Nr203 4Th Semester Renal Drugs/hepatic Drugs

Front 1

Classification/Sub Class ACE inhibitors

Generic/Trade Name Captopril, Fosinopril,(pril’s), Benazepril (Lotensin), accupril

Back 1

Captopril

Actions
Decrease in blood pressure without appearance of side effects
Decrease in signs and symptoms of CHF
Reduction of risk of death or development of CHF following MI
Decrease in progression of Diabetic Nephropathy

Side Effects SIDE EFFECTS
Rash. Pruritus, altered taste perception. Headache, cough, insomnia, dizziness, fatigue, paresthesia, malaise, nausea, diarrhea/constipation, dry mouth, tachycardia.
AGRANULOCYTOSIS, NEUTROPENIA, ANGIOEDEMA
Route IV,PO
Nursing Implications

Hypertension: Monitor blood pressure and pulse frequently during initial dose adjustment and periodically during therapy. Notify health care professional of significant changes. Monitor frequency of prescription refills to determine adherence. CHF: Monitor weight and assess patient routinely for resolution of fluid overload (peripheral edema, rales/crackles, dyspnea, weight gain, jugular venous distention).
Assess urine protein. Monitor WBC with differential in pts at risk for Neutropenia

Patient Teaching Warn pt not to discontinue ACE inhibitor therapy unless directed by doctor

Front 2

Classification/Sub Class Calcium Acetate Calcium Salts
Generic/Trade Name phosLo, calcium carbonate

Back 2

Actions
Calcium is essential for function, integrity of nervous, muscular, skeletal systems. calcium acetate Important role in normal cardiac/renal function, respiration, blood coagulation, cell membrane and capillary permeability. Assists in regulating release/storage of neurotransmitter/hormones. Neutralizes/reduces gastric acid (increase pH). Calcium Acetate: Combines with dietary phosphate, forming insoluble calcium phosphate.

Therapeutic Effect: Replaces calcium in deficiency states, controls hyperphosphatemia in end-stage renal disease.

SIDE EFFECTS
FREQUENT: Parenteral: Hypotension, flushing, feeling of warmth, nausea, vomiting; pain, rash, redness, burning at injection site; diaphoresis, decreased B/P. PO: Chalky taste. OCCASIONAL: PO: Mild constipation, fecal impaction, peripheral edema, metabolic alkalosis (muscle pain, restlessness, slow breathing, poor taste). Calcium carbonate: Milk-alkali syndrome (headache, decreased appetite, nausea, vomiting, unusual fatigue). RARE: PO: Difficult/painful urination

Nursing Implications BASELINE ASSESSMENT
Assess B/P, EKG/cardiac rhythm, renal function, serum magnesium, phosphate, potassium concentrations.

INTERVENTION/EVALUATION
Monitor B/P, EKG, cardiac rhythm, serum magnesium, phosphate, potassium, renal function. Monitor serum, urine calcium concentrations. Monitor for signs of hypercalcemia. Monitor pt on digitalis glycosides for signs of toxicity
Patient Teaching Stress importance of diet. Take tablets with full glass of water, ½–1 hr after meals. Give liquid before meals. Do not take within 1–2 hrs of other oral medications, fiber-containing foods. Avoid excessive alcohol, tobacco, caffeine. Do not administer concurrently with foods containing large amoungs of oxalic acid (spinach, rhubarb), phytic acid (brans, cereals), or phosphorus (milk or dairy products).

Front 3

Calcitriol, Vitamin D

Calcijex,

Back 3

Vitamin D
Calcijex, Rocatrol

Actions
Calcitriol is the active form of vitamin D, available in both oral and IV formulation. It promotes the intestinal absorption of calcium and elevates serum levels of calcium-for people on hemodialysis. This medication is used in cases when patients have impaired kidney function or have hypoparathyroidism. Calcitriol reduces bone reabsorption and is useful in treating rickets. The effectiveness of calcitriol depends on the patient receiving an adequate amount of calcium; therefore, it is usually prescribed in combination with calcium supplements. Tx and management of metabolic bone disease. Improves calcium/phosphorus homeostasis in pts with renal failure.

