PYRAMID POINTS CHAPTER 62: RENAL MEDICATIONS. ADULT HEALTH: Renal Medications Elsevier items and...

PYRAMID POINTSPYRAMID POINTS

CHAPTER 62:CHAPTER 62:

RENAL MEDICATIONSRENAL MEDICATIONS

Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.

ADULT HEALTH:Renal Medications

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I. Urinary Tract AntisepticsI. Urinary Tract Antiseptics DescriptionDescription

• Inhibit growth of bacteria in urineInhibit growth of bacteria in urine

Side effects and nursing considerationsSide effects and nursing considerations• Cinoxacin (Cinobac)Cinoxacin (Cinobac)

Dosages should be reduced in clients with renal Dosages should be reduced in clients with renal impairment.impairment.

• Methenamine (Mandelamine, Hiprex, Urex)Methenamine (Mandelamine, Hiprex, Urex) Requires acidic urine with pH of 5.5 or lowerRequires acidic urine with pH of 5.5 or lower Increasing fluids reduces antibacterial effectsIncreasing fluids reduces antibacterial effects Should not be combined with sulfonamidesShould not be combined with sulfonamides Clients should avoid alkalinizing agents, including antacidsClients should avoid alkalinizing agents, including antacids



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I. Urinary Tract Antiseptics (continued) I. Urinary Tract Antiseptics (continued) Nalidixic acid (NegGram)Nalidixic acid (NegGram)

• May produce intracranial hypertension in pediatric clientsMay produce intracranial hypertension in pediatric clients• Can intensify effects of orally administered Can intensify effects of orally administered

anticoagulantsanticoagulants Nitrofurantoin (Furadantin, Macrodantin, Macrobid)Nitrofurantoin (Furadantin, Macrodantin, Macrobid)

• May cause pulmonary reactions, including dyspnea, May cause pulmonary reactions, including dyspnea, chest pain, alveolar infiltrateschest pain, alveolar infiltrates

• May produce harmless brown color in urineMay produce harmless brown color in urine• Contraindicated in clients with renal impairmentContraindicated in clients with renal impairment



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II. FluoroquinolonesII. Fluoroquinolones DescriptionDescription

• Suppress bacterial growth by inhibiting an enzyme Suppress bacterial growth by inhibiting an enzyme necessary for DNA synthesisnecessary for DNA synthesis

• Are active against a broad spectrum of microbesAre active against a broad spectrum of microbes Side effects and nursing considerationsSide effects and nursing considerations

• Administer with full glass of waterAdminister with full glass of water• Ensure maintenance of urine output of at least 1200 to Ensure maintenance of urine output of at least 1200 to

1500 mL/day1500 mL/day• Advise client to report dizziness, visual disturbances, Advise client to report dizziness, visual disturbances,

photophobia, feelings of depressionphotophobia, feelings of depression• Instruct client of signs of hepatic, renal toxicity; if they Instruct client of signs of hepatic, renal toxicity; if they

occur, report to physicianoccur, report to physician



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III. SulfonamidesIII. Sulfonamides DescriptionDescription

• Suppress bacterial growthSuppress bacterial growth• Are active against a broad spectrum of microbesAre active against a broad spectrum of microbes• Are used primarily to treat acute urinary tract infectionsAre used primarily to treat acute urinary tract infections

Side effects and nursing considerationsSide effects and nursing considerations• Should be discontinued if rash is notedShould be discontinued if rash is noted• Instruct client to complete entire course of antibiotics Instruct client to complete entire course of antibiotics

prescribedprescribed• Adults should maintain urine output of 1200 mL/dayAdults should maintain urine output of 1200 mL/day• IV doses should be administered over IV doses should be administered over

60 to 90 minutes, not mixed with other medications60 to 90 minutes, not mixed with other medications



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IV. Urinary Tract AnalgesicIV. Urinary Tract Analgesic DescriptionDescription

• Administered with an antibioticAdministered with an antibiotic

Side effectsSide effects• NauseaNausea

• HeadacheHeadache

• VertigoVertigo

Nursing considerationsNursing considerations• Instruct client that urine will turn red or orangeInstruct client that urine will turn red or orange



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V. Anticholinergics and AntispasmodicsV. Anticholinergics and Antispasmodics DescriptionDescription

• Relax smooth muscles of the urinary tractRelax smooth muscles of the urinary tract• Decrease bladder muscle spasmsDecrease bladder muscle spasms• Reduce urinary incontinence, urgency, and frequency by Reduce urinary incontinence, urgency, and frequency by

controlling bladder contractions controlling bladder contractions Side effectsSide effects

• Anticholinergic effectsAnticholinergic effects• DizzinessDizziness• DrowsinessDrowsiness

Nursing considerationsNursing considerations• Do not administer oxybutynin (Ditropan) to clients with known Do not administer oxybutynin (Ditropan) to clients with known

hypersensitivity, gastrointestinal or genitourinary obstruction, hypersensitivity, gastrointestinal or genitourinary obstruction, glaucoma, severe colitis, myasthenia gravisglaucoma, severe colitis, myasthenia gravis

• Monitor for signs of toxicityMonitor for signs of toxicity



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VI. Cholinergic MedicationsVI. Cholinergic Medications DescriptionDescription

• Increase bladder tone and functionIncrease bladder tone and function Side effectsSide effects

• HeadacheHeadache• HypotensionHypotension• Flushing and sweatingFlushing and sweating• Abdominal crampsAbdominal cramps• Urinary urgencyUrinary urgency

