renal/urinary system drugs & vitamins/electrolytes

what are the basic functions of the kidneys?

cleansing of ECF, maintenance of ECF volume, maintenance of acid base balance, excretion of metabolic wastes

what is the basic premise of how diuretics work?

block Na and Cl reabsorption → water follows salt so water, salt, and chloride stay in nephron and become excreted

what are the 5 types of diuretic medications and which are the most common in a med-surge setting?

thiazide & thiazide like diuretics, loop diuretics, carbonic anhydrase inhibitors, potassium sparing diuretics, osmotic diuretics → most common: thiazide, loop, potassium sparing

how do the classes of diuretics differ?

in their sites of action within the kidney and the intensity of their effects

what to assess on a patient when questioning if a diuretic is needed?

assess for fluid volume status (edema, BP, crackles, I&O), assess lab values (K, Na, glucose), assess renal function (BUN, creatinine)

what are some common thiazide & thiazide like medications?

hydrochlorothiazide (HCTZ; most common), chlorothiazide, chlorthalidone, metolazone

what are the uses for thiazides & thiazide like medications?

HTN, edema or heart failure, renal disease, liver disease → primarily dosed orally; most commonly used as a first line tx for HTN

what are some adverse effects of thiazides and thiazide like medications?

hypokalemia (potassium wasting), hypotension, CNS effects, hyperglycemia, hyperuricemia (incr uric acid in blood) → most common AE for DM patients are hypokalemia and hypotension

what are some nursing assessment/monitoring when patient is on thiazides/thiazide like medications?

monitor BP and electrolyte (K) status, monitor fluid status (hypoten, BUN, creatinine), be aware/cautious of chronic conditions like DM, gout, renal disease

what are some common loop diuretics?

furosemide, bumetanide, torsemide → can be dosed orally or IV

what are the uses for loop diuretics?

heart failure, acute pulmonary edema, edema d/t heart failure liver and renal disease, HTN → more potent and have shorter duration of action compared to thiazides; better for rapid fluid removal/acute situations

what are the adverse effects of loop diuretics?

hypokalemia (potassium wasting), hypotension, CNS effects, hyperglycemia, hyperuricemia, ototoxicity (most common when administered via IV push)

are loop diuretics recommended during pregnancy?

no (ld)

what is a common carbonic anhydrase inhibitor?

acetazolamide (diamox) → can be dosed orally or via IV; usually not first or only diuretic choice

what are some uses for carbonic anhydrase inhibitors?

glaucoma (most common use), heart failure fluid overload, can be used in epilepsy

what are some adverse effects of carbonic anhydrase inhibitors?

metabolic acidosis (carb anhydr is a catalyst for sodium bicarb so carb anhydr inhibitors slow the movement of H ions and more sodium bicarb is lost in urine and water follows), hypokalemia (potassium wasting), hyponatremia, tinnitus

what are some common potassium sparing diuretics?

spironolactone (most common), triamterene → dosed orally; used as an additive with other diuretics like loop or thiazide to counteract potassium wasting of the other meds

what are some uses of potassium sparing diuretics?

edema from heart failure liver or renal disease, diuretic-induced hypokalemia, additive for HTN tx, hyperaldosteronism (blocks androgen production; tx hormonal acne and PCOS)

what are some adverse effects of potassium sparing diuretics?

hyperkalemia (potassium accumulates), CNS effects, diarrhea

are potassium sparing diuretics recommended during pregnancy?

no (psd)

what is a common osmotic diuretic?

mannitol → pulls water into renal tubule without sodium loss; only administered via IV in ICU settings as it uses pressure to move large amounts of fluid in emergent situations

what are some uses for osmotic diuretics?

incr intracranial pressure, acute renal failure, acute glaucoma

what are some adverse effects of osmotic diuretics?

hypotension, fluid and electrolyte imbalances

why is the male urethra prone to obstruction?

it goes through the prostate gland

what are some common anti-infectives?

fosfomycin, trimethoprim-sulfamethoxazole (bactrim), methenamine, nitrofurantoin, trimethoprim → used to tx UTIs, cystitis (infection travels from urinary tract to bladder), pyelonephritis (infection travels from ureter to kidney)

what are some adverse effects of anti-infectives?

