71 terms

week 8 (ch. 17 & 18)

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what is the function of the kidneys?
-the kidneys regulate fluid volume, electrolytes, acids, and bases
- secrete renin (enzyme) - help regulate BP
- secrete erythropietin - simulates RBC production
- produces calcitriol (active form of Vit. D) helps maintain bone homeostasis
which of the following is not function of the kidneys?
1) acid-base balance
2) secretion of renin
3) production of white blood cells
4) production of calcitriol
3) production of white blood cells
two important things for the kidney for drug levels are affected?
re-absorption and secretion (when the kidney is damaged these are affected therefore the drug serum levels are affected as well)
why is renal failure a significant problem for pharmacotherapy?
drugs will accumulate to high concentrations in the blood and tissues, resulting in toxicity
reason for acute renal failure?
heart failure, dysrhythmias, hemorrhage, dehydration
reasons for chronic renal failure (ESRD) end-stage renal disease
HTN, diabetes
what are the treatments for chronic renal failure?
dialysis and kidney transplant
what are renal impairment TX?
- diuretics
- cardiovascular drgus (treating underlying cause:HTN, heart failure)
- diet
- erythropoietin
what do diuretics do?
increased urine output
diseases treated by diuretics?
HTN, heart failure, kidney failure, pulmonary edema, liver failure or cirrhosis
How do diuretics work?
- block sodium (Na+) re-absorption in the nephron
- send more Na+ to the urine
- chloride ion (Cl-) follows sodium
- water molecules tend to stay with sodium ions
- blocking the re-absorption of sodium will increase the volume of urine
what are some LOOP diuretics?
- furosemide (lasix)
- torsemide (demadex)
how do Lasix work?
blocks re-absorption of Na+ in the loop of henle
- b/c of abundance of Na+ in the loop of henle, lasix is capable of producing large increases in urine output
What is a Thiazide Diuretic?
- act on the distal tubule
- b/c most Na+ has already been reabsorbed, thiazides produce less diuresis than lasix
what is the most effective diuretic?
Loop Diuretics
what is one thing we should watch for when taking off fluid on a patient?
Potassium (leading to dysrhythmias)
Forusemide (lasix) side effects?
dydration, hypotension, hyokalemia
what is the MOA of lasix?
blocks Na+ re-absorption in the loop of henle, increasing urine output
Thiazides are the most frequently prescribed class of diuretics?
true
how do thiazides work?
act on the distal tubule to block sodium re-absorption and increase water excretion
what are some SE for thiazides?
dehydration, dizziness, orthostatic hypotension, hypokalemia
what are examples of thiazides?
- Hydrochlorothiazide (microzide)
- chlorothiazide (diruril)
Hydrochlorothiazide (HCTZ) can be combined with drugs from other classes to treat HTN?
true: which allows for lower doses of each drug thus decreasing side effects
a patient newly diagnosed with hypertension will most likely be started on which of the following medications?
1) ethacrynic acid (edecrin)
2) chlorothiazide (diuril)
3) spirronolactone (aldactone)
4) mannitol
2) chlorothiazide (diuril)
along with diuretics, what do we try to minimize the loss of?
K+ (potassium)
what is a potassium sparing drug?
spironolactone (aldactone)
what does spironolactone do?
blocks aldosterone
what does aldosterone do?
secreted by adrenal cortex and promotes the retention of Na+
what is something we should not take while on potassium sparing drugs?
potassium supplements (leads to hyperkalemia)
what are some other commonly prescribed diuretics that have specific indications?
- acetazolamide (diamox)
- mannitol
what does diamox do?
is a carbonic anhydrase inhibitor used to decrease intraocular fluid pressure in patients with open-angle glaucoma
what does mannitol do?
maintain urine flow in patiens with acute renal failure or during prolonged surgery
- reduce swelling in the brain
- lower intraocular pressure in certain types of glaucoma
when assessing for dehydration, the nurse will look for:
1) headache and increased urinary output
2) weight gain and edema
3) hypertension and decreased urinary output
4) hypotension, headache, and dry mucous membranes
4) hypotension, headache, and dry mucous membranes
the patient recently started on diuretic therapy should be taught to:
1) take medication at night
2) rise slowly from a sitting position
3) increase sodium intake
4) decrease fluid intake
2) rise slowly from a sitting position
what are electrolytes?
small, inorganic molecules possessing a positive or negative charge essential to nerve conduction, muscle contraction, bone growth, and remodeling
what is the term for high or low sodium?
hypernatremia and hyponatremia
hypernatremia is caused by what?
kidney disease, Na+ accumulates in the blood due to decreased excretion
hyponatremia is caused by what?
burns, vomiting, diarrhea, kidney disease, excessive sweating or prolonged fever
Sodium Bicarbonate is what?
bicarbonate ion raises the pH of the body fluids
what are the indications for sodium bicarbonate?
acidosis (due to shock, cardiac arrest or DM) make the urine more basic to speed the excretion of acidic drugs like ASA and barbiturates
what are some SE?
alkalosis- confusion, irritability, slow respiratory rate, vomiting
what are certain diseases that cause HTN?
cushing's syndrome
hyperthyroidism
chronic renal disease
what are the primary antihypertensive agents?
