Class Talk Fall 2016

Spironolactone is a class of potassium-sparing diuretics that is mainly used to manage primary hyperaldosteronism and edema that is associated with heart failure. It may also be administered for the treatment of hypokalemia, in that it counteracts potassium loss that may be caused by other diuretics. Spironolactone is a potassium-sparing diuretic, meaning it acts to conserve the amount of sodium within the body. Therefore, it is highly contraindicated in patients with renal insufficiency, renal impairment, hyperkalemia, or Addison’s disease.

It’s highly advised for nurses to assess their patients frequently for development of hyperkalemia, and to watch for symptoms such as fatigue, muscle weakness, paresthesia, confusion, dyspnea, or cardiac arrythmias. In addition, skin rashes may frequently occur during treatment therapy and should be discontinued at the first sign of rashes. Serum potassium levels should routinely be evaluated, as well as BUN, serum creatinine, and electrolytes, as these are important ways to measure proper kidney functioning.

Spironolactone is a class of potassium-sparing diuretics that is mainly used to manage primary hyperaldosteronism and edema that is associated with heart failure. It may also be administered for the treatment of hypokalemia, in that it counteracts potassium loss that may be caused by other diuretics. Spironolactone is a potassium-sparing diuretic, meaning it acts to conserve the amount of sodium within the body. Therefore, it is highly contraindicated in patients with renal insufficiency, renal impairment, hyperkalemia, or Addison’s disease.

It’s highly advised for nurses to assess their patients frequently for development of hyperkalemia, and to watch for symptoms such as fatigue, muscle weakness, paresthesia, confusion, dyspnea, or cardiac arrythmias. In addition, skin rashes may frequently occur during treatment therapy and should be discontinued at the first sign of rashes. Serum potassium levels should routinely be evaluated, as well as BUN, serum creatinine, and electrolytes, as these are important ways to measure proper kidney functioning.

Should be used with caution in patients with renal insufficiency
Risk of toxicity is increased by high, prolonged blood concentrations
Should be used in pregnancy only if clearly needed
Most cases of nephrotoxicity occur in patients taking aminoglycosides or who had preexisting kidney disfunction

Should be used with caution in patients with renal insufficiency
Risk of toxicity is increased by high, prolonged blood concentrations
Should be used in pregnancy only if clearly needed
Most cases of nephrotoxicity occur in patients taking aminoglycosides or who had preexisting kidney disfunction

Should be used with caution in patients with renal insufficiency
Risk of toxicity is increased by high, prolonged blood concentrations
Should be used in pregnancy only if clearly needed
Most cases of nephrotoxicity occur in patients taking aminoglycosides or who had preexisting kidney disfunction

Should be used with caution in patients with renal insufficiency
Risk of toxicity is increased by high, prolonged blood concentrations
Should be used in pregnancy only if clearly needed
Most cases of nephrotoxicity occur in patients taking aminoglycosides or who had preexisting kidney disfunction

Zosyn

(piperacillin/tazobactam)

Normal Dose: The usual total daily dose of Zosyn for adults is 3.375 g every six hours totaling 13.5 g

Renal Dose: According to the FDA,  Zosyn should be adjusted to the degree of actual renal function impairment. For patients who have a creatinine clearance below 40 mL/min, a dosage adjustment of Zosyn is recommended (See picture).

Metabolism/Excretion: Zosyn is eliminated by the kidney and excreted as an unchanged drug in the urine.

Half-life: Adults 0.7-1.2hr

Adverse Reaction: The GU adverse reaction we are worried about is interstitial nephritis.

Labs:Zosyn may increase BUN, creatinine, AST, ALT, serum bilirubin. In addition Zosyn can decrease hemoglobin and hematocrit. It may also cause proteinuria, hematuria and pyuria.

Nursing considerations:  drug-drug interactions and to monitor for abnormalities in sodium and potassium.

 

http://www.fda.gov/ohrms/dockets/dockets/06p0195/06P-0195-EC1-Attach-1.pdf

Zosyn

(piperacillin/tazobactam)

Normal Dose: The usual total daily dose of Zosyn for adults is 3.375 g every six hours totaling 13.5 g

Renal Dose: According to the FDA,  Zosyn should be adjusted to the degree of actual renal function impairment. For patients who have a creatinine clearance below 40 mL/min, a dosage adjustment of Zosyn is recommended (See picture).

Metabolism/Excretion: Zosyn is eliminated by the kidney and excreted as an unchanged drug in the urine.

Half-life: Adults 0.7-1.2hr

Adverse Reaction: The GU adverse reaction we are worried about is interstitial nephritis.

Labs:Zosyn may increase BUN, creatinine, AST, ALT, serum bilirubin. In addition Zosyn can decrease hemoglobin and hematocrit. It may also cause proteinuria, hematuria and pyuria.

Nursing considerations:  drug-drug interactions and to monitor for abnormalities in sodium and potassium.

 

http://www.fda.gov/ohrms/dockets/dockets/06p0195/06P-0195-EC1-Attach-1.pdf

Lithium (Lithobid) is a mood stabilizer that is the drug of choice for patients with bipolar disorder. Its mechanism of action is altering cation transport in nerve and muscle, and influencing the reuptake of neurotransmitters. renal excretion of lithium is highly dependent on serum sodium levels and this is because the kidneys process lithium and sodium in the same way.

Lithium can cause many adverse effects on the kidneys including polyuria, glycosuria, renal toxicity, chronic interstitial nephritis, and glomerulonephritis. Long-term lithium therapy should be avoided if possible, and the dosage should be kept as low as possible to reduce renal damage. Kidney function (BUN, serum creatinine, creatinine clearance, urinalysis) should be assessed before starting treatment and at least once a year after. Lithium is contraindicated in patients with severe renal disease.

Other nursing considerations for this drug is to be aware of lithium levels if the patient is taking a diuretic concurrently.  The nurse must monitor intake and output, and report any significant changes. Weight must be monitored every 3 months, and unless contraindicated, fluid intake should be about 2000 to 3000 mL a day. Important labs to monitor during therapy are renal and thyroid function, WBCs, serum electrolytes, adn glucose. It’s also really important to monitor lithium levels, making sure they stay in the therapeutic range, every 2 to 3 days during initial therapy and every 3 to 6 months during maintenance therapy.

 

Lithium (Lithobid) is a mood stabilizer that is the drug of choice for patients with bipolar disorder. Its mechanism of action is altering cation transport in nerve and muscle, and influencing the reuptake of neurotransmitters. renal excretion of lithium is highly dependent on serum sodium levels and this is because the kidneys process lithium and sodium in the same way.

Lithium can cause many adverse effects on the kidneys including polyuria, glycosuria, renal toxicity, chronic interstitial nephritis, and glomerulonephritis. Long-term lithium therapy should be avoided if possible, and the dosage should be kept as low as possible to reduce renal damage. Kidney function (BUN, serum creatinine, creatinine clearance, urinalysis) should be assessed before starting treatment and at least once a year after. Lithium is contraindicated in patients with severe renal disease.

Other nursing considerations for this drug is to be aware of lithium levels if the patient is taking a diuretic concurrently.  The nurse must monitor intake and output, and report any significant changes. Weight must be monitored every 3 months, and unless contraindicated, fluid intake should be about 2000 to 3000 mL a day. Important labs to monitor during therapy are renal and thyroid function, WBCs, serum electrolytes, adn glucose. It’s also really important to monitor lithium levels, making sure they stay in the therapeutic range, every 2 to 3 days during initial therapy and every 3 to 6 months during maintenance therapy.