DRUGS ACTING ON THE RENAL SYSTEM

Irene L. Gardiner, MD
Pharmacology FEU Institute of Nursing

RENAL DRUGS
Diuretics Anti-infectives Antiseptics Antispasmodics Analgesics Cholinergics Hematopoietic Growth factors
renal drugs IRENE L. GARDINER, MD 2

DIURETICS
Any drug that elevates the rate of urination and thus provides a means of force diuresis

renal drugs

IRENE L. GARDINER, MD

INDICATIONS
Edema associated with CHF Acute pulmonary edema (left sided CHF) Liver disease (edema and ascites) Renal disease Treatment of hypertension Decrease fluid pressure in the eye (glaucoma)
renal drugs IRENE L. GARDINER, MD 4

renal drugs

IRENE L. GARDINER, MD

DIURETIC AGENTS
CONTRAINDICATIONS Allergy Electrolyte and water imbalance Severe renal diseases CAUTION SLE, DM, gout Pregnancy and lactation
renal drugs IRENE L. GARDINER, MD 6

NURSING RESPONSIBILITY
Monitor VS, weight gain, peripheral edema, urine output Monitor electrolytes, glucose, calcium and uric acid levels Instruct client to take the medication in the morning to avoid nocturia and sleep disturbance Instruct client to eat foods rich in potassium except when taking K+ sparing diuretics Administer IV drugs slowly to prevent severe changes in fluid and electrolytes
renal drugs IRENE L. GARDINER, MD

THIAZIDE DIURETICS
Belongs to the Sulfonamides Considered to be mild diuretics Not effective for immediate diuresis MOA block the chloride pump thereby preventing reabsorption of Cl- and Na+
Chloride is actively pumped out of the LH and DCT Sodium follows to maintain electrical neutrality
renal drugs IRENE L. GARDINER, MD 8

THIAZIDE DIURETICS
INDICATION Edema in CHF, renal and liver disease Adjunct in the treatment of HPN SIDE EFFECTS Hypokalemia weakness, cramps, arryhthmia Give K+ supplements hyperglycemia, hypercalcemia, hyperuricemia hyponatremia, hypovolemia hypotension, headaches, N/V
renal drugs IRENE L. GARDINER, MD 9

THIAZIDE DIURETICS
CHLORTHIAZIDE
Oldest drug, prototype

HYDROCHLOROTHIAZIDE
Most potent and most frequently used

THIAZIDE-LIKE DIURETICS

CHLORTHALIDONE INDAPAMIDE
renal drugs IRENE L. GARDINER, MD 10

LOOP DIURETICS
Exert their action in the loop of Henle Also called the HIGH CEILING DIURETICS
Causes the most diuresis than the other groups DOC when rapid and extensive diuresis is needed - vascular fluid volume, CO and BP

May be used in patients with renal and liver diseases

renal drugs IRENE L. GARDINER, MD

11

LOOP DIURETICS
ADVERSE EFFECT Electrolyte imbalance ALKALOSIS drop in blood pH Hypotension and dizziness Reversible ototoxicity and deafness

renal drugs

IRENE L. GARDINER, MD

12

LOOP DIURETICS
ETHACRYNIC ACID First loop diuretic FUROSEMIDE The most commonly used; less powerful than the others therefore safe for home use BUMETANIDE TORSEMIDE
renal drugs IRENE L. GARDINER, MD 13

CARBONIC ANHYDRASE INHIBITORS

MOA Inhibits the enzyme carbonic anhydrase which results in:
Decrease secretion of aqueous humor in the eye Loss of Hydrogen in the urine alkaline Loss of Sodium and Bicarbonate in the urine

INDICATION
To decrease IOP in open angle glaucoma Produces diuresis, manage epilepsy Used to treat metabolic alkalosis
renal drugs IRENE L. GARDINER, MD 14

CARBONIC ANHYDRASE INHIBITORS

ADVERSE EFFECTS
Related to the disturbance in acid - base and electrolyte imbalance METABOLIC ACIDOSIS Paresthesia, confusion and drowsiness

DRUGS ACETAZOLAMIDE METHAZOLAMIDE

renal drugs IRENE L. GARDINER, MD 15

POTASSIUM SPARING DIURETICS

MOA Act on the distal tubule to promote sodium and water excretion and potassium retention INDICATION Used for edema and hypertension, to increase urine output, to treat fluid retention and overloaded associated with CHF, hepatic cirrhosis and nephritic syndrome For diuretic induced hypokalemia
renal drugs IRENE L. GARDINER, MD 16

POTASSIUM SPARING DIURETICS

SIDE EFFECTS Hyperkalemia N/V, diarrhea, dry mouth, photosensitivity NURSING RESPONSIBILITIES Monitor VS, UO Monitor for S/S of hyperkalemia : N/V, diarrhea, abdl cramps, tachycardia followed by bradycardia, peaked narrow T wave on ECG, oliguria
renal drugs IRENE L. GARDINER, MD 17