Side Effects
Headache, hypercalcemia, weakness, dry mouth, thirst, increased urination, and muscle or bone pain. Thiazide diuretics may enhance the effects of vitamin D, causing hypercalcemia. To much Vitamin D may cause dysrhythmia in patients receiving cardiac glycosides. Magnesium supplements should not be given concurrently due to increased risk of hypermagnesemia.

Nursing Implications
Carefully monitor the pt’s condition, Evaluate and monitor patients taking this lipid soluble vitamin, because accumulation can lead to toxicity. Before a patient begins treatment, the nurse should obtain a history of medications taken, and complete physical exam. Liver function tests are also done. Pts should be monitored for side effects such as hypercalcemia, headache, weakness, dry mouth, thirst, increased urination, and muscle or bone pain. Periodic electrolyte levels should be obtained, as vitamin D therapy may lead to abnormal serum levels of calcium, magnesium, and phosphate. Assess for symptoms of vitamin deficiency, bone pain, weakness.

Patient Teaching Consume dietary sources of vitamin D such as fortified milk. Take exactly as directed, because vitamin D can build to toxic levels if taken in excess quantities. Signs of overdose include fatigue, weakness, nausea, vomiting, and impairment of kidney function. Exposure to sunlight, 20 minutes a day, has been shown to supply enough vitamin D to prevent disease such as rickets. Avoid Alcohol and hepatoxic drugs. Avoid use of antacids containing magnesium

Front 4

epoetin alfa
Epogen, EprexJ,

Back 4

epoetin alfa
Epogen, EprexJ, Procrit

Actions
Stimulates division, differentiation of erythroid progenitor cells in bone marrow. Therapeutic Effect: Induces erythropoiesis, releases reticulocytes from marrow. Stimulates production of RBC (erythropoiesis). Treatment of anemia with associated chronic renal failure, management of anemica w/ AZT therapy in HIV, chemotherapy

Side Effects
CHRONIC RENAL FAILURE PTS:
Hypertension, headache, nausea, arthralgia.
Fatigue, edema, diarrhea, vomiting, chest pain, skin reactions at administration site, asthenia (loss of strength, energy), dizziness.

Nursing Implications BASELINE ASSESSMENT
Assess B/P prior to drug initiation (80% of pts with chronic renal failure have history of hypertension). B/P often rises during early therapy in pts with history of hypertension. Consider that all pts eventually need supplemental iron therapy. Assess serum iron (should be greater than 20%) and serum ferritin (should be greater than 100 ng/ml) prior to and during therapy. Establish baseline CBC (esp. note Hct). Monitor aggressively for increased B/P (25% of pts on medication require antihypertensive therapy, dietary restrictions).

INTERVENTION/EVALUATION
Monitor Hct level diligently (if level increases greater than 4 points in 2 wks, dosage should be reduced); assess CBC routinely. Monitor temperature, esp. in cancer pts on chemotherapy and zidovudine-treated HIV pts. Monitor BUN, serum uric acid, creatinine, phosphorus, potassium, esp. in chronic renal failure pts.

Patient Teaching Frequent blood tests needed to determine correct dosage. Inform physician if severe headache develops. Avoid potentially hazardous activity during first 90 days of therapy (increased risk of seizures in renal pts during first 90 days). Diet: increase iron (liver, pork, green veg. strawberries) decrease K+

Front 5

Aluminum hydroxide AlternaGel, Amphojel, Nephrox

Back 5

Aluminum hydroxide AlternaGel, Amphojel, Nephrox

Indications
For pts with increased phosphorus and decreased calcium in their system-(pts in renal failure)

Actions
Binds phosphates in GI tract to be excreted in feces

Side Effects
Constipation

Nursing Implications
Give with meals or times of phosphorus intake. Laxatives to treat constipation should be without Mg+
Assess location, duration, character, and precipitating factors of gastric pain

