Chapter IV DRUGS ACTING ON THE

RENAL SYSTEM
SUBMITTED BY:
BASI, PAULINE R. NBD
 Name of Drug Classification Mechanism of Action Indication Contraindication Adverse Effects Nursing
consideration
 Diuretics Hydrochlorothiazide, Treatment of edema associated w/ heart Pregnancy & lactation. ● Administer in the
Generic name: a thiazide diuretic, failure & renal hepatic disorders. HTN, Patients w/ severe renal Dry mouth, thirst, morning to prevent
Hydrochlorothiazid inhibits Na either alone or together w/ other impairment or anuria, weakness, disruption of sleep
e reabsorption in the antihypertensives eg, ACE inhibitors & β- Addison's disease, lethargy, cycle.
distal tubules blockers. Treatment of edema preexisting drowsiness, ● Intermittent dose
resulting to increased accompanying premenstrual syndrome, hypercalcemia. restlessness, schedule may be
excretion of Na, K, prevention of water retention associated w/ muscle pain & used for continued
Brand name: Mg hydrogen ions corticosteroids & estrogens, treatment of cramps, seizures, control of edema.
Diuzid and water.. diabetes insipidus & prevention of renal oliguria, ● PO: May give with
calculus formation in patients w/ hypotension & GI food or milk to
hypercalciuria disturbances. minimize GI
Dose: Anorexia, gastric irritation. Tablets
25-100 mg  irritation, nausea, may be crushed and
vomiting, mixed with fluid to
Route: constipation, facilitate swallowing
PO diarrhea, ● Instruct patient to
sialadenitis, take this medication
headache, at the same time
Frequency: dizziness, each day. Take
OD photosensitivity missed doses as
reactions, postural soon as
hypotension, remembered but not
paraesthesia, just before next
impotence & yellow dose is due. Do not
vision. Skin rashes, double doses. ●
fever, pulmonary Instruct patient to
edema, monitor weight
pneumonitis, biweekly and notify
anaphylaxis & toxic health care
epidermal professional of
necrolysis. significant changes.
● Caution patient to
change positions
slowly to minimize
orthostatic
hypotension. This
may be potentiated
by alcohol. ● Advise
patient to use
sunscreen and
protective clothing
to prevent
photosensitivity
reactions.
 Name of Drug Classification Mechanism of Action Indication Contraindication Adverse Effects Nursing
consideration
 Diuretics Furosemide inhibits Fluid retention associated with chronic Hypersensitivity to  Assess patient’s
Generic Name: reabsorption of Na congestive cardiac failure (if diuretic furosemide and severe underlying
Furosemide and Cl mainly in the treatment is required). sulfonamides. Anuria or anaphylactic or condition before
medullary portion of Fluid retention associated with acute renal failure, Addison's anaphylactoid starting therapy.
the ascending loop of congestive cardiac failure. disease, hypovolaemia reactions (e.g. w/  Monitor for renal
Classification: Henle. Excretion of K Fluid retention associated with chronic renal or dehydration, shock), Stevens- cardiac,
Diuretic and ammonia is also failure. precomatose state Johnson syndrome, neurologic, GI
increased while uric Maintenance of fluid excretion in acute renal associated w/ liver toxic epidermal manifestations of
acid excretion is failure, including that due to pregnancy or cirrhosis.. necrolysis; hypokalemia.
reduced. It increases burns. increased liver  Monitor for CNS,
Dosage: 40 mg plasma-renin activity, Fluid retention associated with nephrotic enzyme, GI,
plasma- syndrome (if diuretic treatment is required); cholesterol and cardiovascular,
norepinephrine and Fluid retention associated with liver disease triglyceride serum integumentary
plasma-arginine- (if necessary to supplement treatment with levels. neurologic
Frequency: Every vasopressin aldosterone antagonists). Potentially manifestations of
12 hours concentrations Hypertension. Fatal: Serious Hypocalcemia,
Hypertensive crisis (as a supportive cardiac  Monitor for CNS,
measure). arrhythmias. hyperactive
Support of forced diuresis reflexes,
Route: depressed
Intravenous cardiac output,
nausea,
vomiting,
tachycardia
 Assess fluid
volume status
(urine, color,
quality and
specific gravity)
 Assess patient
tinnitus, or Pain
 Name of Drug Classification Mechanism of Action Indication Contraindication Adverse Effects Nursing consideration
 Diuretics The mechanism of Treatment of seizures: absence or petit Chronic non-congestive  Maintain
Generic Name: anticonvulsant action mal, generalized tonic-clonic (grand mal), closed angle glaucoma. Flushing, thirst, adequate
Acetazolamide with acetazolamide and focal; reduction of intraocular pressure Marked renal or hepatic headache, fluid intake
is unknown but in open-angle glaucoma and secondary impairment, suprarenal drowsiness, (1.5–2.5 L/24
thought to involve glaucoma; preoperative treatment of acute gland failure, polyuria, h; 1 liter is
inhibition of CNS closed-angle glaucoma; drug-induced hyperchloraemic paraesthesia, approximately
carbonic anhydrase, edema and as adjunct in treatment of acidosis, sodium or blood dyscrasias, equal to 1
which retards edema due to congestive heart failure; potassium depletion. rash, metabolic quart) to
Dosage: 250— abnormal acute high-altitude sickness. Hypersensitivity to acidosis. Reports reduce risk of
375mg paroxysmal sulfonamides. of acute kidney
discharge from CNS Pregnancy. generalised stones.
neurons. Diuretic exanthematous  Report any of
effect is due to pustulosis  the following:
Frequency: OD inhibition of carbonic numbness,
anhydrase activity in tingling,
proximal renal burning,
tubule, preventing drowsiness,
Route: PO formation of carbonic and visual
acid. Inhibition of problems,
carbonic anhydrase sore throat or
in eye reduces rate mouth,
of aqueous humor unusual
formation with bleeding,
consequent lowering fever, skin or
of intraocular renal
pressure. problems.
 Eat
potassium-
rich diet and
take
potassium
supplement
when taking
this drug in
 high doses or
for prolonged
periods.
 Do not breast
feed while
taking this
drug without
consulting
physician.