POTASSIUM SPARING DIURETICS

SPIRONOLACTONE AMILORIDE TRIAMTERENE

renal drugs

IRENE L. GARDINER, MD

18

OSMOTIC DIURETICS
MOA Increase osmotic pressure of the glomerular filtrate, inhibiting reabsorption of water without Na+ loss INDICATION Used for oliguria and to prevent renal failure DOC in intracranial pressure Used to decrease IOP in narrow angle glaucoma Used with chemotherapy to induce diuresis
renal drugs IRENE L. GARDINER, MD 19

OSMOTIC DIURETICS
SIDE EFFECTS Fluid and electrolyte imbalance Pulmonary edema from rapid fluid shifts Nausea and vomiting Tachycardia from rapid fluid loss Dehydration
renal drugs IRENE L. GARDINER, MD 20

OSMOTIC DIURETICS
NURSING RESPONSIBILITY
Monitor VS, weight, UO, electrolyte levels Monitor lungs and heart sounds for signs of pulmonary edema Monitor for signs of dehydration, neurological status Assess for signs of decreasing ICP if appropriate Monitor for signs of CRYSTALLIZATION of mannitol prior to administration
renal drugs IRENE L. GARDINER, MD 21

OSMOTIC DIURETICS
MILD AGENTS For treatment of glaucoma GLYCERIN ISOSORBIDE POWERFUL AGENTS For ICP and acute renal failure MANNITOL UREA
renal drugs IRENE L. GARDINER, MD 22

URINARY TRACT ANTI-INFECTIVES

URINARY TRACT INFECTIONS Female Patients with catheters Signs and Symptoms Frequency and urgency Chills, fever, flank pain, tenderness
renal drugs IRENE L. GARDINER, MD 23

URINARY TRACT ANTI-INFECTIVES

ANTIBIOTICS Suppresses bacterial growth Ciprofloxacin Cotrimoxazole Nalidixic Acid

renal drugs

IRENE L. GARDINER, MD

24

URINARY TRACT ANTISEPTICS

Inhibit the growth of bacteria in the urine Act as disinfectants within the urinary tract Used to treat urinary tract infections These medications do not achieve effective antibacterial concentrations in blood or tissues and therefore cannot be used for infections at sites outside the urinary tract
renal drugs IRENE L. GARDINER, MD 25

URINARY TRACT ANTISEPTICS

DRUGS NITROFURANTOIN METHENAMINE NALIDIXIC ACID

renal drugs

IRENE L. GARDINER, MD

26

URINARY TRACT ANTISPASMODICS

OXYBUTININ

Relaxes smooth muscles of the urinary tract SIDE EFFECTS : leukopenia, anxiety, N/V, palpitations Nursing Responsibility : avoid hazardous activities
Decreases bladder muscle spasm SIDE EFFECTS : dry mouth, palpitations, blurred vison Nursing Responsibility : Provide gum or candy for dry mouth
IRENE L. GARDINER, MD 27

PROPANTHELINE BROMIDE

renal drugs

URINARY ANALGESIC
PHENAZOPYRIDINE HCL Used for pain from urinary tract infection or irritation exerts a direct, topical analgesic effect Administered with an antibiotic because it does not treat infection, it only treats pain
SIDE EFFECT
Nausea, headache and vertigo

Nursing Responsibilities
Instruct client that urine will turn red or orange
renal drugs IRENE L. GARDINER, MD 28

CHOLINERGICS
DESCRIPTION Used to treat non obstructive urinary retention and neurogenic bladder Used to increase bladder tone and function SIDE EFFECTS Headache, hypotension, flushing and sweating Increased salivation, abdominal cramps urinary urgency
renal drugs IRENE L. GARDINER, MD 29

CHOLINERGICS
NURSING RESPONSIBILITIES Do not give if with urinary obstruction Monitor for increased bladder tone Monitor for cholinergic overdose Have ATROPINE SULFATE (antidote) readily available DRUG : BETHANECOL
renal drugs IRENE L. GARDINER, MD 30

HEMATOPOEITIC GROWTH FACTORS

EPOITIN ALFA
Used to stimulate red blood cell production Reverses anemia associated with chronic renal failure Initial effects can be seen within 1-2 wks and the hematocrit reaches normal levels in 2-3 months SIDE EFFECT : Hypertension
renal drugs IRENE L. GARDINER, MD 31

HEMATOPOEITIC GROWTH FACTORS

NURSING RESPONSIBILITY Monitor CBC, VS, BP The extent of hypertension is directly related to the rate of rise in the hematocrit CI in patients with uncontrolled HPN or allergy to mammalian-cell derived products of human albumin Use with caution in clients with cancers of myeloid origin
renal drugs IRENE L. GARDINER, MD 32