306- Renal Pharm

How do ACE inhibitors work?

Block angiotensin II production, reducing vascular resistance.

What are major ACE inhibitor adverse effects?

Postural hypotension, angioedema, hyperkalemia.

What should nurses monitor with ACE inhibitors?

Blood pressure and kidney function.

What teaching helps prevent ACE inhibitor postural hypotension?

Move slowly when changing positions.

How do ARBs work?

Block angiotensin II receptors, causing vasodilation.

What major adverse effect is shared by ARBs and ACE inhibitors?

Angioedema.

What should nurses monitor with ARBs?

Blood pressure and kidney function.

How do ACE inhibitors and ARBs help protect the kidneys?

Reduce harmful angiotensin II effects and preserve GFR.

How do SGLT2 inhibitors help patients with CKD?

Reduce intraglomerular pressure, proteinuria, and kidney workload.

How do SGLT2 inhibitors increase urinary glucose?

Block sodium and glucose reabsorption in the proximal tubule.

What are major SGLT2 inhibitor adverse effects?

Polyuria, dehydration, UTIs, and genital fungal infections.

What should nurses monitor with SGLT2 inhibitors?

Vital signs, fluid status, glucose, and infection.

What dangerous complication can SGLT2 inhibitors cause?

Euglycemic diabetic ketoacidosis; glucose may not be very high.

How do phosphate binders work?

Bind dietary phosphate in the GI tract for fecal excretion.

Why are phosphate binders used in CKD? How do they effect calcium?

Lower phosphate and help preserve calcium balance for bones and heart.

When should phosphate binders be administered?

With meals or snacks.

What if a patient forgets a phosphate binder dose?

Take within 30 minutes of the meal or skip the dose.

What are common phosphate binder adverse effects?

Constipation, diarrhea, gas, nausea, and stomach pain.

What is sodium bicarbonate used for in CKD?

Treats metabolic acidosis by buffering excess hydrogen ions.

What are sodium bicarbonate adverse effects?

Bloating, sodium overload, edema, and metabolic alkalosis.

What should nurses monitor with sodium bicarbonate?

Fluid/electrolyte status, serum bicarbonate, and kidney function.

How do vitamin D analogs help CKD patients?

Increase calcium absorption and suppress PTH.

What is a major vitamin D analog adverse effect?

Hyperphosphatemia; monitor phosphate levels.

How do calcimimetics treat secondary hyperparathyroidism? (activates _____, reducing _____)

Activate calcium-sensing receptors, reducing PTH secretion.

What are major calcimimetic adverse effects?

Hypocalcemia, hypotension, nausea, vomiting, and diarrhea.

What symptoms may suggest hypocalcemia?

Muscle cramps, twitching, and increased neuromuscular excitability.

How do potassium binders lower serum potassium?

Bind potassium in the GI tract for fecal excretion.

Which newer potassium binders are listed in the notes?

Patiromer and sodium zirconium cyclosilicate.

What should nurses monitor with potassium binders?

Serum potassium levels.

How does epoetin alfa work?

Stimulates bone marrow red blood cell production.

How is epoetin alfa administered?

Subcutaneously or intravenously.

What are major epoetin alfa adverse effects?

Hypertension, headache, and thromboembolic events such as stroke or MI.

What should nurses monitor with epoetin alfa?

Blood pressure, labs, injection site, bone pain, and neurologic status.

How do statins lower cholesterol?

Inhibit HMG-CoA reductase, reducing liver cholesterol synthesis.

Which statins are listed in the notes?

Atorvastatin and rosuvastatin.

What are major statin adverse effects?

Rhabdomyolysis and hepatotoxicity.

What should nurses assess with statins?

Muscle pain and liver enzymes.

When can most statins be taken according to the notes?

At night, without regard to meals.

Which antibiotic damages bacterial DNA, proteins, and cell walls and is used for uncomplicated UTIs?

Nitrofurantoin.

What teaching is important for nitrofurantoin?

Take with food or milk; urine may turn brown.

How long is nitrofurantoin usually taken for uncomplicated UTIs?

Usually 5 days.

How does trimethoprim-sulfamethoxazole work?

Blocks two steps in bacterial folic acid synthesis.

What should be assessed before giving trimethoprim-sulfamethoxazole?

Sulfa allergy; monitor renal labs and CBC.

What important adverse effects can trimethoprim-sulfamethoxazole cause? ____ and _____

Photosensitivity and rare Stevens-Johnson syndrome.

What teaching is important with trimethoprim-sulfamethoxazole?

Increase fluid intake, use sun protection, and complete the antibiotic.

How does fosfomycin work?

Inhibits early bacterial cell wall synthesis.

How is fosfomycin usually administered for uncomplicated UTIs?

One oral dose of powder mixed thoroughly.

Where is fosfomycin excreted, and what UTIs is it used for?

Excreted in urine; used for lower uncomplicated UTIs.

What antibiotic class includes cephalexin and cefdinir?

Cephalosporins; beta-lactam antibiotics.

Which bacteria does cephalexin primarily target in the notes?

Gram-positive bacteria, including Streptococcus and Staphylococcus.

Which bacteria does cefdinir primarily target in the notes?

Gram-negative bacteria.

What should be checked before giving cephalosporins?

Penicillin/cephalosporin allergies, culture and sensitivity, renal and liver function.

Which supplements or products should not be taken with cefdinir?

Iron, iron-containing vitamins, and aluminum/magnesium antacids.

Why should cefdinir be separated from iron and certain antacids?

They reduce the medication's effectiveness.

How does amoxicillin-clavulanate work?

Amoxicillin inhibits cell wall synthesis; clavulanate blocks beta-lactamase.

What should be assessed with amoxicillin-clavulanate?

Allergies, renal function, liver function, and anticoagulant therapy.

How should amoxicillin-clavulanate be taken?

With food to enhance absorption.

What common adverse effects occur with amoxicillin-clavulanate?

Nausea, vomiting, and diarrhea.

What interaction warning is listed for amoxicillin-clavulanate?

May decrease birth control effectiveness.

How do fluoroquinolones such as ciprofloxacin and levofloxacin work?

Inhibit bacterial DNA replication; broad-spectrum bactericidal antibiotics.

When are fluoroquinolones used in the notes?

Complicated UTIs or resistant infections.

What serious FDA warning applies to fluoroquinolones?

Tendon and nerve adverse effects.

What CNS effects can fluoroquinolones cause, especially in older adults?

Dizziness, confusion, restlessness, and hallucinations.

Why should fluoroquinolones be avoided in myasthenia gravis?

They can worsen the condition.

What cardiac risk is associated with fluoroquinolones?

Potentially lethal arrhythmias.

How can fluoroquinolones affect glucose in patients taking antidiabetics?

May cause severe hypoglycemia or hyperglycemia.

What is phenazopyridine used for?

Relieves urinary burning and urgency; it does not treat the infection.

What must be obtained before starting phenazopyridine?

Urinalysis with culture and sensitivity.

What color change can phenazopyridine cause?

Orange or red urine.