Renal Medications

Name of Drug
Generic
(Trade)
Class Primary
Mode of
Action
Usual Dosage Range Side Effects Related
a! Studies
S"ecific Nursing
#nter$entions related to
drug
%&'urosemide
(asi()
Loop Diuretic Inhibits the
reabsorption of
sodium and
chloride from
the ascending
limb of the loop
of Henle,
leading to a
sodium-rich
diuresis.
Edema: Initially, 20
80 mgday !" as a single
dose. If needed, a second
dose may be gi#en in $8 hr.
If response is unsatisfactory,
dose may be increased in 20-
to %0-mg increments at $- to
8-hr inter#als. &p to
$00 mgday may be gi#en.
Intermittent dosage schedule
'2% consecuti#e days()* is
preferred for maintenance, or
20%0 mg I+ or I, 'slo( I,
in-ection o#er .2 min*. +ay
increase dose in increments
of 20 mg in 2 hr. High-dose
therapy should be gi#en as
infusion at rate not e/ceeding
% mgmin.
Acute pulmonary edema:
%0 mg I, o#er .2 min. +ay
be increased to 80 mg I,
gi#en o#er .2 min if
response is unsatisfactory
after . hr.
Hypertension: %0 mg bid !".
If needed, additional
antihypertensi#e agents may
be added.
CNS) Dizziness, vertigo,
paresthesias, xanthopsia, weakness,
headache, dro(siness, fatigue,
blurred #ision, tinnitus, irre#ersible
hearing loss
C*) Orthostatic hypotension,
#olume depletion, cardiac
arrhythmias, thrombophlebitis
Dermatologic) hotosensitivity,
rash, pruritus, urticaria, purpura,
e/foliati#e dermatitis, erythema
multiforme
G#) !ausea, anorexia, vomiting, oral
and gastric irritation, constipation,
diarrhea, acute pancreatitis, -aundice
GU) !olyuria, nocturia, glycosuria,
urinary bladder spasm
+ematologic) "eukopenia, anemia,
thrombocytopenia, fluid and
electrolyte imbalances,
hyperglycemia, hyperuricemia
,t-er) #uscle cramps and muscle
spasms
010, serum
electrolytes
'including
calcium*,
blood sugar,
li#er and renal
function tests,
uric acid,
urinalysis,
(eight
2dminister (ith food or mil) to
pre#ent 3I upset.
4educe dosage if gi#en (ith
other antihypertensi#es5 read-ust
dosage gradually as 1!
responds.
3i#e early in the day so that
increased urination (ill not
disturb sleep.
2#oid I, use if oral use is at all
possible.
.ARN#NG) Do not mi/
parenteral solution (ith highly
acidic solutions (ith pH belo(
6.7.
Do not e/pose to light, may
discolor tablets or solution5 do
not use discolored drug or
solutions.
Discard diluted solution after 2%
hr.
4efrigerate oral solution.
+easure and record (eight to
monitor fluid changes.
2rrange to monitor serum
electrolytes, hydration, li#er
function.
2rrange for potassium-rich diet
or supplemental potassium as
needed.
Name of Drug
Generic
(Trade)
Class Primary
Mode of
Action
Usual Dosage Range Side Effects Related
a! Studies
S"ecific Nursing
#nter$entions related to
drug
/& 0umetamide
(0ume()
Loop diuretic Inhibits the
reabsorption of
sodium and
chloride from
the pro/imal
and distal renal
tubules and the
loop of Henle,
leading to a
natriuretic
diuresis.
0.72 mgday !" in a single
dose5 may repeat at %- to 7-hr
inter#als up to a ma/imum
daily dose of .0 mg.
Intermittent dosage schedule
of drug and rest days is 6%
on.2 off, (hich is most
effecti#e (ith edema.