-diuretics
- renin-andiotensin-aldosterone inhibitors
- calcium channel blockers
- beta-adrenergic blockers
the patient is taking forosemide (lasix) 40 mg BID. the patient should be monitored for:
1) hyperkalemia
2)hypokalemia
3) hypernatremia
4) hypercalcemia
2) hypokalemia
what do calcium channel blockers do?
CCB's block these channels to prevent Ca+2 from entering the cell (inhibits muscular contraction, at low doses cause vasodilation in arterioles, decrease blood pressure)
Calcium channel blockers treat what kind of cardiovascular diseases?
angina pectoris
cardiac dysrhythmias
HTN
what are some calcium channel blockers?
- nifedipine (procardia)
- diltiaxem (cardizem)
- verapamil (calan)
what are some SE to Procardia?
facial flushing, dizziness to avoid rebound hypertension
What does grapefruit juice do when taking CCB's?
enhances the absorption
Blocking the renin-angiotensin-aldosterone system leads to a decrease in blood pressure?
true
what does the renin-angiotensin-aldosterone system do?
- one of the primary homeostatic mechanisms controlling blood pressure and fluid balance in the body
- drugs that modify the RAAS decrease blood pressure and increase urine volume.
- block angiotensin II, thus decreasing blood pressure through two mechanisms: dilating arteries and decreasing blood volume
there are three ways to block this action?
- ACE inhibitors
- Angiotensin-receptor blockers
- inhibit renin (to transfer to angiotensin to angiotensin II
what do ACE inhibitors do?
inhibit angiotensin converting enzyme and reduces the formation of angiotensin II and aldosterone
what are SE for ACE inhibitors?
persistent dry cough, rarely andioedema (swelling around the lips, eyes, throat and other body regions)
what are some ACE inhibitors?
- enalapril (vasotec)
- captopirl (captoen)
- lisinopril (prinivil)
What are ARB's?
angiotensin-receptor blockers
- results in decreased BP
what are SE to ARB's
dizziness, facial flushing, does not cause cough
what are some ARB's
- irbesartan (avapro)
- losartan (cozaar)
- valsartan (diovan)
Drugs that inhibit renin directly?
-aliskiren (tekturna)
- combo drugs with HCTZ (tektuna Hct) and amlodipine (tekamlo)
what are SE with drugs that inhibit renin?
diarrhea, cough, flu-like symptoms, rash
Alpha and beta blockers can be used to treat hypertension?
true
What are SE for alpha blockers?
orthostatic hypotension, dizziness, nausea, bradycardia, dry mouth, impotence
what are SE for beta blockers?
slow HR, bronchoconstriction
what are some beta blockers drugs?
- atenolol (tenormin)
- metoprolol (lopressor)
- propranolol (inderal)
- carvedilol (coreg)
- "LOL" drugs
what is the MOA for atenolol?
relaxing blood vessels and slowing heart rate to improve flood flow and decrease blood pressure
what are some alpha blocker drugs?
- prazosin (minipress)
- terazonsin ( hytrin )
- doxaosin (cardura)
- tamsulosin (flomax) for BPH
Vasodilators lower blood pressure by relaxing arteriolar smooth muscle?
true
what are SE for vasodilators?
- lcompensatory reflex tachycardia (normal physiological response to sudden decrease in blood pressure, can be prevented with concurrent administration of a beta blocker)
- sodium and water rention (kidney retains more sodium and water, blood volume, increases, raises blood pressure....diuretic can be administered concurrently to prevent retention of water and sodium)
is vasodilators a drug of first choice?
no
what are some vasodilator drugs?
- nitroprusside (nitropress)
- hydralazine (apresoline)
- isosorbide dinitrate (isordil)
- nitroglycerin
the patient is on two antihypertensive drugs. the nurse recognizes that the advantage of multidrug treatment is
1) blood pressure decreases faster
2) adverse effects are fewer and patient adherence is greater
3) there is daily medication dosing
4) multidrug therapy treats the patient's other medical conditions
2) adverse effects are fewer and patients adherence is greater