Name of Drug Classification Mechanism of Indication Contraindication Adverse Effects Nursing consideration
Action
  Diuretics Spironolactone acts  Diagnosis and maintenance of  Anuria,  History: Allergy
on the distal renal thrombocytopenia,
Generic name: tubules as a primary hyperaldosteronism hyperkalemia, acute transient elevation in to
Spironolactone competitive or progressive renal BUN concentration. spironolactone;
 Adjunctive therapy in edema
antagonist of Rarely, breast
aldosterone. It associated with CHF, nephrotic insufficiency. enlargement hyperkalemia;
Brand Name: increases the syndrome, hepatic cirrhosis when Addison’s disease. renal disease;
Aldactone excretion of NaCl Potentially
other therapies are inadequate or pregnancy,
and water while . Fatal: Hyperkalaemia
conserving K and inappropriate lactation
hydrogen ions..  Give daily
Dosage:25 mg (1  Treatment of hypokalemia or
tab) doses early so
prevention of hypokalemia in patients
that increased
who would be at high risk if
Frequency: urination does
hypokalemia occurred: Digitalized
ODHS not interfere
patients, patients with cardiac
with sleep.
arrhythmias
Route: PO  Make
 Essential hypertension, usually
suspension as
in combination with other drugs
follows:
sickness.
Tablets may
be pulverized
and given in.
 Measure and
record regular
weight to
monitor
mobilization of
edema fluid.
  Avoid giving
food rich in
potassium.
 Arrange for
regular
evaluation of
serum
electrolytes
and BUN.

Name of Drug Classification Mechanism of Action Indication Contraindication Adverse Effects Nursing consideration
 Diuretic Induces diuresis by raising To promote diuresis in Anuria; marked  Take care to
 s osmotic pressure of prevention and treatment of pulmonary congestion CNS: Headache, tremor, convulsions, avoid
Generic name: glomerular filtrate, thereby oliguric phase of acute or edema; severe dizziness, transient muscle extravasation.
Mannitol inhibiting tubular kidney failure following CHF; metabolic rigidity. CV: Edema, CHF, angina-like Observe injection
reabsorption of water and cardiovascular surgery, edema; organic CNS pain, hypotension, hypertension, site for signs of
solutes. Reduces elevated severe traumatic injury, disease, intracranial thrombophlebitis. Eye: Blurred inflammation or
Brand Name: intraocular and surgery in presence of bleeding; shock, vision. GI: Dry mouth, nausea, edema.
Osmitrol cerebrospinal pressures severe jaundice, hemolytic severe dehydration, vomiting. Urogenital: Marked diuresis,  Lab tests:
by increasing plasma transfusion reaction. Also history of allergy; urinary retention, nephrosis, Monitor closely
osmolality, thus inducing used to reduce elevated pregnancy (category uricosuria. Metabolic: Fluid and serum and urine
diffusion of water from intraocular (IOP) and C), lactation; electrolyte electrolytes and
Dosage:100 g these fluids back into intracranial pressure (ICP), concomitantly with imbalance, especially hyponatremia; kidney function
as a 10–20 % plasma and extravascular to measure glomerular blood. dehydration, acidosis. Other: With during therapy.
solution over 2– spaces. filtration rate (GFR), to extravasation (local edema, skin  Measure I&O
6h promote excretion of toxic necrosis; chills, fever, allergic accurately and
substances, to relieve reactions). record to achieve
Frequency: symptoms of pulmonary proper fluid
ODHS edema, and as irrigating balance.
solution in transurethral  Monitor vital
prostatic reaction to signs closely.
Route: PO minimize hemolytic effects Report significant
of water. Commercially changes in BP
available in combination and signs of
with sorbitol for urogenital CHF.
irrigation.  Monitor for
possible
indications of
fluid and
electrolyte
imbalance (e.g.,
thirst, muscle
cramps or
weakness,
paresthesias, and
signs of CHF).
 Be alert to the
possibility that a
 rebound increase
in ICP sometimes
occurs about 12
h after drug
administration.
Patient may
complain of
headache or
confusion.
 Take accurate
daily weight.

