Carbonic Anhydrase Inhibitor -blocks Na and HCO reabsorp in proximal tubule

Action: Slows movement of H ions, mild diuretic

Indication: Not seen often, used for glaucoma

SE: Kidney stones (renal calculi), metabolic acidosis, hypokalemia

Contraindications: Allergies to sulfonamides

Special consideration: Older adults hypotension, rapid water loss, and diurectics may raise blood sugar levels

Loop diuretic: ascending loop of henle

Action: potent diuretic, blocks chloride pump, fast acting, increase Ca excretion, can produce fluid loss up to 20 lb/day

ADME: fairly well absorbed, peak 1-2 hr, t 1/2 <1 hr

Indication: Acute HF, pulmonary edema, and edema related to HF, renal, or liver disease

SE: Postural hypotension, ototoxicity, nephrotoxicity, neurotoxicity, hypokalemia (watch for muscle tremors), alkalosis, hypocalcemia and tetany

Drug-drug interactions: Lithium, NSAIDs

OD: hypovolemia, and electrolyte imbalance

Education: Positional hypotension, dietary counseling (rich in potassium), avoid sun, hearing loss, and NSAID use

Thiazide diuretic: ascending loop of henle

Acion: blocks chloride pumps, reduces plasma and extracellular fluid

ADME: 1 to 3 hr

Indication: first line drug for HTN, mild diuretic

SE: Fluid and electrolyte imbalance, increase cholesterol and lipid balance, increased risk of digitalis toxicity

Education: supplement K or increase in diet, monitor BP, lipid, K, creatinine clearance, feel fatigue

Potassium Sparing diuretic

Used in conjunction with other diurectic

SE: hyperkalemia, androgen effects like hirsutism, gynecomastia, irregular menses, deepening voice

Drug-drug: loses its effect if used with salicylates, decreases anticoagulant effects

OD: hypovolemia, hypotension

Osmotic diuretic, a sugar that pulls water into the renal tubule w/out loss of sodium

Indications: increased intracranial pressure, acute renal failure due to shock, drug overdose, acute glaucoma

ADME: IV administration, t1/2 90 minutes, PO agent for glaucoma

SE: hypotension, fluid and electrolyte imbalance, CNS weakness

Contraindication: renal or cardiac dysfunction, intracranial bleeding

Nursing implications: crystillization is common, used indwelling catheter w/ urometer to measure hourly output

thirst, muscle weakness, lethargy, depression

later: muscle cramping, vomiting

UTI anti-infective

newer drug, broad spectrum with greater effects on gram-neg bacteria

Urinary tract analgesic

Action: direct topical anesthesia on urinary tract mucosa

ADME: widely used, very rapid

SE: turns urine reddish-orange, potential liver/kidney toxicity so only use for 2 days

Antispasmodics

Indications: muscle spasms along with urinary tract

Action: relaxes smooth muscle in bladder

SE: urinary hesitancy

Antispasmodic

Indication: overactive bladder

Action: muscarinic receptor antagonist, inhibition of bladder contractions

SE: constipation, dyspepsia

bladder protectanct

indication: relief of bladder pain assiciated with interstitial cystitis

Action: adheres to bladder wall and acts as a buffer

Drug to treat BPH

Indications: relief symptoms of BPH, also used with HTN

Action: Alpha 1 selective blocker

SE: HA, fatigue, postural hypotension, tachycardia, hypotension, GI sx, decreased libido

Drug to treat BPH

Indication: long term to shrink prostate

Action: inhibits cellular enzyme the prostate is dependent on for development and maintenance

SE: decreased libido, ED

Drug to treat BPH

Indication: manage outflow obstruction from BPH

Action: decreases smoth muscle cntractions of prostate

ADME: 94-99% protein bound

SE: dizziness, HA, orthostatic hypotension

inflammation of the prostate, cmmon in older men, thought to be associated with relux of infected urine, STI, most often gram-neg organism

S/S: sudden onset fever, urinary symptoms, bacteriuria

Digital exam: swollen prostate, warm, tender, purulent discharge

Tx: same as UTI

upper tract infection, kidney

Sx: high-grade fever, severe flank pain in addition to lower tract symptoms

Tx: outpatient for uncomplicated cases, 2wks of abx, inpatient if severe signs, bacterim or fluoroquinolone for gram-neg, amoxicillin for gram-pos, may require combo IV antibiotics

Most common is strep throat, Other immune disorder, HTN, DM, viruses, endocarditis

Sx: tea-colored urine, foamy urine (due to protein), sweling of face and distal extremities, less frequent urination

Tx: mediation of inflammatory process, loop diuretic, ACEI, lipd-lowering agent anticoagulant, dialysis

Most common type is calcium oxalate crystals, formed in kidney, can later migrate into ureter (natural occurrence or drug induced)

