1
Q
AKI Nursing Focus
A
- Prevent harm from occurring during physiological instability
- Support perfusion, volume, electrolytes, and acid-base balance
- Reduce risk of medication-induced harm
2
Q
CKD Nursing Focus
A
- Prevent disease progression
- Decrease cardiovascular risk
- Volume, electrolyte, acid-base balance
- Bone/mineral disease
- Anemia
3
Q
CKD Absorption Effects
A
- Unpredictable due to uremia effects on gut motility and perfusion
- Decreased motility can increase time for absorption
- Decreased perfusion can decrease absorption
4
Q
CKD Distribution Effects
A
- Decreased serum albumin can increase the level of free drug in the bloodstream
- This can increase toxicity risk
5
Q
Medications Associated With Nephrotoxicity
A
- Aminoglycoside antibiotics
- Vancomycin
- Lithium
- NSAIDS
- Contrast
- Some chemo drugs
6
Q
Loop Diuretic Generic
A
- Furosemide (Lasix)
- Torsemide
7
Q
Loop Diuretic Mechanism of Action
A
- Block Na reabsorption in the ascending loop of Henle
- Increase urine Na and water excretion
8
Q
Loop Diuretic Indications
A
- Edematous states (HF, renal disease, cirrhosis)
- Hypertension (thiazide diuretics preferred)
9
Q
Loop Diuretic Contraindcations
A
- Hypokalemia
- Sulfa allergy
- Azotemia (increase in Cr, urea, nitrogen), anuria
10
Q
Creatinine
A
- Waste product of protein metabolism
- Normally filtered out by kidneys
11
Q
Loop Diuretic Adverse Effects
A
- Hypokalemia, hyponatremia, hyperuricemia
- Metabolic alkalosis
- AKI due to volume depletion, concurrent admin with nephrotoxic meds
12
Q
How do Loop Diuretics Cause Metabolic Alkalosis
A
- Increased Na excretion into collecting duct
- Collecting duct tries to reabsorb Na as a result
- K is put out to maintain electrical neutrality (also cause of hypokalemia)
- H follows K out, raising pH
13
Q
Loop Diuretic Nursing Considerations
A
- Review renal function
- Review electrolytes
- Monitor daily weight, I&O, edema
- If IV, administer slowly to reduce ototoxicity risk
14
Q
Ototoxicity
A
- Damage to inner ear resulting from diuretic use
15
Q
Sodium Bicarbonate
A
- Indicated for metabolic acidosis resulting from AKI
- Monitor volume status as water is produced by buffer reaction
16
Q
Na Monitoring in AKI
A
- Na reabsorption can be impaired with tubule dysfunction, leading to low serum levels
- Excessive Na intake should still be avoided because it builds up fast
17
Q
Treatments for Hyperkalemia in AKI
A
- Calcium Polystyrene Sulphonate, Sodium Zirconium Cyclosilicate
- Loop diuretics
- IV short acting (Humulin R) insulin and dextrose
- Sodium bicarbonate (fixes acidosis, causing K to shift into cells)
- Calcium gluconate
18
Q
Sodium Zirconium Cyclosilicate
A
- Non-absorbable exchange resin
- Bings to K in GI tract so it can be eliminated with stool
- Monitor for BM
- Delayed onset, not for emergent situation
19
Q
Calcium Polystyrene Sulphonate
A
- Less commonly used than sodium zirconium cyclosilicate
20
Q
Temporary K Shifting with Insulin
A
- As insulin shifts glucose into the cell, K and Ph temporarily follow
21
Q
Bicarb as Treatment for Hyperkalemia in AKI
A
- Bicarb decreases H in blood
- H moves out of cells
- K moves in to maintain electrical neutrality
- Not a first line treatment unless there is associated acidosis
22
Q
How AKI Causes Hyperkalemia
A
- Decreased acid excretion leads to excess H in extracellular space
- Excess H shift into cells
- K shift out to maintain electrical neutrality
23
Q
Intravenous Calcium Gluconate
A
- Indicated for severe hyperkalemia with ECG changes
- Stabilizes cardiac membrane
- Does not lower serum K
24
Q
Parameters for CKD
A
- Albuminuria >30 mg/day
- GFR <60 mL/min
- Present for 3+ months
25
