PYRAMID POINTS CHAPTER 62 RENAL MEDICATIONS PYRAMID POINTS

PYRAMID POINTS CHAPTER 62: RENAL MEDICATIONS

PYRAMID POINTS I. Urinary Tract Antiseptics Description • Inhibit growth of bacteria in urine Ø Side effects and nursing considerations • Cinoxacin (Cinobac) Ø Dosages should be reduced in clients with renal impairment. • Methenamine (Mandelamine, Hiprex, Urex) Requires acidic urine with p. H of 5. 5 or lower Increasing fluids reduces antibacterial effects Should not be combined with sulfonamides Clients should avoid alkalinizing agents, including antacids ADULT HEALTH: Renal Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 2

PYRAMID POINTS I. Urinary Tract Antiseptics (continued) Ø Nalidixic acid (Neg. Gram) • May produce intracranial hypertension in pediatric clients • Can intensify effects of orally administered anticoagulants Ø Nitrofurantoin (Furadantin, Macrobid) • May cause pulmonary reactions, including dyspnea, chest pain, alveolar infiltrates • May produce harmless brown color in urine • Contraindicated in clients with renal impairment ADULT HEALTH: Renal Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 3

PYRAMID POINTS II. Fluoroquinolones Ø Description • Suppress bacterial growth by inhibiting an enzyme necessary for DNA synthesis • Are active against a broad spectrum of microbes Ø Side effects and nursing considerations • Administer with full glass of water • Ensure maintenance of urine output of at least 1200 to 1500 m. L/day • Advise client to report dizziness, visual disturbances, photophobia, feelings of depression • Instruct client of signs of hepatic, renal toxicity; if they occur, report to physician ADULT HEALTH: Renal Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 4

PYRAMID POINTS III. Sulfonamides Description • Suppress bacterial growth • Are active against a broad spectrum of microbes • Are used primarily to treat acute urinary tract infections Ø Side effects and nursing considerations • Should be discontinued if rash is noted • Instruct client to complete entire course of antibiotics Ø prescribed • Adults should maintain urine output of 1200 m. L/day • IV doses should be administered over 60 to 90 minutes, not mixed with other medications ADULT HEALTH: Renal Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 5

PYRAMID POINTS IV. Urinary Tract Analgesic Description • Administered with an antibiotic Ø Side effects • Nausea • Headache • Vertigo Ø Nursing considerations • Instruct client that urine will turn red or orange Ø ADULT HEALTH: Renal Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 6

PYRAMID POINTS V. Anticholinergics and Antispasmodics Ø Ø Ø Description • • • Relax smooth muscles of the urinary tract Decrease bladder muscle spasms Reduce urinary incontinence, urgency, and frequency by controlling bladder contractions Side effects • • • Anticholinergic effects Dizziness Drowsiness Nursing considerations • Do not administer oxybutynin (Ditropan) to clients with known hypersensitivity, gastrointestinal or genitourinary obstruction, glaucoma, severe colitis, myasthenia gravis • Monitor for signs of toxicity ADULT HEALTH: Renal Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 7

PYRAMID POINTS VI. Cholinergic Medications Ø Description Ø Side effects Ø • Increase bladder tone and function • • • Headache Hypotension Flushing and sweating Abdominal cramps Urinary urgency Nursing considerations • • • Do not administer if client has urinary stricture or obstruction Monitor intake and output Monitor for cholinergic overdose (excessive salivation, sweating, involuntary urination and defecation, bradycardia, and severe hypotension) ADULT HEALTH: Renal Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 8

PYRAMID POINTS VII. Medications for Prevention of Organ Rejection Ø Include immunosuppressants, corticosteroids, cytoxic medications, antibodies ADULT HEALTH: Renal Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 9

PYRAMID POINTS VII. Medications for Prevention of Organ Rejection (continued) Ø Cyclosporine (Sandimmune, Gengraf, Neoral) • Most common adverse effects are nephrotoxicity, infection, hypertension, tremor, hirsutism • Client should be instructed to monitor for early signs of infection; report immediately • Instruct client to dispense oral liquid medication into glass container using specially calibrated pipette, mix well, drink immediately, rinse glass container with diluent, drink to ensure ingestion of complete dose • Instruct client to mix medication with milk, chocolate milk, orange juice just before administration ADULT HEALTH: Renal Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 10

PYRAMID POINTS VII. Medications for Prevention of Organ Rejection (continued) Ø Sirolimus (Rapamune) • Increases risk of infection, renal injury, lymphocele, raises cholesterol, triglyceride levels Ø Tacrolimus (Prograf) • Adverse effects include nephrotoxicity, infection, hypertension, tremor, neurotoxicity, hyperkalemia Prednisone (Deltasone) • Hyperglycemia, hypokalemia can occur Ø Azathioprine (Imuran) • Can cause neutropenia, thrombocytopenia Ø ADULT HEALTH: Renal Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 11

PYRAMID POINTS VII. Medications for Prevention of Organ Rejection (continued) Ø Mycophenolate mofetil (Cell. Cept) • Major adverse effects include diarrhea, severe neutropenia, vomiting, sepsis Ø Daclizumab (Zenapax), basiliximab (Simulect) • Contraindicated in clients with allergy to protein Ø Antithymocyte globulin, equine (Atgam) • Before first infusion, client should undergo intradermal skin test for hypersensitivity Ø Muromonab-CD 3 (Orthoclone OKT 3) • Adverse reactions include fever, chills, dyspnea, chest pain ADULT HEALTH: Renal Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 12

PYRAMID POINTS VIII. Hematopoietic Growth Factors Erythropoietic growth factors • Major side effect is hypertension Ø Leukopoietic growth factors • Can cause bone pain, leukocytosis, elevation of plasma Ø uric acid, lactate dehydrogenase, alkaline phosphatase levels Ø Thrombopoietic growth factor • Adverse effects include fluid retention, cardiac dysrhythmias, conjunctival infections, visual blurring, papilledema ADULT HEALTH: Renal Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 13

A client must begin medication therapy with mycophenolate mofetil (Cell. Cept) to prevent organ rejection following renal transplantation. The nurse plans to teach the client which of the following teaching points? 1. 2. 3. 4. Notify the physician if a fever develops. Take the medication with an aluminum-based antacid. Take the dose following meals. Open the capsule and mix with food before use. ADULT HEALTH: Renal Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 14