Sx: may be asymptomatic, dull flank pain, excruciating pain, hematuria

Tx: analgesia, strain all urine for stone for lab analysis, lithotripsy

monitor intake/output - note amount, color, clarity, odor

dietary and fluid management

restrict Na, water, potassium, phosphate, excess protein when appropriate

daily weight

emotional support

dialysis preparation when fluid overload, hyperkalemia, acidosis, GFR<10ml.min

education

Action: stimulates steroid release from adrenals

Indications: antiinflammatory properties, test the functioning of adrenal

SE: water and sodium retention, hypokalemia, myalgia

Action: stimulates anabolic processes

Indication: children with growth failure

SE: antibodies to GH, insulin resistance, joint pain, HA

Action: dopamine agonist that inhibits GH (acromegaly), opposite effect in normal people

Indication: acromegaly for people >15yrs old

SE: dizziness, HA, N/V, constipation, nasal congestion, diarrhea, fatigue

Action: synthetic vasopressin (ADH) analog, enables kidneys to concentrate urine, also stop bleeding in hemophilia A

Indications: diabetes insipidus, nocturnal enuresis

SE: HTN, flushing, water retention, rhinitis, nausea

Action: replaces T4

ADME: well absorbed, 50-75%

SE: dose related, most common cardiac dysrhythmias

Drug-drug: decreases effect of beta blockers, digoxin, and theophyline, increases effects of warfarin

Education: life long therapy needed, labs to guide

Indication: hyperthyroidism

Action: interfers with release of T3 and T4

ADME: slowly absorbed and about a third stored

SE: sore gums, swelling of salivary glands, metalic taste

Caution: harmful with pregnancy, new born goiter

Education: bad taste, evaporates quickly, discolors teeth

Action: inhibits incorporation of iodine into tyrosine and conversion of T4 to T3 in tissues

ADME: peak effects 17 weeks

SE: loss of taste, pruritus, fever, smokey-colored urine, muscle and joint ache

Caution: pregnancy D, may cause permanent hypothyroidism in fetus

Education: evenly spaced doses, same time every day with meals, report fever, sore throat, rash, no OC foods containing iodine

Antihypocalcemic agents

Action: with vit. D regulates absorption of calcium and phosphate

ADME: well absorbed and stored in fat, liver, muscle, skin, bones. Excreted in bile

SE: weakness, muscle and bone pain, metalic taste

Antihypercalcemic agent

Action: blocks bone reabsorption thus lowering calcium levels, no effects on new bone growth

ADME: slow onset and long duration

SE: bone pain, must stand or sit for atleast 30minutes after dose because it can cause esophageal erosion

Caution: must be taken with a full glass of water before eating

Antihypercalcemic agent, postmenopausal osteoporosis

Action: inhibits bone resorption, increases increase excretion of phosphate, calcium, and sodium

SE: flushing, n/v, nasal irritation if spray is used

ADME: affected by circulation, formulation and route also affect absorption, usually given subcut, but can be given on pump, IV for emergency, intra-abdominal sites prefered, 1 mL syringes and small needles used, dosage given usually based off a sliding scale, look at consistency, not all insulins can be mixed

Drug-drug interactions: beta blockers inhibit insulin release, ETOH increases bg levels, ASA increases baseline insulin levels

Hgb A1C - marker for hyperglycemic serum levels and diabetes control

SE: hypoglycemia (hunger, weakness, diaphoresis, nervousness, tremor, tachycardia, HA, blurred vision, disorientation, coma)

First generation: tolbutamide (Orinase)

Second generation: glyburide (Micronase)

Action: enhances releance of insulin from beta cells, decreases liver glycogen breakdown, increases cell sensitivity to insulin

ADME: well absorbed, oral, attaches to protien

SE: GI sx, anorexia, muscle cramps, edema of the face, weakness, confusion

Drug-drug: adrenergics, steroids, thiazides, thyroid meds decrease hypoglycemic effects, ETOH has antabuse reaction, oral anticoagulants

Meglitinides

Action: stimulation of beta cells in pancreas

SE: similar to sulfonylureas

Biguanides

Action: decreases glucose absorption from intestine, increases insulin sensitivity, does not stimulate beta cells

SE: GI sx, HA

Alpha-glucosidase inhibitors

Action: delay absorption and digestion of carbohydrates

ADME: poorly absorbed

SE GI sx

pioglitazone (Actose), and rosiglitazone (Avandia)

Action: resensitizes the body to insulin, activates receptors that control producation, transport and use

SE: HA, edema, myalgia, sinusitis, URIs, wt gain

Caution: monitor LFTs q2mo for a year

Hyperglycemic agent

Severe hypoglycemia, raises bg, provides 4kcal/gm,

well absorbed and rapid response

Hyperglycemic agent

when oral glucose can not be used, t1/2 10minutes

Acts on the liver to stimulate glycogen breakdown to glucose to increase blood levels

Parenteral use only

cortisone (Cortone), prednisone (Deltasone), and dexamethasone (Decadron)

ADME: absorbed well all routes except rectal

SE: increased appetite, insomnia, restlessness, anxiety, low BP, HA, hirsutism, low resistance to infection, increased thirst and urination, Na and water retention, muscle wasting, decreased growth in children