Parenteral
0.7. mg I, or I+. 3i#e
o#er .2 min. Dose may be
repeated at inter#als of 26
hr. Do not e/ceed .0 mgday
CNS) Asterixis, dizziness, #ertigo,
paresthesias, confusion, fatigue,
nystagmus, weakness, headache,
drowsiness, fatigue, blurred #ision,
tinnitus, irre#ersible hearing loss
C*) Orthostatic hypotension,
#olume depletion, cardiac
arrhythmias, thrombophlebitis
G#) !ausea, anorexia, vomiting,
diarrhea, gastric irritation and pain,
dry mouth, acute pancreatitis,
-aundice
GU) olyuria, nocturia, glycosuria,
renal failure
+ematologic) Hypokalemia,
leu)openia, anemia,
thrombocytopenia
ocal) ain, phlebitis at in$ection
site
,t-er) +uscle cramps and muscle
spasms, (ea)ness, arthritic pain,
fatigue, hi#es, photosensiti#ity, rash,
pruritus, s(eating, nipple tenderness
010, serum
electrolytes
'including
calcium*,
blood sugar,
li#er and renal
function tests,
uric acid,
urinalysis
3i#e (ith food or mil) to
pre#ent 3I upset.
+ar) calendars or use reminders
if intermittent therapy is best for
treating edema.
3i#e single dose early in day so
increased urination (ill not
disturb sleep.
2#oid I, use if oral use is
possible.
2rrange to monitor serum
electrolytes, hydration, li#er
function during long-term
therapy.
!ro#ide diet rich in potassium or
supplemental potassium.
Name of Drug
Generic
(Trade)
Class Primary
Mode of
Action
Usual Dosage Range Side Effects Related
a! Studies
S"ecific Nursing
#nter$entions related to
drug
1& C-lorot-ia2ide
(Diuril)
8hia9ide
diuretic
Inhibits
reabsorption of
sodium and
chloride in
distal renal
tubule,
increasing the
e/cretion of
sodium,
chloride, and
(ater by the
)idney.
Edema)
0.7---2 g !" or I, 'if patient
unable to ta)e !"* :id or bid.
+y"ertension)
0.7---2 gd !" as a single or
di#ided dose5 ad-ust dose to
1! response, gi#ing up to 2
gd in di#ided doses. I, use
is not recommended.
0;<= Dizziness, vertigo,
paresthesias, (ea)ness, headache,
dro(siness, fatigue
3I= !ausea, anorexia, vomiting, dry
mouth, diarrhea, constipation,
-aundice, hepatitis, pancreatitis
0,= "rthostatic hypotension, #enous
thrombosis, #olume depletion,
cardiac arrhythmias, chest pain
Hematologic= Leu)openia,
thrombocytopenia, agranulocytosis,
aplastic anemia, neutropenia, fluid
and electrolyte imbalances
3&= olyuria, nocturia, impotence,
loss of libido
Dermatologic= !hotosensiti#ity, rash,
purpura, e/foliati#e dermatitis
"ther= +uscle cramps and muscle
spasms, fe#er, hi#es, gouty attac)s,
flushing, (eight loss, rhinorrhea
010, serum
electrolytes,
blood glucose,
li#er and renal
function tests,
serum uric
acid, urinalysis
8a)e drug early in the day, so
sleep (ill not be disturbed by
increased urination.
>eigh yourself daily, and record
(eights.
!rotect s)in from e/posure to the
sun or bright lights.
Increased urination (ill occur.
&se caution if di99iness,
dro(siness, feeling faint occur.
4eport rapid (eight change,
s(elling in an)les or fingers,
unusual bleeding or bruising,
muscle cramps.
Name of Drug
Generic
(Trade)
Class Primary
Mode of
Action
Usual Dosage Range Side Effects Related
a! Studies
S"ecific Nursing
#nter$entions related to
drug
3&
C-lort-alidone
(+ygroton)
8hia9ide
diuretic
0hlortalidone
increases the
e/cretion of
sodium,
chloride, and
(ater into the
renal lumen by
inhibiting
sodium ion
transport across
the renal tubular
epithelium. Its
primary site of
action is in the
cortical diluting
segment of the
ascending limb
of the loop of
Henle.
