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1、 Paradigm Publishing,Inc.,1,Chapter 11,Renal System Drugs,2,Paradigm Publishing,Inc.,Chapter 11 Topics,Function of the Renal SystemDrugs for Urinary Tract Diseases and DisordersDiuretics,Paradigm Publishing,Inc.,3,Learning Objectives,Understand the renal system,its importance,and how it works.Differ
2、entiate the parts of the renal system.Understand the drugs used to treat renal disease.,Paradigm Publishing,Inc.,4,Learning Objectives,Know the causes and treatment of urinary tract infections.Understand the classes of diuretics and how they work.,5,Paradigm Publishing,Inc.,Function of the Renal Sys
3、tem,Primary functionsMaintain water balanceMaintain electrolyte balanceMaintain acid and base balanceProduce urine,6,Paradigm Publishing,Inc.,Urine Production,In forming urine,the kidneys regulateBlood volume,thus blood pressureConcentration of waste products in bloodConcentration of electrolytes(Na
4、+,K+,HCO3-,Ca+,PO4-3)in plasmapH(acid-base balance)of plasma,7,Paradigm Publishing,Inc.,Kidneys,Nephrons are the working units of kidneys2 million per kidneyRenal tubules of nephrons produce urine through filtration,reabsorption,and secretion,8,Paradigm Publishing,Inc.,Three Processes of Urine Produ
5、ction,FiltrationRemoval of substances from bloodOccurs in the glomeruliReabsorptionFiltered substances selectively absorbed back into bloodSodium and chloride absorbed in distal tubule and loop of Henle,9,Paradigm Publishing,Inc.,10,Paradigm Publishing,Inc.,Three Processes of Urine Production,Secret
6、ionHydrogen ions,potassium ions,weak acids,weak basesHydrogen ion secretion regulates the acid-base balanceBlood pH between 7.32 and 7.42,slightly acidic,11,Paradigm Publishing,Inc.,Anatomy of the Nephron,12,Paradigm Publishing,Inc.,Acute Renal Failure,Rapid reduction in kidney functionResults in ac
7、cumulation of nitrogen and other wastes in the blood streamCauses:renal ischemia,trauma,pregnancy,volume depletion,hemorrhage,surgery or shock,13,Paradigm Publishing,Inc.,Acute Renal Failure,Can result in uremiaExcessive urea retained in blood,causing nausea,vomiting,vertigo,convulsions,and coma,14,
8、Paradigm Publishing,Inc.,Four Stages of Renal Disease,Loss of Renal ReserveGenerally no symptomsRenal InsufficiencyGenerally asymptomatic,but may have nocturia and hypertensionBlood urea level and creatinine levels slightly elevated,mild anemia,15,Paradigm Publishing,Inc.,Four Stages of Renal Diseas
9、e,3.Chronic Renal InsufficiencyEasily fatigued,intolerant to cold,abnormal taste sensation,anorexiaAnemia worsens,uremia beginsDialysis is indicatedEnd-Stage Renal DiseasePatient requires chronic dialysis,16,Paradigm Publishing,Inc.,Causes of Renal Failure,Prerenal EventsReduced renal blood flow due
10、 to a problem occurring above kidneys,17,Paradigm Publishing,Inc.,Causes of Renal Failure,Prerenal EventsIntrarenal EventsDamage to kidneyDamage to glomeruli may result from damage to vascular tree,change in glomerular permeability,autoimmune reactions,or radiocontrast dyesContrast dyes third most c
11、ommon cause of renal failure in hospitalized patients,18,Paradigm Publishing,Inc.,Technicians and Radioactive Dye Tests,Technician make surePatient is well hydratedNephrotoxic drugs(NSAIDs,aminoglycosides,cyclosporines)held 48 hours after testMetformin stopped,restarted 48 hours after testAcetylcyst
12、eine started 1 day before testMake pharmacist or prescriber aware if no orders,19,Paradigm Publishing,Inc.,Causes of Renal Failure,Prerenal EventsIntrarenal EventsPostrenal EventsCan occur in structures below the kidneyObstruction can cause increased pressure and tubular damage,20,Paradigm Publishin
