1. Renal Medications 1

2. Anemia

3. Thiazide and Thiazide–like Diuretics
Increases sodium and water retention by inhibiting sodium reabsorption in the distal tubule of the kidney
Used for HTN and peripheral edema
Used in patients with normal renal function
Not effective for immediate diuresis
Contraindicated in renal failure
Used with caution when taking digoxin, corticosteroids, or antidiabetic meds

4. Thiazide and Thiazide–like Diuretics
Side effects
Hypercalcemia
Hyperglycemia
Hyperuricemia
Hypokalemia
Hyponatremia
Hypovolemia
Hypotension
Constipation
Rashes
Photosensitivity
Blood dyscrasias
Headaches
Nausea and vomiting

5. Thiazide and Thiazide–like Diuretics
Nursing Implementation
Monitor vital signs
Monitor weight
Monitor urine output
Monitor electrolytes
Monitor glucose, calcium, and uric acid
Check peripheral pulses for edema
Instruct to take in the morning to avoid nocturia and sleep interruption

6. Thiazide and Thiazide–like Diuretics
Nursing Implementation
Instruct to take BP and record
Instruct to eat foods rich in potassium
Instruct to take potassium supplements
Instruct to take med with food to avoid GI upset
Instruct to change position slowly to avoid orthostatic hypotension
Instruct to use sunscreen
Instruct those with DM to have BS checked frequently

7. Thiazide and Thiazide–like Diuretics
Bendroflumethazide (Naturetin®) Benzthiazide (Exna®) Chlorothiazide (Diuril®) Chlorthalidone (Hygroton®) Hydrochlorothiazide (HydroDiuril®) Hydroflumethiazide (Saluron®) Idnapamide (Lozol®) Methyclothiazide (Enduron®) Metolazone (Zaroxylon®) Polythiazide (Renese®) Quinethazone (Hydromox®) Trichloromethiazide (Diurese®)

8. Loop Diuretics
Inhibit sodium and chloride reabsorption from the loop of Henle and distal tubule
They have little effect on the blood glucose; however they cause marked depletion of water and electrolytes, increased uric acid levels, and the excretion of calcium
Are more potent than thiazide, causing rapid diuresis, thus decreasing vascular fluid volume, cardiac output, and blood pressure
Used for HTN, edema associated with CHF, hypercalcemia, and renal disease
Use with caution when taking digoxin or lithium
Use with caution when taking aminoglycosides, anticoagulants, corticosteroids, or amphotericin B

9. Loop Diuretics Side Effects Orthostatic hypotension Hypokalemia
Hyponatremia
Hypocalcemia
Hypomagnesemia
Hypochloremia
Thrombocytopenia
Hyperuricemia
Orthostatic hypotension
Skin disturbances
Ototoxicity and deafness
Thiamine deficiency
dehydration

10. Loop Diuretics Nursing Implementation Monitor vital signs
Monitor weight
Monitor urine output
Monitor electrolytes, calcium, magnesium, and uric acid levels
Check peripheral extremities for edema
Monitor for signs of digitalis toxicity if on this also
Monitor for lithium toxicity if on this also

11. Loop Diuretics Nursing Implementation Instruct to take in the morning
Instruct to monitor own BP and record
Eat foods rich in potassium
Take potassium supplements as prescribed
Take med with food
Change position slowly
ADMINISTER IV FUROSEMIDE (LASIX) SLOWLY BECAUSE HEARING LOSS CAN OCCUR IF INJECTED RAPIDLY

12. Potassium sparing diuretics
Act on the distal tubule to promote sodium and water excretion and potassium retention
Used for edema and HTN, to increase UO, to treat fluid retention and overload associated with CHF, hepatic cirrhosis or nephrotic syndrome and for diuretic-induced hypokalemia
Contraindicated in severe kidney or hepatic disease or in severe hyperkalemia
Used with caution in the client with diabetes
Used with caution in the client taking antihypertensives or lithium
Used with caution in the patient taking ACE inhibitors because hyperkalemia can result
Used with caution in the patient taking potassium supplements

13. Potassium sparing diuretics
Side effects
Hyperkalemia
Nausea, vomiting, diarrhea
Rash
Dizziness, weakness
Headache
Dry mouth
Photosensitivity
Anemia
thrombocytopenia

14. Potassium sparing diuretics
Nursing Implementation
Monitor vital signs
Monitor urine output
Monitor S/S of hyperkalemia
Nausea, vomiting diarrhea,
Abdominal cramps
Tachycardia followed by bradycardia
Peaked T waves
Oliguria
Monitor potassium level
Instruct to avoid foods high in potassium
Instruct to avoid direct exposure to sun
Instruct on S/S of hyperkalemia
Instruct to avoid salt substitutes (contain a lot of potassium)
Instruct to take with or after meals to decrease GI irritation

15. Urinary Tract Antiseptics
Inhibit growth of bacteria in the urine
Act as disinfectants within the urinary tract
Used to treat urinary tract infections
These meds do not achieve effective antibacterial concentrations in blood or tissues and therefore cannot be used for infections outside the urinary tract

16. Urinary Tract Antiseptics
Nitrofurantoin (Furadantin, Furalan, Macrobid)
an antibiotic, eliminates bacteria that cause urinary tract infections. Antibiotics will not work for colds, flu, or other viral infections.
This medication is sometimes prescribed for other uses
Brown color to urine

17. Urinary Tract Antiseptics
Side Effects of Nitrofurantoin (Furadantin, Furalan, Macrobid)
difficulty breathing
excessive tiredness
fever or chills
chest pain
persistent cough
numbness, tingling, or pinprick sensation in the fingers and toes
muscle weakness
swelling of the lips or tongue
skin rash

18. Urinary Tract Antiseptics
Methenamine (Mandelamine, Hipex, Urex)
Relatively safe and well tolerated
May cause gastric distress
Chronic high-dose therapy can cause bladder irritation
Can cause crystalluria and should no the used in patients with renal impairment
Decomposition of med yields ammonia, bad if patient already has liver dysfunction
Requires acidic urine with 5.5 or less
Ingestion of large amounts of fluid will reduce antibacterial effects
Should not combine with sulfonamides because of the risk of crystalluria and urinary tract injury
Patients taking this med should not be given alkalinizing agents

19. Urinary Tract Antiseptics
Nalidixic acid (NegGram)
Gastrointestinal disturbances: nausea, vomiting and abdominal discomfort
Rash
Visual disturbances
Photosensitivity reactions
May produce intracranial HTN in pediatric patients
After 2 weeks, patient requires blood work-CBC and liver function
Can intensify effects of oral anticoagulants
Contraindicated with history of convulsive disorders

20. Urinary Tract Antiseptics
Cinaxacin (Cinobac)
Side effects are similar to those of nalidixic acid
Dosage should be reduced in patients with renal impairment; failure to do so will result in accumulation of the med to toxic levels

21. Urinary Tract Antiseptics
Norfloxacin
Can cause fatigue, headache, nausea, constipation, rash, and elevated liver function tests
Encourage high fluid intake
Advise patient to take medication 1 hour before or 2 hours after meals because food will hamper absorption