+y"ertension= 27-.00
mgday !" or .00 mg 6
times(ee)5 usual dose range
is .2.7-27 mgday
Edema= 70-.00 mgday !"
or .00 mg e#ery other day5
not to e/ceed 200 mgday
+eart failure= .2.7-27 mg
!" :Day5 not to e/ceed .00
mg
Renal #m"airment=
0r0l ? .0 mLminute= Do
not use
0r0l ? 60 mLminute=
Ineffecti#e
dry mouth, thirst, nausea, #omiting5
feeling (ea), dro(sy, restless, or
light-headed5 fast or une#en
heartbeat5 muscle pain or (ea)ness5
urinating less than usual or not at all5
easy bruising or bleeding, unusual
(ea)ness5 red or purple spots on
your s)in5 numbness or tingly
feeling5 or nausea, stomach pain, lo(
fe#er, loss of appetite, dar) urine,
clay-colored stools, -aundice
'yello(ing of the s)in or eyes*.
010, serum
electrolytes,
blood glucose,
li#er and renal
function tests,
serum uric
acid, urinalysis
8a)e drug early in the day, so
sleep (ill not be disturbed by
increased urination.
>eigh yourself daily, and record
(eights.
!rotect s)in from e/posure to the
sun or bright lights.
Increased urination (ill occur.
&se caution if di99iness,
dro(siness, feeling faint occur.
4eport rapid (eight change,
s(elling in an)les or fingers,
unusual bleeding or bruising,
muscle cramps.
Name of Drug
Generic
(Trade)
Class Primary
Mode of
Action
Usual Dosage Range Side Effects Related
a! Studies
S"ecific Nursing
#nter$entions related to
drug
4& S"ironolactone
(Aldactone)
!otassium-
sparing
diuretic
2ldosterone
antagonist
0ompetiti#ely
bloc)s the
effects of
aldosterone in
the renal tubule,
causing loss of
sodium and
(ater and
retention of
potassium.
Edema: Initially, .00 mgday
'range 27200 mgday*
(hen gi#en as the sole
agent5 continue @ 7 days,
then ad-ust dose or add
another diuretic or both.
Diagnosis o%
hyperaldosteronism:
%00 mgday !" for 6%
() 'long test*.
0orrection of
hypo)alemia and
hypertension are
presumpti#e e#idence of
primary
hyperaldosteronism.
%00 mgday !" for %
days 'short test*. If
serum A
B
increases but
decreases (hen drug is
stopped, presumpti#e
diagnosis can be made.
#aintenance therapy %or
hyperaldosteronism: .00
%00 mgday !".
Essential hypertension: 70
.00 mgday !". +ay be
combined (ith other
diuretics.
Hypokalemia: 27
.00 mgday !".
CNS) Dizziness, headache,
drowsiness, fatigue, ata/ia,
confusion
Dermatologic) &ash, urticaria
G#) 'ramping, diarrhea, dry mouth,
thirst, #omiting.
GU) Impotence, irregular menses,
amenorrhea, postmenopausal
bleeding
+ematologic) Hyper)alemia,
hyponatremia, agranulocytosis
,t-er) 0arcinogenic in animals,
deepening o% the voice, hirsutism,
gynecomastia
010, serum
electrolytes,
renal function
tests,
urinalysis
4ecord alternate-day therapy on
a calendar, or prepare dated
en#elopes.
8a)e the drug early because of
increased urination.
>eigh yourself on a regular
basis, at the same time and in the
same clothing, and record the
(eight on your calendar.
2#oid foods that are rich in
potassium 'fruits, (anka*.