13、g,Inc.,Diagnosis of Renal Disease,Diagnosis of renal disease made by signs and evaluationsSignsOrthostatic BP,skin turgor(swelling),temperature,color,edema,weight loss,changes in urine volume,bad urine odor,21,Paradigm Publishing,Inc.,Diagnosis of Renal Disease,EvaluationsFiltration rate,urine volum
14、e,electrolyte levels and osmolality,urine protein level,measuring of other urine contents,serum creatinine levels,and blood urea level(BUN),22,Paradigm Publishing,Inc.,Renal Drug Therapy,Aimed at correcting Intravascular volume and pressureRestricting fluidsTreating underlying problemsAnemia caused
15、by lack of erythropoietin(hormone that stimulates red blood cell production)causes anemia,23,Paradigm Publishing,Inc.,Renal Drug Therapy,Most renal patients show erythropoietin deficiencyPatients undergoing dialysis must be watched for aluminum intoxicationCould be caused by sucralfate and aluminum-
16、containing antacidsBlood loss and reduced dietary intake lead to iron and vitamins B6 and B9 deficiency,Paradigm Publishing,Inc.,24,Drug List,Agents for Renal Diseasecinacalcet(Sensipar)darbepoetin alfa(Aranesp)epoetin alfa(erythropoietin)(Epogen,Procrit)ergocalciferol(vitamin D)(none)folic acid(vit
17、amin B9)(many)iron dextran(INFeD),Paradigm Publishing,Inc.,25,Drug List,Agents for Renal Diseaseiron sucrose(Venofer)levocarnitine(Carnitor)methoxy polyethylene glycol-epoetin beta(Mircea)multiple vitamin complex(many)pyridoxine(vitamin B6)(many)sevelamer(Renagel,Renvela),26,Paradigm Publishing,Inc.
18、,epoetin alfa,erythropoietin(Epogen,Procrit),Treats anemia associated with end-stage renal diseaseInduces reticulocytes(immature red blood cells)from bone marrow into blood,where they mature to erythrocytesFrequent blood tests required,27,Paradigm Publishing,Inc.,methoxy polyethylene glycol-epoetin
19、beta(Mircea),Red blood cell formation stimulating agent for anemia associated with chronic renal failure1 monthly dose,up to six weeks before improvementDo not shake vial,store in original container,28,Paradigm Publishing,Inc.,sevelamer(Renagel,Renvela),Limits phosphate concentrations,does not affec
20、t other electrolyte levelsDo not take at the same time as other medicationsRenagel:hydrochloride salt formRenvela:carbonate salt form,29,Paradigm Publishing,Inc.,Renal Transplants,Performed when kidneys fail completelyPatient must take drugs to prevent body from rejecting new organDoses may be adjus
21、ted,usually lowered,but drugs taken rest of life,Paradigm Publishing,Inc.,30,Drug List,Renal Transplant Drugscyclosporine(Sandimmune)mycophenolate(CellCept)mycophenolic acid(Myfortic),31,Paradigm Publishing,Inc.,mycophenolic acid(Myfortic),Indicated specifically to prevent rejection of the kidneyImm
22、unosuppressant,Paradigm Publishing,Inc.,32,Terms to Remember,nephronacute renal failurefiltrationreabsorptionsecretionuremiareticulocytes,33,Paradigm Publishing,Inc.,Drugs for Urinary Tract Diseases and Disorders,Spastic bladderFrequent urinationUrinary tract infections(UTIs)caused by bacteriaBenign
23、 prostatic hyperplasia,abnormal enlargement of the prostrate gland,34,Paradigm Publishing,Inc.,Drugs for Urinary Tract Diseases and Disorders,Overactive bladder(common in elderly)Voiding 8 or more times in 24 hoursAwakening 2 or more times during nightCan affect quality of lifeNumerous medications a
24、vailable as well as behavioral techniques,Paradigm Publishing,Inc.,35,Drug List,Agents for Urinary Problemsbethanechol(Urecholine)darifenecin(Enablex)duloxetine(Cymbalta)flavoxate(Urispas)methenamine(Cystex,Hiprex,Urex)methylene blue(Urolene Blue)oxybutynin(Ditropan,Oxytrol),Paradigm Publishing,Inc.
