RENAL DRUGS

NAME INDICATIONS CONTRAINDICATIONS ADVERSE EFFECTS NURSING REPONSIBILITIESCALCIUM CARBONATE(Cal-Sup)

Dosage(s):350 mg to 1.25 g P.O.

MECAHANISM OFACTION(S)

Raises calcium level and relieves mild gastric discomfort

Gastric hyperacidity, calcium supplement

Patients with ventricular fibrillation or hypercalcemia

Use caoutiosly in patient recieveing Digoxin and those with sarcoidosis

NAME INDICATIONS CONTRAINDICATIONS ADVERSE EFFECTS NURSING REPONSIBILITIES

FUROSEMIDE(Lasix)

Dosage(s):Tab Adult Initially ½- 1-2tab daily. Maintenance: ½-1 tab daily. Children 2mg/ kg body wt up to max of 40 mg daily. Inj Adult Initially 20-40 mg IM/IV. If diuretic effect is not satisfactory, dose may be increased stepwise, at 2- hourly interval by 20 mg each time until satisfactory diuresis is obtained, the dose should then be given once- bid.

MECAHANISM OFACTION(S)

Inhibits sodium and chloride reabsorption in the ascending loop of Henle, thus increasing renal excretion of sodium, chloride and water.

Edema due to cardiac, hepatic, and renal disease, burns; mild to moderate hypertension, hypertensive crisis, acute heart failure, chronic renal failure, nephritic syndrome

Anuria; hepatic coma and precoma, severe hypokalemia &/or hyponatremia, hypovolemia w/ or w/o hypotension; hypersensitivity to furosemide or sulfonamides.

CCNS: dizziness, encephalopathy, headache, insomnia, nervousnessEENT: hearing loss, tinnitusCV: hypotensionGI: constipation, diarrhea, dry mouth, dyspepsia, nausea, vomitingDERM: photosensitivity, rashesENDO: hyperglycemiaF&E: dehydration, hypokalemia, hypomagnesemsia, hyponatremia, hypovolimia, metabolic alkalosisHEMA: Blood dyscrasiasMETAB: hyperglycemia, hyperuricemiaMS: arthralgia, muscle cramps, myalgiaMISC: increased BUN

Asses fluid status during therapy. Monitor daily weight, intake & output ratios, amount and location of edema, lung sounds, skin turgor, and mucous membranes.

Monitor BP and pulse before and during administration

Assess patient for any signs and symptoms of the adverse effects

Monitor electrolytes, renal and hepatic function, serum glucose, and uric acid levels before and periodically throughout therapy.

NAME INDICATIONS CONTRAINDICATIONS ADVERSE EFFECTS NURSING REPONSIBILITIES

DIGOXIN(Lanoxin)

Dosage(s):Loading dose, 0.75–1.25 mg PO or 0.125–0.25 mg IV. Maintenance dose, 0.125–0.25 mg/day PO

MECAHANISM OFACTION(S)

Increases intracellular calcium and allows more calcium to enter the myocardial cellduring depolarization via a sodium–potassium pump mechanism; this increases force ofcontraction (positive inotropic effect), increases renal perfusion (seen as diuretic effect inpatients with CHF), decreases heart rate (negative chronotropic effect), and decreases AV node conduction velocity.

CHF Atrial

fibrillation

Contraindicated with allergy to digitalis preparations, ventricular tachycardia,ventricular fibrillation, heart block, sick sinus syndrome, IHSS, acute MI, renalinsufficiency and electrolyte abnormalities (decreased K+, decreased Mg++,increased Ca++).

CNS: Headache, weakness, drowsiness, visual disturbances, mental status changeC V:ArrhythmiasGI: GI upset,anorexia

Monitor apical pulse for 1 min before administering; hold dose if pulse < 60 inadult or < 90 in infant; retake pulse in 1 hr. If adult pulse remains < 60 or infant <90, hold drug and notify prescriber. Note any change from baseline rhythm orrate.

Take care to differentiate Lanoxicaps fromLanoxin; dosage is very different

Check dosage and preparation carefully.

Avoid IM injections, which may be very painful.

Follow diluting instructions carefully, and use diluted solution promptly.

Avoid giving with meals; this will delay absorption.

