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Urinary System. Name the structures of the urinary system.Identify the functional unit of the kidney.Discuss the importance of overall kidney function. . Kidneys. Discuss kidney function as it relates to the following mechanisms:RegulationSecretionProduction . Nephron. Processes Critical to Drug Pharmacokinetics.
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1. Diuretic Therapy and Drugs for Renal Failure Chapter 30
2. Urinary System Name the structures of the urinary system.
Identify the functional unit of the kidney.
Discuss the importance of overall kidney function.
3. Kidneys Discuss kidney function as it relates to the following mechanisms:
Regulation
Secretion
Production
4. Nephron
5. Processes Critical to Drug Pharmacokinetics Tubular reabsorption
Small molecules
Water
Glucose, amino acids, sodium, chloride, calcium, bicarbonate
Tubular secretion
Larger molecules
Potassium, phosphate, Hydrogen, Ammonium
6. Discussion You patients urinalysis is positive for protein. What is the significance of this finding?
Impaired tubular reabsorption and secretion mechanisms will affect drug levels. Describe how pharmacotherapy will be adapted.
7. Renal Failure Kidney function decreases ? inability to maintain electrolyte and fluid balance and excrete waste products.
Identify the etiology of renal failure.
Describe the primary treatment goal.
8. Assessment of Kidney Function Identify lab/diagnostic tests used to assess kidney function.
Describe the best marker for estimating kidney function.
Discuss the nephrons ability to compensate for decreased kidney function.
9. Classifications of Renal Failure Acute
Sudden onset
Requires immediate care
May be reversible
Chronic
Insidious, develops over time
Associated with DM, HTN
Can progress to ESRD
10. Pharmacotherapy and Renal Failure Nephrotoxic drugs can cause acute or chronic renal failure.
Remember common nephrotoxic drugs:
11. Pharmacotherapy of Renal Failure What is the overarching goal of pharmacotherapy?
What types of drugs will be included? Why?
Discuss associated pharmacotherapy for diabetics.
12. Diuretic Therapy Describe the most common mechanism of action.
Compare and contrast the MOA of the three major and 1 miscellaneous diuretic groups.
Pharmacology Illustrated
30.1 Mechanism of Action of Diuretics. P. 427
14. Combining Diuretics Common combination drugs
Aldactazide
Apresazide
Dyazide
What is the indication for this process?
What is the rationale for this process?
15. Loop Diuretics Review previous material
IV administration ? rapid diuresis
Furosemide:? urine output when ? perfusion
Key baseline info:
Current urine output
K+, Na+, CL-, BUN, Creatinine, uric acid, glucose
Elderly: ? risk of dehydration and electrolyte imbalance
17. Thiazide Diuretics Review previous material
For edema 2 mild to moderate renal failure
Not effective in severe renal disease
Classified by duration of action
Key baseline info:
Current level of urine output
Electrolytes, BUN, creatinine, uric acid, glucose
Can cause photosensitivity
19. Potassium-sparing Diuretics Review previous material
Eplerenone fewer adverse reactions than spironolactone
Key baseline info:
Current level of urine output
Electrolytes, BUN, Creatinine
Must monitor of hyperkalemia
Elderly: ? risk confusion, dehydration, electrolyte imbalances
Monitor K+ intake
21. Osmotic Diuretics Mannitol; Urea
Potent diuretic
Only administered IV
Can worsen edema associated with pre-existing HF or pulmonary edema
Decreases ICP 2 cerebral edema
22. Carbonic Anhydrase Inhibitors Acetazolamide (Diamox)
? intraocular pressure 2 open-angle glaucoma
Anticonvulsant
Motion sickness; mountain sickness
Dichlorphenamide (Daranide)--
Methazolamide (Neptazine)