Patient Teaching
Take antacids at least 2 hours before other oral medications. Antacids directly affect the acidity of the stomach and may interfere with drug absorption-so don’t take within 1-2 hours of other meds
Note number and consistency of stools, since antacids may alter bowel activity
Medication may make stools appear white. Shake liquid preparations before dispensing

Expected Outcomes Normal phosphorus, Normal calcium

Front 6

Classification/Sub Class Folic Acid and vitamins Antianemic
Generic/Trade Name Folacin, Folvite

Back 6

Folic Acid and vitamins Antianemic
Folacin, Folvite Folate

Actions
Replaces water-soluble vitamins dialyzed off
Required for protein synthesis and red blood cell function. Stimulates the production of red blood cells, white blood cells, and platelets.

Indications
anemia Prevention and treatment of megaloblastic and macrocytic anemias

Side Effects
Uncommon.
May feel flushed following IV injections. Allergies are possible.
Continued weakness and fatigue. Rashes, fever
Nursing Implications Give after dialysis on days of dialysis. Assess for signs of megaloblastic anemia

Patient Teaching
Eat foods high in folic acid: veggies, fruits, and organ meats. Rest when tired and not to overexert. Plan activities to avoid fatigue. Avoid alcohol because it increases folic acid requirements. Comply with diet may make urine more intensely yellow.

Expected outcome Exhibit improvement in serum folic acid level.

Front 7

Classification/Sub Class
Hypokalemics

Sodium polystyrene (sulfonate) (Kayexalate c sorbitol)

Back 7

Hypokalemics
Sodium polystyrene (sulfonate) (Kayexalate c sorbitol)

Indications/
route Oral, rectal, for hyperkalemia

Actions Stimulates Production of RBCs, Ion exchange resin that releases sodium ions in exchange primarily for potassium ions. Removes potassium in the intestine before the resin is passed from the body. Reduces potassium levels

Side Effects
Diarrhea?, anorexia, nausea, vomiting, constipation, fecal impaction, hypocalcemia, hypokalemia

Nursing Implications Monitor K+ level frequently and stop med when K+ normal, assess EKG. Monitor magnesium, calcium levels. Monitor daily bowel activity, stool consistency, fecal impaction can occur on high doses. Monitor for fluid overload.

Patient Teaching
Stop meds call dr. if tinnitus, drink plenty of fluids

Expected Outcomes Lowers serum potassium.

Front 8

Ammonia Detoxican Laxative
Lactulose (Chronulac)

Back 8

Indications: Used for constipation and hepatic encephalopathy FECOR HEPATICUS (fecal breath), ammonia detox, laxative.

Actions:
Increases water content/ softens stool, decreases blood ammonia levels to poop it out

S.E.
Belching, cramps, distention, flatulence

NR Implications
Can be given as enema. Give on empty stomach, with 8 oz water or juice (improves flavor)

pt. teaching
Diet: increase bulk and fluids, call dr. if Diarrhea occurs.

Front 9

Aminoglycosides
Antibiotic
Neomycin Sulfate
(Mycifradin Sulfate)

Back 9

Neomycin Sulfate

Indications
Prepares GI tract for surgery, management of hepatic encephalopathy

Actions
Inhibits protein synthesis in bacteria

S.E.
Ototoxicity
Nephrotoxicity

NR Implications
Assess infection, hearing loss, vertigo, ataxia, N/V, Monitor I/O, daily wt, hydration and renal function, BUN, Cr. Neuro. Hydrate well. ALTERNATE INJECTION SITE

PT TEACHING
Stop meds call dr if tinnitus, drink plenty fluids

Front 10

Volume Expanders
Albumin

Back 10

Albumin

Indications
Fluid volume deficit, shock, hemorrhage, burns, portal hypertension, endstage liver disease.

Actions
Mobilize fluid from extravascular tissues back into intravascular space

S.E. PULMONARY EDEMA, FVO

NR implications
Monitor VS, CVP, I/O. If feer-Stop infusion and call the Dr. Assess for vascular overload, bleeding (no clot factors in albumin, solution clear, no sediment or discoloration.

Pt. teaching
Report s/s of hypersensitivity rx.