NVD, bladder irritation, dysuria

what are some important education topics about anti-infectives?

finish complete course, stay hydrated, take abx with food to minimize GU adverse effects

what is important to do before starting an anti-infective/abx?

take urine culture to ensure pathogen will be affected by med of choice, also want to assess for allergies

what are some common antispasmodics?

oxybutynin, tolterodine → anticholinergics (act on parasympathetic system by blocking signals that stimulate the bladder to contract); used for neurogenic bladder & overactive bladder

what are some adverse effects of antispasmodics?

anticholinergic effects like NV, dry mouth, tachycardia, decr sweating

what are some things to assess prior to administering an antispasmodic?

assess the patient’s baseline urinary symptoms and elimination pattern, also important to make sure pt is maintaining consistent fluid intake

what is an analgesic relating to UTIs/bladder?

phenazopyridine (pyridium or azo) → short-term med (< 2 days) used to tx pain specific to the urinary tract; often used in tandem with abx for UTI or post urinary surgical procedures

what are some adverse effects of phenazopyridine (analgesic)?

GI upset, causing orange/red tinge to skin and body fluids

what are the two types of medications given to tx BPH?

testosterone blockers (finasteride, dutasteride) and alpha 1 adrenergic blockers (doxazosin, tamsulosin (flomax), terazosin) → alpha blockers inhibit sympathetic NS (fight or flight)

what is the function of testosterone blockers in tx BPH?

address hypertrophy of prostate gland over time → work slowly, used long-term but does reduce prostate size

what is the function of alpha 1 adrenergic blockers in tx BPH?

work on the smooth muscle to allow for vasodilation and relaxation of the urethra → help with urine outflow; do NOT change size of prostate

what are some adverse effects of testosterone blockers for BPH?

GI upset, impotence, decr libido, breast enlargement/tenderness (gynecomastia)

what are some important education topics for those taking testosterone blockers for BPH?

limit caffeine & alcohol and avoid drinking fluids before bed as these can aggravate symptoms of BPH

what are some adverse effects of alpha 1 adrenergic blockers for BPH?

fatigue, dizziness, vertigo, sexual dysfunction

what are some important education topics for alpha 1 adrenergic blockers for BPH?

caution with other meds used to lower BP or for erectile dysfunction

what are some uses for administering ascorbic acid (vitamin C)?

vitamin deficiency, large wound healing, severe burns → can educate clients on getting this vitamin from dietary sources (borccoli, green peppers, spinach, brussel sprouts, citrus, tomatoes, potatoes) at home

what are some adverse effects of ascorbic acid/vitamin C?

NVD, also toxic in high doses

/what are some uses for administering cholecalciferol/vitamin D?

vitamin deficiency, bone diseases, hypocalcemia, hypoparathyroidism → can educate patient on getting this vitamin from dietary sources at home (dairy, cereals, orange juice, liver, fish, saltwater fish, butter, eggs, also sunlight)

what are some adverse effects of cholecalciferol/vitamin D?

NVD

what are some uses for cyanocobalamin/vitamin B12?

vitamin deficiency, anemia → can educate patient on getting this vitamin from liver, kidney, shellfish, eggs, milk, blue cheese, poultry

what are some adverse effects of cyanocobalamin/vitamin B12?

NVD, excess is excreted in urine (b12)

what are some uses for thiamine/vitamin B1?

vitamin deficiency → can be consumed in meat, poultry, fish, egg yolk, beans, whole grains, cereal, peanuts

what are some adverse effects of thiamine/vitamin B1?

NVD, excess is excreted in urine (thiamine)

what are some uses for folic acid/vitamin B9?

vitamin deficiency, pregnancy → important for RBC production and growth; can get this from liver, kidney beans, fresh greens, grains

what are some adverse effects of folic acid/B9?

NVD, excess is excreted in urine (folic)

what is calcium administered for?

deficiency, parathyroid dysfunction, bone and joint disorders → can get it from consuming liver, kidney beans, fresh greens, grains

what are some adverse effects of calcium?

NVD, cardiovascular effects

what are the different types of magnesium and what are they indicated for?

mg oxide (deficiency), mg hydroxide (antacid and mild laxative), mg citrate (strong laxative), mg sulfate (replacement and seizure prophylaxis)

what are the adverse effects of magnesium replacements?

cardiovascular effects in high amounts

when is the only time phosphorus is replaced?

for deficiency → adverse effects: NVD

when is potassium replaced/why is it used?

for deficiency → adverse effects: cardiovascular effects in high amounts, can be toxic if serum levels are too elevated >5.0, also never IV push K

when is sodium replaced/why is it used?

for deficiency → adverse effects: neurologic effects in too high or low states

what are some common forms of isotonic solutions?

0.9% NaCl “normal saline”, lactated ringers “LR”, 5% dextrose in water “D5W” → used for hypovolemia & NVD; adverse effects: fluid overload

what are some common hypotonic solutions?

0.45 NaCl “1/2 NS” & 5% dextrose in water “D5W” → used for hypernatremia; adverse effects: “cell swell”, cerebral edema, hypovolemia