4eport (eight change of more
than 6 lb in one day,
s(elling in your an)les or
fingers, di99iness,
trembling, numbness,
fatigue, enlargement of
breasts, deepening of #oice,
impotence, muscle
(ea)ness or cramps.
Name of Drug
Generic
(Trade)
Class Primary
Mode of
Action
Usual Dosage Range Side Effects Related
a! Studies
S"ecific Nursing
#nter$entions related to
drug
5& Amiloride
(Midamor)
!otassium-
sparing
diuretic
!re#ent your
body from
absorbing too
much salt and
)eeps your
potassium
le#els from
getting too lo(
7-.0 mg once daily ;umbness or tingly feeling5 muscle
pain or (ea)ness5 slo(, fast, or
une#en heartbeat5 feeling dro(sy,
restless, or light-headed5 urinating
less than usual or not at all5 dry
mouth, increased thirst, tiredness,
nausea, #omiting5 shallo( breathing,
tremors, confusion or stomach pain,
lo( fe#er, loss of appetite, dar)
urine, clay-colored stools, -aundice
010, serum
electrolytes,
renal function
tests,
urinalysis
8a)e each does (ith a full glass
of (ater.
8a)e (ith food.
1e sure this medication is not
causing harmful effects, blood
(ill need to be tested regularly.
2miloride can interfere (ith the
results of a glucose tolerance
test, stop using this medication
for 6 days before you ha#e this
test.
Name of Drug
Generic
(Trade)
Class Primary
Mode of
Action
Usual Dosage Range Side Effects Related
a! Studies
S"ecific Nursing
#nter$entions related to
drug
6& Garamycin
(Gentamycin)
2minoglycosi
de
3entamicin is
an
aminoglycoside
that binds to
60s and 70s
ribosomal
subunits of
susceptible
bacteria
disrupting
protein
synthesis, thus
rendering the
bacterial cell
membrane
defecti#e.
6 mg)gday in three e:ual
doses : 8 hr I+ or I,. &p to
7 mg)gday in three to four
e:ual doses in se#ere
infections. Cor I, use, a
loading dose of .2 mg)g
may be infused o#er 60$0
min, follo(ed by a
maintenance dose, usually for
D.0 days.
!ID= 2 mg)g I, follo(ed by
..7 mg)g tid plus
clindamycin $00 mg I, :id.
0ontinue for at least % days
and at least %8 hr after patient
impro#es, then continue
clindamycin %70 mg orally
:id for .0.% days total
therapy.
<urgical prophyla/is
regimens= <e#eral comple/,
multidrug prophyla/is
regimens are a#ailable for
preoperati#e use5 consult
manufacturerEs instructions.
Di99iness or #ertigo5 acute renal
failure, interstitial nephritis, acute
tubular necrosis5 electrolyte
imbalances5 transient ele#ation of
serum bilirubin and
aminotransferases5 purpura5 nausea,
#omiting5 con#ulsions, mental
depression, hallucinations. 2trophy
or rat necrosis at in- sites.
!otentially Catal= ;ephroto/icity,
ototo/icity and neuromuscular
bloc)ade 'may unmas) or aggra#ate
myasthaenia gra#is*.
urinalysis,
1&;, serum
creatinine,
serum
electrolytes,
LC8s, 010
2pply ophthalmic preparations
by tilting head bac)5 place
medications into con-uncti#al sac
and close eye5 apply light
pressure on lacrimal sac for .
minute. 0leanse area before
applying dermatologic
preparations5 area may be
co#ered if necessary.
Fou may e/perience these side
effects= 4inging in the ears,
headache, di99iness 're#ersible5
use safety measures if se#ere*5
nausea, #omiting, loss of
appetite 'eat fre:uent small
meals, perform fre:uent mouth
care*5 burning, blurring of #ision
(ith ophthalmic preparations
'a#oid dri#ing or performing
dangerous acti#ities if #isual
effects occur*5 photosensiti9ation
(ith dermatologic preparations
'(ear sunscreen and protecti#e
clothing*.