Name of Drug Classification Mechanism of Indication Contraindication Adverse Effects Nursing consideration
Action
  anti-infective Potent broad- Complicated and uncomplicated Use in individual with  Take drug at
Generic name:  Quinolone spectrum urinary tract infection (UTI) known factors that Musculoskeletal: Joint swelling, cartilage same times
Norfloxacin antibacterial antibiotic activity. caused by susceptible predispose to erosion in weight-bearing joints, each day.
Alters structure of organisms. Conjunctivitis. seizures; history of tendonitis. In immunosuppressed adult:  Take drug
bacterial DNA hypersensitivity to acute ankle and hip pain followed by exactly as
gyrase, thus norfloxacin and other acute pain, tenderness, and swelling of prescribed.
Brand name: promoting quinolone tendon sheath of middle finger of both Erratic dosing
Noroxin double-stranded antiinfectives; hands after 4 wk of can encourage
DNA breakage, pregnancy (category therapy. CNS: Headache, dizziness, emergence of
interfering with C), lactation. Safety in lightheadedness, fatigue, drowsiness, resistant
Dose: synthesis of children is not somnolence, depression, insomnia, bacteria;
400mg bacterial protein established. seizures, peripheral underdosing or
and blocking neuropathy. GI: Nausea, abdominal pain, premature
Route: bacterial survival. diarrhea, vomiting, anorexia, dyspepsia, discontinuation
PO dysphagia, dry mouth, bitter taste, of treatment
heartburn, flatulence, pruritus ani, can cause
increased serum AST, ALT, alkaline return of UTI
Frequency: phosphatase. Hematologic: Leukopenia, symptoms.
OD neutropenia. Urogenital: With high doses:  Keep fluid
Crystalluria (not associated with renal intake high (at
toxicity), vulvar irritation. least 2500–
3000 mL/d if
tolerated) to
provide
adequate urine
output and
hydration,
important in
the prevention
of crystalluria
(rare side
effect).
 Do not breast
feed while
taking this
drug without
 consulting
physician.

Name of Drug Classification Mechanism of Indication Contraindication Adverse Effects Nursing consideration
Action
 Anticholinergic, Synthetic tertiary To relieve symptoms associated Hypersensitivity of  Periodic
Generic name: antispasmodic, amine that exerts with voiding in patients with oxybutynin; narrow Body as a Whole: Severe allergic interruptions
Oxybutynin autonomic direct uninhibited neurogenic bladder angle glaucoma, reactions including urticaria, skin of therapy are
nervous system antispasmodic and reflex neurogenic bladder. myasthenia gravis, rashes, suppression of lactation, recommended
agent action and inhibits Also has been used to relieve pain partial or complete GI decreased sweating, to determine
muscarinic effects of bladder spasm following obstruction, gastric fever. CNS: Drowsiness, dizziness, patient's need
Brand name: of acetylcholine on transurethral surgical procedures. retention, paralytic weakness, insomnia, restlessness, for continued
Oxytrol smooth muscle. ileus, intestinal atony psychotic behavior treatment.
(especially older adult (overdosage). CV: Palpitations, Tolerance has
or debilitated patients), tachycardia, flushing. Special occurred in
Dose: megacolon, severe Senses: Mydriasis, blurred some
5 mg colitis, GU obstruction, vision, cycloplegia, increased patients.
urinary retention, ocular tension. GI: Dry  Keep
Route: unstable mouth, nausea, physician
PO cardiovascular status.. vomiting, constipation, bloated informed of
feeling. Skin: Pruritus at expected
application site, rash, application responses to
Frequency: site vesicles, drug therapy
BID erythema. Urogenital: Urinary (e.g., effect on
hesitancy or retention, impotence.. urinary
frequency,
urgency, urge
incontinence,
nocturia,
completeness
of bladder
emptying).
 Monitor
patients with
colostomy or
ileostomy
closely;
abdominal
distension
and the onset
of diarrhea in
these patients
may be early
signs of
intestinal
obstruction or
of toxic
megacolon.
 Name of Drug Classification Mechanism of Indication Contraindication Adverse Effects Nursing consideration
Action
 Urinary Azo dye. Symptomatic relief of Renal insufficiency,  Be aware that
Generic name: tract Precise pain, burning, frequency, glomerulonephritis, pyelonephritis Body as a Whole: Headache, drug will
Phenazopyridine analgesic mechanism of and urgency arising from during pregnancy (category B); vertigo. GI: Mild GI impart an
hydrochloride action not irritation of urinary tract severe hepatitis. disturbances. Urogenital: Kidney orange to red
known. mucosa, as from stones, transient acute kidney color to urine
infection, trauma, failure. Metabolic: Methemoglobinemia, and may stain
surgery, or hemolytic anemia. Skin: Skin fabric.
instrumentation.. pigmentation. Special Senses: May  Discontinue
Brand name: stain soft contact lenses., impotence.. drug report to
Pyronium physician
immediately
the
Dose: appearance
200 mg of yellowish
tinge to skin
Route: or sclerae
PO may indicate
drug
accumulation
Frequency: due to renal
TID impairment.
 Discontinue
drug when
pain and
discomfort
are relieved
(usually 3–15
d). Keep
physician
informed.
 Do not breast
feed while
taking this
drug without
 consulting
physician.