Have emergency equipment ready; have K+ salts, lidocaine, phenytoin, atropine,

cardiac monitor on standby in case toxicity develops.

Monitor for therapeutic drug levels: 0.5–2 ng/ml

NAME INDICATIONS CONTRAINDICATIONS ADVERSE EFFECTS NURSING REPONSIBILITIES

HYDROCORTISONE(Cortef)

Dosage(s):20-240 mg/day insingle dose ordivided doses

MECAHANISM OFACTION(S)

Enters target cells and binds to cytoplasmic receptor; initiates many complex reactions that are responsible for its anti inflammatory,immunosuppressive(glucocorticoid), and salt-retaining (mineralocorticoid)actions. Some actions maybe undesirable, depending on drug use.

Replacement therapy in adrenal cortical insufficiency

Allergic states –severe orincapacitating allergic conditions

Hematologicdisorders

Ulcerative colitis

Kidney disease Liver disease

Cirrhosis Hypothyroidism

Ulcerative colitis withimpending perforation

Diverticulitis Recent GI surgery Active or latent

peptic ulcer Inflammatory bowel

disease Hypertension Heart failure Thromboembolic

tendencies Osteoporosis Convulsive disorders Metastatic

carcinoma Diabetes mellitus

CNS: Vertigo, headache,paresthesias, insomnia,seizures, psychosisCV: Hypotension, shock, HPN and heart failure secondary to fluid retention, thromboembolism,thrombophlebitis, fat embolism, cardiac arrhythmiasDermatologic: Thin, fragile skin, petechiae, ecchymoses,purpura, striae, subcutaneousfat atrophyEENT: Cataracts, glaucoma, increased IOPEndocrine:Amenorrhea,irregular mens, growthretardation, decreasedcarbohydrate tolerance and DM, cushingoid state, HPA suppression systemic hyperglycemia

Give daily before 9am to mimicnormal peak diurnal corticosteroid levels. Space multiple doses evenlythroughout the day.Use minimal doses for minimalduration to minimize adverse effects.Do not give IM injections if patient has thrombocytopenic purpura.Taper doses when discontinuinghigh-dose or long-term therapy. Monitor client for at least 30minutes.Educate client on the side effects of the medication and what to expect. Instruct client to report pain at injection site.Instruct client to take drug exactly as prescribed. Dispose of used materials properly.

NAME INDICATIONS CONTRAINDICATIONS ADVERSE EFFECTS NURSING REPONSIBILITIES

DOBUTAMINE HCL(Dobutrex)

Dosage(s):20ml(280mg/20ml)IVTT

MECAHANISM OFACTION(S)

Stimulates heart’s beta1receptors to increasemyocardial contractilityand stroke volume.At therapeutic dosages, drug increases cardiac output by decreasingperipheral vascularresistance, reducingventricular fillingpressure, and facilitating AV nodeconduction

To increase cardiacoutput caused bydepressed contractilityof the heart

Contraindicatedto hypersensitivityto other sympathomimetic amines, ventriculartachycardia.

CNS: headache, tremors, Paresthesias, mild leg cramps, nervousness fatigue(with over dose)CV: increaseheart rate and BP premature ventricularbeats palpitationsangina painGI: nausea, vomitingOTHER: non- specific chest pain, shortness ofbreath.

Give a plasma volume expander first before startingdobutamine therapy first to correct hypovolemia.

Monitor the effects of the medication by monitoring ECGand BP continuously duringadministration.

Observe patient with pre-existing hypertension closely for exaggerated pressor infusion.

Monitor intake and output ratio and pattern.

Report angina pain and report any unusualities to the physician.

NAME INDICATIONS CONTRAINDICATIONS ADVERSE EFFECTS NURSING REPONSIBILITIES

CIPROFLOXACIN(Laitun)

Dosage(s):250 mg or 200mg IV q 12hours

MECAHANISM OFACTION(S)

They interfere with DNA replication insusceptible gram-negative bacteria,preventing cellreplication and leadingto death of bacteria

Mild tomoderate UTI Infectiousdiarrhea

Hypersensitivity to quinolones

Nausea/vomitingRestlessnessAnorexiaDysphagiatachycardia

Maintain adequate hydration, tell patient that it may impair ability to drive& operate machinery

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