Pharmacology - Kidney Drugs

8/8/2019 Pharmacology - Kidney Drugs

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Renal Pharmacology

Drugs affecting the Kidney


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Drug classification

The nursing process

applied to

pharmacology

Pharmacokinetics

Pharmacodynamic

s


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Diuretics

Agents that increase the amount

of urine produced by the kidneys


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Classes of Diuretics

Five major classes

1. Thiazides and thiazide-like

2. Loop diuretics

3. Potassium-sparing

4. Carbonic anhydrase inhibitors 5. Osmotic diuretics


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General indications for the use of

the diuretics Treatment of CHF

The sodium loss in the kidney is

associated with water loss


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the diuretics Treatment of Hypertension

Diuretics will decrease the blood

volume and serum sodium


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the diuretics Treatment of Glaucoma

Diuretics will provide osmotic

pull to remove some of the fluidfrom the eye to decrease the IOP


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time of administration of the

diuretics Usually in the morning!!


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Diuretics Comparison

Diuretic class Major site of

action

Special Side

effect (s)

1. Carbonic

anhydrase inhibitorProximal tubule Acidosis

2. Thiazide and

thiazide likeProximal tubule Hyperuricemia

Hypokalemia

3. Loop diuretics Loop of Henle Hypokalemia

Ototoxicity

4. Potassium

sparingDistal tubule Hyperkalemia

5. Osmotic diuretic Glomerulus Hypovolemia &

hypotension


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Diuretics Comparison

Diuretic class Special Uses

1. Carbonic

anhydrase inhibitorMountain sickness

Menieres disease

2. Thiazide and

thiazide like

Nephrolithiasis due to calcium stones

Hypocalcemia

3. Loop diuretics Hypercalcemia

4. Potassium

sparingCHF taking digoxin

5. Osmotic diuretic Increased ICP

LITHIUM TOXICITY


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Thiazides

Prototype: Hydrochlorothiazide

1. Bendroflumethiazide 2. Benthiazide

3. Chlorothiazide (Diuril)

4. Hydroflumethiazide

5. Methylclothiazide

6. Trichlormethiazide


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Thiazides

Pharmacodynamics

These drugs BLOCK the chloride pump

This will keep the Chloride and Sodium inthe distal tubule to be excreted into the

urine

Potassium is alsoflushed out!!


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Thiazide

Special Pharmacodynamics: Side effects

Hypokalemia

DEC

REASED calcium excretion

hypercalcemia

DECREASED uric acid secretion

hyperuricemia

Hyperglycemia


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Loop Diuretics

Prototype: Furosemide

1. Bumetanide 2. Ethacrynic acid

3. Torsemide


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Loop Diuretics

Pharmacodynamics

High-ceiling diuretics

BLOCK the chloride pump in theascending loop of Henle

SODIUM and CHLORIDE reabsorption is

prevented Potassium is also excreted together with

Na and Cl


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Loop Diuretics

Special Pharmacodynamics: side-effects

Hypokalemia

Bicarbonate is lost in the urine INCREASED calcium excretion

Hypocalcemia

Ototoxicity- due to the electrolyte imbalances


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Potassium sparing diuretics

Prototype: Spironolactone

1. Amiloride 2. Triamterene


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Pharmacodynamics

Spironolactone is an ALDOSTERONE

antagonist Triamterene and Amiloride BLOCK the

potassium secretion in the distal tubule

Diuretic effect is achieved by the sodiumloss to offset potassium retention


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Pharmacokinetics: Side effects

HYPERkalemia!

Avoid high potassium foods:

Bananas Potatoes

Spinach

Broccoli

Nuts

Prunes

Tomatoes

Oranges

Peaches


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Osmotic Diuretics

Prototype: Mannitol

1. Glycerin 2. Isosorbide

3. Urea


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Osmotic Diuretics

Pharmacodynamics

Mannitol is a sugar not well absorbed in

the nephron

osmotic pull of water

diuresis


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Carbonic Anhydrase Inhibitors

Prototype: Acetazolamide

1. Methazolamide


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Pharmacodynamics

Carbonic Anhydrase forms sodium

bicarbonate BLOCK of the enzyme results to slow

movement of hydrogen and

bicarbonate into the tubules

plus sodium is lost in the urine


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Pharmacokinetics: side effects

Metabolic ACIDOSIS happens when

bicarbonate is lost

Hypokalemia


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The Nursing Process and the

diuretics

ASSESSMENT

Assess the REASON why the drug is

given:______

______

____________


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diuretics

ASSESSMENT

The nurse must elicit history of allergy to

the drugsAllergy to sulfonamides may

contraindicate the use of thiazides

Assess fluid and electrolyte balance

Assess other conditions like gout,

diabetes, pregnancy and lactation


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diuretics

ASSESSMENT

Physical assessment

Vital signs Special electrolyte and laboratory examination

Assess symptom of body weakness which

may indicate hypokalemia


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diuretics

IMPLEMENTATION

Administer IV drug slowly

Safety precaution fordizziness/hypotension

Provide potassium RICH foods for mostdiuretics, with the exception of

spironolactone Provide skin care, oral care and urinary

care


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diuretics

IMPLEMENTATION

Monitor DAILY WEIGHT- to evaluate the

effectiveness of the therapy Monitor urine output, cardiac rhythm.

Serum electrolytes

ADMINISTER in the MO

RNING

! Administer with FOOD!


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diuretics

EVALUATION: for effectiveness of therapy

Weight loss

Increased urine outputResolution of edema

Decreased congestion

Normal BP

Pharmacology - Kidney Drugs

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