25、,36,Drug List,Agents for Urinary Problemspentosan polysulfate sodium(Elmiron)phenazopyridine(Azo-Standard,Uristat)propantheline(Pro-Banthine)solifenacin(Vesicare)tolterodine(Detrol)trospium(Sanctura),37,Paradigm Publishing,Inc.,Urinary Antispasmodics,Used to decrease urinary frequencyoxybutynin(Ditr
26、opan,Oxytrol)Inhibits spasms in smooth muscle and increases bladder capacitytolterodine(Detrol)Greater selectivity for urinary bladder receptors than salivary receptors,38,Paradigm Publishing,Inc.,pentosan polysulfate sodium(Elmiron),First oral therapy for interstitial cystitis Used for relief of bl
27、adder painMay work by exerting protective effect on bladder wall,reducing irritation and inflammation,39,Paradigm Publishing,Inc.,Urinary Tract Infections(UTIs),Bacteria enter through the urethra and begin to multiplyBlood may appear in urineUrination may be difficult or painfulHighest incidence in
28、sexually active women,Paradigm Publishing,Inc.,40,Discussion,Why are UTIs more prevalent in sexually active women?Bacteria readily colonize the vagina and travel the short urethra into the bladder.,41,Paradigm Publishing,Inc.,Classification of UTIs,Cystitis Urethritis(lower tract infection)Prostatit
29、isPyelonephritis(upper tract infection),42,Paradigm Publishing,Inc.,Description of UTIs,ComplicatedNo underlying structural or neurologic problems of urinary tractUncomplicatedPredisposing lesion of urinary tract:stone,stricture,neurogenic bladder,prostate hyperplasia,or obstruction,43,Paradigm Publ
30、ishing,Inc.,Treatment of UTIs,UTIs treated with antibioticsSome antibiotics require only a short course to clear the infectionIf several infections occur in sequence,an antibiotic may be prescribed for 6 to 12 months to prevent recurrence,Paradigm Publishing,Inc.,44,Drug List,Medications to Treat UT
31、IsAntibioticsamoxicillin(Amoxil)amoxicillin-clavulanate(Augmentin)ampicillin(Principen)ciprofloxacin(Cipro)methenamine(Cystex,Hiprex,Urex)nitrofurantoin(Macrobid,Macrodantin),Paradigm Publishing,Inc.,45,Drug List,Medications to Treat UTIsAntibioticssulfamethoxazole-trimethoprim(Bactrim,Bactrim DS,Co
32、trim,Cotrim DS,Septra DS)Urinary Analgesicphenazopyridine(Azo-Standard,Uristat),46,Paradigm Publishing,Inc.,methenamine(Cystex,Hiprex,Urex),Local anesthetic effect on urinary tract mucosa and antimicrobial effectShould be taken with foodAvoid alkaline foods,antacids,and others such as bicarbonateAvo
33、id sulfonamides,47,Paradigm Publishing,Inc.,Dispensing Issues of nitrofurantoin(Macrobid,Macrodantin),Take with food or milkMay turn urine brown or dark yellowAvoid alcohol,Warning!,48,Paradigm Publishing,Inc.,phenazopyridine(Azo-Standard,Uristat),OTC agent with local anesthetic effect on urinary tr
34、act mucosaColors urine orange,stains anythingDo not take more than 2 daysTake with antibiotic(not antimicrobial)Symptomatic relief of urinary burning,itching,frequency,urgency in UTIs,49,Paradigm Publishing,Inc.,Benign Prostatic Hyperplasia(BPH),Abnormal enlargement of the prostate that obstructs ur
35、ine outflowCommon medical problem in older menDrug therapy is primary treatmentAlpha blockers work well when treating both hypertension and BPH,50,Paradigm Publishing,Inc.,Male Reproductive System,51,Paradigm Publishing,Inc.,Contraindicated and Alternative Drugs for BPH,52,Paradigm Publishing,Inc.,C
36、ontraindicated and Alternative Drugs for BPH,Paradigm Publishing,Inc.,53,Drug List,Agents for Prostatic Diseasealfuzosin(Uroxatral)doxazosin(Cardura)dutasteride(Avodart)finasteride(Propecia,Proscar)flutamide(Eulexin)goserelin(Zoladex),Paradigm Publishing,Inc.,54,Drug List,Agents for Prostatic Diseas
37、eleuprolide(Eligard,Lupron Depot,Viadur)megestrol(Megace)nilutamide(Nilandron)prazosin(Minipress)tamsulosin(Flomax)terazosin(Hytrin),55,Paradigm Publishing,Inc.,doxazosin(Cardura),Alpha blockerPrevents constriction of blood vessels which decreases blood pressureRelaxes muscles around prostate gland,
