:
Monitor Creatinine phosphokinase level, serum cholesterol
Monitor for triglyceride, cholesterol baseline throughout treatment
Assess liver function test prior to therapy and periodically thereafter
Evaluate therapeutic response and Adverse reaction on a regular basis

Pt. and Family Teachings:

Instruct pt to take drug with evening meal- enhances absorption and increases cholesterol biosynthesis
Teach about proper dietary management of cholesterol and triglycerides. Recommend wt. control,
exercise and smoking cessation program.
Tell pt to notify physician if adverse reaction occur.

26
Sweet Glomerulus: A Case of Diabetic Nephropathy

27
 Sweet Glomerulus: A Case of Diabetic Nephropathy

DRUG SODIUM BICARBONATE 650mg/tab TID

CLASSIFICATION MECHANISM INDICATION CONTRINDICATION/ ADVERSE
OF ACTION SPECIAL EFFECTS
PRECAUTION
Anti- ulcer agent Increases Treatment of Metabolic or Edema
Alkalinizing agent plasma metabolic respiratory alkalosis Flatulence
Fluid and bicarbonate acidosis Hypocalcemia Gastric
Electrolyte which excess Use to Excessive chloride distension
Replacement buffers alkalinize loss Metabolic
Solution Hydrogen ion urine and Severe abdominal alkalosis
concentrations promote pain of unkown cause Hypernatremia
reverses excretion of esp if associated with Hypocalcemia
metabolic certain drugs fever Hypokalemia
acidosis in over SP; pts with CHF Sodium and
Neutralizes dosage Children with diabetic water retention
gastric acid situations ketoacidosis because tetany
which forms Used as taking sodium
NaCl, CO2, antacid bicarbonate increase
raises blood the riskof cerebral
pH edema

NURSING CONSIDERATIONS

Assessment:
Asses for alkalosis by monitoring the client for confusion, irritability, paresthesia, tetany and altered
breathing pattern
Pt. should be assessed for :
HYPERNATREMIA- edema, weight gain, hypertension, tachycardia, fever, flushed ski9n and mental
irritability
HYPOKALEMIA-weakness, fatigue, arrhythmis, polyuria and polydipsia
Monitor clients serum calcium, sodium, potassium, bicarbonate concentration, serum osmolarity, acid
base balance and renal function before and throughout the therapy
For peptic ulcer treatment, administer 1 hour before and 3hours after meal

DRUG CALCITRIOL (ROCALTROL) 0.25mg/tab OD

28
 Sweet Glomerulus: A Case of Diabetic Nephropathy

CLASSIFICATION MECHANISM INDICATION CONTRINDICATION/ ADVERSE

OF ACTION SPECIAL EFFECTS
PRECAUTION
Vitamin D Analog Stimulates Management of Hypercalcemia Low
Dietary/ absorption of hypocalcemia in pts. Hypersensitivity incidence
Nutritional calcium of the undergoing chronic Pts. known to suffer of skin
preparation GI tract, renal dialysis from aberrant calcium irritation
promotes Post menopausal metabolism
secretion from osteoporosis PREGNANCY
bones to hypoparathyroidism CATEGORY C
blood
Increase renal
tubular
resorption of
phosphate

NURSING CONSIDERATIONS

Assessment:
Determine baseline and periodic levels of serum calcium, phosphorous, alkaline phosphatase, creatinine
Monitor for hypercalcemia
Withhold calcitriol and calcium supplement and notify physician if hypercalcemia develops

Pt. and Family Teachings:

Do not use any other source of vitamin D during therapy, since calcitriolis the most potent form of
vitamin D to void possibility of hypercalcemia
Oral dose can be taken with food or meal or an empty stomach
Capsule should be protected from heat, light and moisture. Store in tightly closed container

DRUG EPOETIN ALFA 4,000 IU SQ every 10 days

CLASSIFICATION MECHANISM INDICATION CONTRINDICATION/ ADVERSE
OF ACTION SPECIAL EFFECTS
PRECAUTION
Blood Former, Mimics effect of Management of Uncontrolled Hypertension
Hematopoietic erythropoietin anemia hypertension and Tachycardia
Growth Factor which functions associated with known hypersensitivity Clotted VA
Antianemic Human as a CRF in dialysis to ammalian cell- Headache
Erythropoietin differentiating and predialysis derived products and Seizure
factor, pt. may reduce albumin Nausea and
enhancing RBC or obviate the SP: vomiting
production need for blood Pregnancy category C
transfusion in During HD, pt. may
need to increase
29
 Sweet Glomerulus: A Case of Diabetic Nephropathy

these patients anticoagulation to

May also be prevent clotting of VA
used to its pts.
with moderate
anemia before
elective surgery

NURSING CONSIDERATIONS

Assessment:
Control BP prior to initiation of therapy and closely monitor and control during therapy. Hypertension an
adverse effect must be controlled.
Monitor closely for thrombotic event. Pts may require additional heparin during dialysis to prevent
clotting of VA.

Pt. and Family Teachings:

Instruct to comply with antihypertensive medication and dietary restrictions.
Understand that headache is a common adverse effect. Report if severe or persistent, may indicate
developing hypertension
Do not shake solution. Shaking may denature glycoprotein rendering it biologically inactive.
Inspect solution for particulate matter prior to use. Do not use if solution is discolored.
Use only one dose per vial and do not reenter vial or pre filled syringe.

DRUG SEVELAMER CARBONATE (RENVELA) 800mg TID

CLASSIFICATION MECHANISM INDICATION CONTRINDICATION ADVERSE EFFECTS
OF ACTION / SPECIAL
PRECAUTION
Electrolyte and Polymer Reduction CI: Body as a
Water Water that binds of serum phosph Hypophosphatemi Whole: Headache,
Balance Agent intestinal orus in patients a infection, pain.
Phosphate Binder phosphate; with end-stage hypersensitivity to CV: Hypertension,
interacts kidney disease. sevelamer HCl hypotension,
with fecal impaction thrombosis.
phosphate bowel obstruction GI: Diarrhea,
by way of hypophosphatemi dyspepsia,
ion- a; appendicitis vomiting, nausea, cons
exchange a dysphagia tipation, flatulence.
nd GI bleeding, Respiratory: Increased
hydrogen major GI surgery; cough.
binding. SP:
Advantage GI motility
ously, does disorders
not contain vitamin
30
 Sweet Glomerulus: A Case of Diabetic Nephropathy

aluminum deficiencies (espe

or calcium cially vitamins D,
in treating E, and K and folic
hyperphos acid).
phatemia Pregnancy
in end Category: C
stage kidne
y failure.
Indicated
by
a serum ph
osphate
level 6.0
mg/dL.

NURSING CONSIDERATIONS

Assessment:
Lab tests: Obtain frequent serum phosphate levels.
Patient & Family Education
Do not use capsules after printed expiration date.
Take daily multivitamin supplement approved by physician.

31