Name of Drug Classification Mechanism of Indication Contraindication Adverse Effects Nursing consideration
 Action
 Electrolyte Sulfonic cation- Hyperkalemia... Patients with hypokalemia;  Lab tests:
Generic name: and water exchange resin hypersensitivity to Kayexalate.. GI: Constipation, fecal Determine
Pentosan balance that removes impaction (in older serum
polysulfate sodium agent , potassium from adults); anorexia, gastric potassium
Cation body by irritation, nausea, vomiting, levels daily
Exchange exchanging diarrhea (with sorbitol throughout
sodium ion for emulsions). Metabolic: Sodium therapy.
potassium, retention, hypocalcemia, Monitor acid–
Brand name: particularly in hypokalemia, base balance,
Kayexalate large intestine; hypomagnesemia... electrolytes,
potassium- and minerals
containing in patients
Dose: resin is then receiving
15 g suspended in excreted. Small repeated
70% sorbitol or 20– amounts of doses.
100 mL of other other cations  Serum
fluid  such as potassium
Route: calcium and levels do not
PO magnesium always reflect
may be lost intracellular
during potassium
Frequency: treatment.. deficiency.
TID Observe
patient closely
for early
clinical signs
of severe
hypokalemia
(see Appendix
F). ECGs are
also
recommended.
 Consult
physician
about
 restricting
sodium
content from
dietary and
other sources
since drug
contains
approximately
100 mg (4.1
mEq) of
sodium per
gram (1 tsp,
15 mEq
sodium).

 Check bowel
function daily.
Usually, a mild
laxative is
prescribed to
prevent
constipation
(common
adverse
effect). Older
adult patients
are particularly
prone to fecal
impaction.
 Name of Classification Mechanism of Indication Contraindication Adverse Effects Nursing consideration
Drug Action
 autonomic By selective Mild to Hypersensitivity to doxazosin, prazosin,  Monitor BP with patient
Generic nervous competitive moderate and terazosin; hypotension, syncope. CV: Orthostatic lying down and standing;
name: system inhibition of alpha1- hypertension, Safe use during pregnancy (category B) hypotension, edema.  doses above 4 mg
doxazosin agent adrenoreceptors, it benign prostatic or in children is not established... CNS: Vertigo, headache, dizziness, increase the risk of
produces hypertrophy. somnolence, fatigue, nervousness, postural hypotension.
vasodilation in anxiety.   Monitor BP 2–6 h after
both resistance GI: Nausea, abdominal initial dose or any dose
Brand name: (arterioles) and pain. Hematologic: Leukopenia.  increase. This is when
Cardura capacitance Skin: Pruritus, eczema. postural hypotension is
(veins) vessels most likely to occur.
with the result that
Dose: both peripheral  Do not drive or engage
1mg vascular in other potentially
resistance and hazardous activities for
Route: blood pressure are 12–24 h after the first
PO reduced. dose or an increase in
dosage or when
medication is restarted
Frequency: after an interruption in
TID dosage.
 Use caution when rising
from a sitting or supine
position in order to avoid
orthostatic hypotension
and syncope; make
position and directional
changes slowly and in
stages.
 Report to the physician
episodes of dizziness or
palpitations. These will
require a dosage
adjustment.
 Do not breast feed while
 taking this drug.