Cardiorenal Protective Therapies
- GLP-1 receptor agonists
- SGLT2 inhibitors
26
CKD Antihypertensive Therapy
- ACE Inhibitors reduce intraglomerular pressure and proteinuria, hyperkalemia risk
- ARBS are used as an alternative to ACEs
- thiazide or loop diuretics provide volume control, reduce preload, and control BP
- Calcium channel blockers (non-DHPs) provide additional BP control but do not reduce proteinuria
27
Phosphate Binders
- Reduce mineral and bone disorders by binding to phosphate to increase the amount of free serum Ca
28
Sevelamer Hydrochloride
- Renagel
- Non-calcium Ph binder
- Non-absorbed polymer resin that binds to Ph in intestines, leading to stool excretion
- Lowers serum Ph without increasing Ca
- Often preferred to reduce risk of hypercalcemia and vascular calcification
29
Calcium Carbonate
- Tums, Caltrate
- Ca based Ph binder
- Provides Ca that binds dietary Ph in bowel
- Increases total Ca load
- Risk of hypercalcemia and vascular calcification with excess use
30
Ph Binder Indications
- Hyperphosphatemia in CKD
- Lowers risk of hyperparathyroidism and bone disease
31
Ph Binder Adverse Effects
- GI effects, more common in Ca based binders
- Hypercalcemia
32
Ph Binder Nursing Considerations
- Administer with meals
- Separate from levothyroxine, Fe, certain antibiotics, may reduce their absorption
- Monitor serum Ca and Ph
- Assess bowel function
33
Calcitriol
- Active Vit. D
- CKD reduces renal conversion of vit D leading to low calcitriol, contributes to hypocalcemia and secondary hyperparathyroidism
- Suppresses elevated PTH levels
- Monitor Ca and Ph during treatment
34
Erythropoietin Stimulating Agent Indications
- Deficient erythropoietin production in CKD
35
Erythropoietin Stimulating Agent Mechanism of Action
- Stimulates bone marrow to produce RBCs
- SubQ or IV
- Gradually increases Hgb levels over 2-6 weeks
36
Erythropoietin Stimulating Agent Adverse Effects
- Hypertension due to increased RBC mass
- Increased risk of thromboembolic and cardiovascular effects, especially if Hgb rises too rapidly or excessively
37
Erythropoietin Stimulating Agent Nursing Considerations
- Ensure adequate iron stores before admin
- Monitor Hgb trends
38
Iron Supplementation
- Oral or IV (oral is most common)
- Indicated if transferrin is <20% or serum ferritin <100 ng/mL
- Adequate iron required for erythropoiesis and ESA effectiveness
39
Iron Supplementation Adverse Effects
- GI irritation
- Constipation
- Dark stools
- Infusion reactions
- Hypotension
- Hypersensitivity
40
Iron Supplementation Nursing Considerations
- Separate from Ph binders and interacting meds
- Monitor for GI tolerance
- Administer IV slowly and monitor BP
41
Hyperparathyroidism
- Calcimimetics
- Typically after dialysis has been started
- Lower PTH levels
- Increase sensitivity of Ca sensing receptors in parathyroid gland
- Not recommended for CKD patients not receiving dialysis
Pharmacology I
flashcards
Decks in class (30)
# Cards
-
Coagulation Modifiers46
-
Antiplatelets18
-
Thrombolytics9
-
Abnormal Heart Rates and Rhythms19
-
Heart Failure Medication34
-
Antihypertensives38
-
Adjunct Antihypertensives21
-
Hypotension Therapy7
-
Antilipemics21
-
Anti-Anginal10
-
Pharmacokinetics for Respiratory Drugs7
-
Bronchodilators18
-
Controller Respiratory Medications31
-
Medications for Interstitial Lung Disease6
-
Antiepileptic Drugs71
-
CVA Pharmacology20
-
Renal41
-
Post-Renal Pharmacology6
-
Insulin16
-
Other Hypoglycemics27
-
Endocrine7
-
Acid Neutralization19
-
Antiemetics21
-
Laxatives26
-
Antidiarrheal Agents12
-
GI Specific Pharmacotherapy26
-
Pharmacokinetics in Pain and Inflammation7
-
Anti-Inflammatory Medications17
-
Opioids12
-
Non-Opioids8