38、making urination easier,56,Paradigm Publishing,Inc.,finasteride(Proscar,Propecia),Blocks enzyme that converts testosterone to dihydrotesterone(DHT)Increases intracellular testosterone levels minimizing sexual dysfunctionReduces prostate sizeImproves urine flow and symptom reliefMinimal drug-related
39、adverse effects,57,Paradigm Publishing,Inc.,flutamide(Eulexin),AntiandrogenUsed in combination with leuprolide,and both drugs need to be started simultaneouslyCan cause gynecomastia(breast enlargement)and GI side effects,58,Paradigm Publishing,Inc.,Dispensing Issues of Proscar,Look-alike and sound-a
40、like Proscar(BPH)Prozac(antidepressant)ProSom(sleeping agent),Warning!,59,Paradigm Publishing,Inc.,nilutamide(Nilandron),Used for advanced prostate cancerAn antiandrogen,similar to flutamideHelps reduce metastatic bone pain and improves survivalDosed 1x/daily,60,Paradigm Publishing,Inc.,tamsulosin(F
41、lomax),Alpha-1 blocker More selective than other alpha blockersWorks well for BPH,but not for hypertension,61,Paradigm Publishing,Inc.,terazosin(Hytrin),Long-acting alpha blockerIndicated for hypertension and BPHImproves obstructive symptoms and urinary flow ratesOnce daily dosing,Paradigm Publishin
42、g,Inc.,62,Terms to Remember,stress incontinenceurine leakage during physical movementsurinary tract infection(UTI)an infection caused by bacteria,usually E.coli,that enter via the urethra and progress up the urinary tract,63,Paradigm Publishing,Inc.,Diuretics,Increase urine outputPrimary purpose is
43、to rid the body of excess fluid and electrolytesOften first drug chosen to treat hypertensionMay also be prescribed for edema,64,Paradigm Publishing,Inc.,Mechanism of Action of Diuretics,Have different mechanisms of actionClassified by where and how they work in the kidneysThiazide diureticsLoop diu
44、reticsPotassium-sparing diureticsOsmotic diureticsMiscellaneous diuretics,65,Paradigm Publishing,Inc.,Thiazide Diuretics,Promote sodium and water excretion in urineLower sodium level in bloodReduce vasoconstrictionPatients must ingest potassium daily due to loss of electrolytesBananas,orange juice,c
45、itrus fruits,66,Paradigm Publishing,Inc.,Side Effects of Thiazide Diuretics,HypokalemiaHypomagnesiaHyperuricemiaHyperglycemiaHypercalcemiaMay become more sensitive to sunlight,Paradigm Publishing,Inc.,67,Drug List,DiureticsThiazideshydrochlorothiazide(HCTZ)(Esidrix)methyclothiazide(Enduron)Drug Rela
46、ted to the Thiazideschlorthalidone(Hygroton),Paradigm Publishing,Inc.,68,Drug List,DiureticsCombinationsatenolol-chlorthalidone(Tenoretic)bisoprolol-hydrochlorothiazide(Ziac)linsinopril-hydrochlorothiazidelosartan-hydrochlorothiazide(Zestoretic)triamterene-hydrochlorothiazide(Dyazide,Maxzide),69,Par
47、adigm Publishing,Inc.,Loop Diuretics,Inhibit reabsorption of sodium and chloride in ascending loop of HenleCause increased urinary excretion of water,sodium chloride,magnesium,calcium,and potassiumWork well due to unique site of action,Paradigm Publishing,Inc.,70,Drug List,DiureticsLoop Diureticsbum
48、etanide(Bumex)ethacrynic acid(Edecrin)furosemide(Lasix)torsemide(Demadex),71,Paradigm Publishing,Inc.,Potassium-Sparing Diuretics,Inhibit exchange of sodium from urine for potassium from bloodAdministered with caution to patients on angiotensin-converting enzyme(ACE)inhibitorsCan cause hyperkalemia
49、and gynecomastia in men,Paradigm Publishing,Inc.,72,Drug List,Diuretics Potassium-Sparing Diureticsamiloride(Midamor)eplerenone(Inspra)spironolactone(Aldactone)triamterene(Dyrenium),73,Paradigm Publishing,Inc.,Carbonic Anhydrase Inhibitors,Act in the proximal tube toIncrease urine volumeChange to an
50、 alkaline pHCause decrease in excretion of acid and ammonia,Paradigm Publishing,Inc.,74,Drug List,DiureticsCarbonic Anhydrase Inhibitorsacetazolamide(Diamox)methazolamide(Neptazane),75,Paradigm Publishing,Inc.,Osmotic Diuretics,Increase osmotic pressure of glomerular filtrateInhibits tubular reabsor