Nursing considerationsNursing considerations• Do not administer if client has urinary stricture or obstructionDo not administer if client has urinary stricture or obstruction• Monitor intake and outputMonitor intake and output• Monitor for cholinergic overdose (excessive salivation, Monitor for cholinergic overdose (excessive salivation,

sweating, involuntary urination and defecation, bradycardia, sweating, involuntary urination and defecation, bradycardia, and severe hypotension)and severe hypotension)



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VII. Medications for Prevention of Organ VII. Medications for Prevention of Organ RejectionRejection Include immunosuppressants, corticosteroids, Include immunosuppressants, corticosteroids,

cytoxic medications, antibodiescytoxic medications, antibodies



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VII. Medications for Prevention of Organ Rejection VII. Medications for Prevention of Organ Rejection (continued) (continued) Cyclosporine (Sandimmune, Gengraf, Neoral)Cyclosporine (Sandimmune, Gengraf, Neoral)

• Most common adverse effects are nephrotoxicity, infection, Most common adverse effects are nephrotoxicity, infection, hypertension, tremor, hirsutismhypertension, tremor, hirsutism

• Client should be instructed to monitor for early signs of Client should be instructed to monitor for early signs of infection; report immediatelyinfection; report immediately

• Instruct client to dispense oral liquid medication into glass Instruct client to dispense oral liquid medication into glass container using specially calibrated pipette, mix well, drink container using specially calibrated pipette, mix well, drink immediately, rinse glass container with diluent, drink to ensure immediately, rinse glass container with diluent, drink to ensure ingestion of complete doseingestion of complete dose

• Instruct client to mix medication with milk, chocolate milk, Instruct client to mix medication with milk, chocolate milk, orange juice just before administrationorange juice just before administration



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VII. Medications for Prevention of Organ VII. Medications for Prevention of Organ Rejection (continued) Rejection (continued) Sirolimus (Rapamune)Sirolimus (Rapamune)

• Increases risk of infection, renal injury, lymphocele, Increases risk of infection, renal injury, lymphocele, raises cholesterol, triglyceride levelsraises cholesterol, triglyceride levels

Tacrolimus (Prograf)Tacrolimus (Prograf)• Adverse effects include nephrotoxicity, infection, Adverse effects include nephrotoxicity, infection,

hypertension, tremor, neurotoxicity, hyperkalemiahypertension, tremor, neurotoxicity, hyperkalemia Prednisone (Deltasone)Prednisone (Deltasone)

• Hyperglycemia, hypokalemia can occurHyperglycemia, hypokalemia can occur Azathioprine (Imuran)Azathioprine (Imuran)

• Can cause neutropenia, thrombocytopeniaCan cause neutropenia, thrombocytopenia



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VII. Medications for Prevention of Organ Rejection VII. Medications for Prevention of Organ Rejection (continued) (continued) Mycophenolate mofetil (CellCept)Mycophenolate mofetil (CellCept)

• Major adverse effects include diarrhea, severe neutropenia, Major adverse effects include diarrhea, severe neutropenia, vomiting, sepsisvomiting, sepsis

Daclizumab (Zenapax), basiliximab (Simulect)Daclizumab (Zenapax), basiliximab (Simulect)• Contraindicated in clients with allergy to proteinContraindicated in clients with allergy to protein

Antithymocyte globulin, equine (Atgam)Antithymocyte globulin, equine (Atgam)• Before first infusion, client should undergo intradermal skin test Before first infusion, client should undergo intradermal skin test

for hypersensitivityfor hypersensitivity Muromonab-CD3 (Orthoclone OKT3)Muromonab-CD3 (Orthoclone OKT3)

• Adverse reactions include fever, chills, dyspnea, chest painAdverse reactions include fever, chills, dyspnea, chest pain



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VIII. Hematopoietic Growth FactorsVIII. Hematopoietic Growth Factors Erythropoietic growth factorsErythropoietic growth factors

• Major side effect is hypertensionMajor side effect is hypertension

Leukopoietic growth factorsLeukopoietic growth factors• Can cause bone pain, leukocytosis, elevation of plasma Can cause bone pain, leukocytosis, elevation of plasma

uric acid, lactate dehydrogenase, alkaline phosphatase uric acid, lactate dehydrogenase, alkaline phosphatase levelslevels

Thrombopoietic growth factorThrombopoietic growth factor• Adverse effects include fluid retention, cardiac Adverse effects include fluid retention, cardiac

dysrhythmias, conjunctival infections, visual blurring, dysrhythmias, conjunctival infections, visual blurring, papilledemapapilledema



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A client must begin medication therapy with mycophenolate A client must begin medication therapy with mycophenolate mofetil (CellCept) to prevent organ rejection following renal mofetil (CellCept) to prevent organ rejection following renal transplantation. The nurse plans to teach the client which of the transplantation. The nurse plans to teach the client which of the following teaching points?following teaching points?

1.1. Notify the physician if a fever develops. Notify the physician if a fever develops.

2.2. Take the medication with an aluminum-based antacid. Take the medication with an aluminum-based antacid.

3.3. Take the dose following meals. Take the dose following meals.

4.4. Open the capsule and mix with food before use. Open the capsule and mix with food before use.

PYRAMID POINTS CHAPTER 62: RENAL MEDICATIONS. ADULT HEALTH: Renal Medications Elsevier items and...

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