4eport pain at in-ection site,
se#ere headache, di99iness, loss
of hearing, changes in urine
pattern, difficulty breathing, rash
or s)in lesions5 itching or
irritation 'ophthalmic
preparations*5 (orsening of the
condition, rash, irritation
Name of Drug
Generic
(Trade)
Class Primary
Mode of
Action
Usual Dosage Range Side Effects Related
a! Studies
S"ecific Nursing
#nter$entions related to
drug
7& Nalidi(ic acid
(Neg Gram)
:uinolone
antibacterial
+ar)ed
bactericidal
acti#ity against
most gram-
negati#e urinary
tract pathogens
(ith the
e/ception of
strains of
seudomonas.
2lso effecti#e
against some
strains of
(higella and
(almonella.
3ram-positi#e
bacteria are
relati#ely
resistant to drug
action.
2dults= . g administered four
times daily for one or t(o
(ee)s 'total daily dose, % g*.
CNS) headache, di99iness, #ertigo,
decrease in #isual acuity
G#) abdominal pain, nausea,
#omiting and diarrhea
Allergic= rash, purities, urticaria,
eosinophilia, Grythema
,t-er= paresthesia, metabolic
acidosis, hemolytic anemia
urinalysis,
1&;, serum
creatinine,
serum
electrolytes,
LC8s, 010
&se drug e/actly as prescribed
and do not change dosage.
"mitted doses, especially in
early days of therapy, may
promote de#elopment of
bacterial resistance. 8a)e full
amount of medication.
0ontact physician immediately
for une/plained beha#ior
changes or se#ere headaches.
+aintain ade:uate hydration
'20006000 mLd if tolerated*
during treatment period. 0onsult
physician if you notice a change
in your urination pattern.
2#oid e/posure to direct
sunlight or ultra#iolet light (hile
recei#ing drug. 0ontact
physician if photosensiti#ity
occurs. Fou may be
photosensiti#e up to 6 mo after
termination of drug.
0ontact your physician if you
notice #isual disturbances during
first fe( days of therapy.
<ymptoms usually disappear
promptly (ith reduction of
dosage or discontinuation of
therapy.
Do not breast feed (hile ta)ing
this drug (ithout consulting
physician.
Name of Drug
Generic
(Trade)
Class Primary
Mode of
Action
Usual Dosage Range Side Effects Related
a! Studies
S"ecific Nursing
#nter$entions related to
drug
8& Sulfiso(a2ole
(Gantrisin)
2ntiinfecti#e5
sulfonamide
<hort-acting
deri#ati#e of
sulfanilamide.
1acteriostatic
action belie#ed
to be by
competiti#e
inhibition of p-
aminoben9oic
acid '!212*,
thereby
interfering (ith
folic acid
biosynthesis
re:uired for
bacterial
gro(th.
Adult: P, 2% g initially,
follo(ed by %8 gd in %$
di#ided doses *aginal .
applicator full .2 timesd
CNS) Headache, peripheral neuritis,
peripheral neuropathy, tinnitus,
hearing loss, #ertigo, insomnia,
dro(siness, mental depression, acute
psychosis, ata/ia, con#ulsions,
)ernicterus 'ne(borns*. G#) !ausea,
vomiting, diarrhea, abdominal pains,
hepatitis, -aundice, pancreatitis,
stomatitis. +ematologic) 2cute
hemolytic anemia 'especially in
patients (ith 3$!D deficiency*,
aplastic anemia,
methemoglobinemia,
agranulocytosis, thrombocytopenia,
leu)openia, eosinophilia,
hypoprothrombinemia. 0ody as a
.-ole) Headache, %ever, chills,
arthralgia, malaise, allergic
myocarditis, serum sic)ness,
anaphylactoid reactions,
lymphadenopathy, local reaction
follo(ing I+ in-ection, fi/ed drug
eruptions, diuresis, o#ergro(th of
nonsusceptible organisms, LG
phenomenon. S9in) !ruritus,
urticaria, rash, erythema multiforme
including (tevens)*ohnson syndrome
ex%oliative, dermatitis, alopecia,
photosensiti#ity, #ascular lesions.
Urogenital) 'rystalluria,
hematuria, proteinuria, anuria, to/ic
nephrosis, reduction in sperm count.
Meta!olic) 3oiter, hypoglycemia.
S"ecial Senses) 0on-uncti#itis,
con-uncti#al or scleral infection,
"btain a
specimen for
0H< prior to
initiation of
therapy.
!erform
fre:uent
)idney
function tests
and urinalyses5
complete
blood counts
and li#er
function tests,
especially
during
regimens
longer than 2
().
Do not ta)e "80 medications
(ithout consulting physician.
+any analgesic mi/tures contain
aspirin in combination (ith p-
aminoben9oic acid5 a#oid to
pre#ent crystalli9ation in urine.
&se or add barrier contracepti#es
if using hormonal
contracepti#es, (hich may be
unreliable (hile ta)ing this drug.
2#oid e/posure to ultra#iolet
light and e/cessi#e sunlight to
pre#ent photosensiti#ity reaction
during therapy and for se#eral
months after treatment is
discontinued.
Inform dentist or ne( physician
that you are ta)ing a
sulfonamide.
Do not breast feed (hile ta)ing
this drug.
Name of Drug
Generic
(Trade)
Class Primary
Mode of
Action
Usual Dosage Range Side Effects Related
a! Studies
S"ecific Nursing
#nter$entions related to
drug
retardation of corneal healing
%:& Do"amine
(#ntro"in)
2&8";"+I0
;G4,"&<
<F<8G+
23G;85
2L!H2- 2;D
1G82-
2D4G;G43I
0 23";I<8
'<F+!28H"
+I+G8I0*
;aturally
occurring
neurotransmitte
r and immediate
precursor of
norepinephrine.
+a-or
cardio#ascular
effects
produced by
direct action on
alpha- and beta-
adrenergic
receptors and
on specific
dopaminergic
receptors in
mesenteric and
renal #ascular
beds.
S-oc9
Adult+'hild: #* 27
mcg)gmin increased
gradually up to 2070
mcg)gmin if necessary
Renal 'ailure
Adult: #* 27 mcg)gmin
C*) Hypotension, ectopic beats,
tachycardia, anginal pain,
palpitation, #asoconstriction
'indicated by disproportionate rise in
diastolic pressure*, cold e/tremities5
less fre:uent= aberrant conduction,
bradycardia, (idening of I4<
comple/, ele#ated blood pressure.
G#) ;ausea, #omiting. CNS)
Headache. S9in) ;ecrosis, tissue
sloughing (ith e/tra#asation,
gangrene, piloerection. ,t-er)
29otemia, dyspnea, dilated pupils
'high doses*.
8hyroid le#els +onitor blood pressure, pulse,
peripheral pulses, and urinary
output at inter#als prescribed by
physician. !recise measurements
are essential for accurate titration
of dosage.
4eport the follo(ing indicators
promptly to physician for use in
decreasing or temporarily
suspending dose= 4educed urine
flo( rate in absence of
hypotension5 ascending
tachycardia5 dysrhythmias5
disproportionate rise in diastolic
pressure 'mar)ed decrease in
pulse pressure*5 signs of
peripheral ischemia 'pallor,
cyanosis, mottling, coldness,
complaints of tenderness, pain,
numbness, or burning sensation*.
+onitor therapeutic
effecti#eness. In addition to
impro#ement in #ital signs and
urine flo(, other indices of
ade:uate dosage and perfusion
of #ital organs include loss of
pallor, increase in toe
temperature, ade:uacy of nail
bed capillary filling, and re#ersal
of confusion or comatose state.