Caution: weight gain, round face (cushings)

drug-drug: antacids, vit k, oral hypoglycemics, dig, diuretics, vaccines

Mineralcorticoids

ADME: well absorbed

SE: HA, HTN, dizziness, edema of lower extremities, joint pain, hypokalemia, weakness, paresthesias in legs, CHF

Contraindication: HTN, CHF, renal disease, heart disease

Nursing considerations: weight gain, monitor I&O, BP, Na restrictions, monitor electrolytes (especially K)

Action: affects the release of FSH and LH, conserves Ca Phos for bone formation, inhibits ovulation

Indication: menopausal sx, prostate cancer, inoperable breast cancer, female hypogonadism

Action: increases synthesis of DNA, RNA, and protein in estrogen sensitive tissues, NA and water retention, lowers cholesterol

Indication: estrogen deficiency w/ vasomotor sx, osteoporosis prevention, urinary meatus/vaginal atrophy

SE: stomach cramps or gas, anorexia, HA, n/v, decreased libido, edema in LE, breast pain and enlargement, changes in menstrual bleeding, wt gain

Caution: risk of endrometrial Ca with prolonged use, not given when pregnant or breast feeding, baseline labs before therapy

Contraindications: breast cancer, abnormal vaginal bleeding

Increased risk of MI, pulmonary embolism, DVT, Thrombophlebitis

Action: diminish endometrial tissue proliferation, thicken vaginal mucosa, neg feedback to release FSH an LH, relax uterine smooth muscle, increase appetite

Indication: uterine bleeding due to hormonal imbalance, fibroids, or uterine cancer, combined with estrogen to lower risk of endometrial Ca, to prevent pregnancy

SE: liver dysfunction, thrombophlebitis, and DVT, breakthrough bleeding/spoting, breast tenderness, GI upset, wt gain, rash and depression

Contrandications: pregnancy, idiopathic vaginal bleeding, breast and genital cancer, hx of thromboembolism, hepatic dysfunction, STI/PID or pelvic surgery

Lower risk for adverse CV effects, decreased risk for ectopic pregnancy, increased risk for MI, increased risk for cervical, liver, and earlier onset of breast cancer, increased risk for gallbladder disease. 

Action: inhibit secretions of FSH and LH, changes in endometrum that impair ova implantation, increased vaginal mucus viscosity to impede passage of sperm

allergy to a specific product, higher risk for thromboembolitic events

Interactions: reduced effect if taken with antibiotics, barbiturates, griseiofluvin, INH. decreased effect of anticonvulsants, beta-blockers, hypoglycemic drugs, anticoagulants, theophylline, TCAs, vitamins

Low dose mini pill (Ovrette) that does not contain any estrogen, good for smokers, older females, breastfeeding women, avoids estrogen SE

Long lasting depo-provera (IM injection), progestasert (IUD)

SE: no menstrual periods, vaginal bleeding, muscle pain, GI distress, wt gain, vaginitis, breast discharge

Action: unknown, thought to compete in hypothalamus for estrogen receptor sites to stimulate the release of FSH and LH

ADME: given for 5 days starting on day 5 of cycle, can be taken 3-4 times, if ovulation does not occur then increase dosage for another 5 days

SE: hot flashes, HA, breast tenderness, n/v, insomnia, blurred vision, floaters, photophobia, enlargement of ovarian cysts

Monitor ovarian size before the beginning of each dose, HCG if menses does not occur before next tx, urine LH to predicit ovulation, should take at the same time every day, coitus around time of ovulation, possibility of multiple births

Ritodrine (Yutopar) and Terbutaline (Brethine)

Indication: halt premature labor

Action: beta 2 stimulation relaxes the myometrium, IV produces effects in 5 minutes

SE: Anxiety, n/v, HA, tachycardia, reactive hypoglycemia in newborn

Indication: induce or augment labor, decrease post partum bleeding via muscle contraction

Action: raises Ca in uterine muscle increasing contraction if labor started

SE: hypotension, uterine rupture, induced stroke during labor, abruption placenta

Alendronate (Fosamax) and Ibandronate (Boniva)

inhibit bone reabsorption which enhances bone mineral density

SE: HA, GI sx, joint pain, risk of esophageal burn if they become lodged in esophagus

Contraindication: hypocalcemia, esophageal dysfunction, inabilty to sit or stand for 30 minutes after taking

Only drug available that stimulates bone formation

SE: chest pain, dizziness, hypercalcemia, nausea, arthralgia

inhibits bone reabsorption

SE: facial flushing, nausea, anorexia

SE: increased risk of thromboembolism, teratogenic, leukopenia

Contraindication: women who are pregnant or may become pregnant, thromboembolic disorders

Naturally occuring anabolic steroid

Indication: delayed male puberty, tx of breast cancer and anemia, use for wt gain, muscle building, and strength, androgen deficiency and hypogonadism

SE: abd pain, insomnia, n/v/d, depression, red skin, HA, pruritus, jaundice, change in libido. SE in females: ance, deepening voice, increased hair growth or alopecia, enlarged clitoris, irregular menses. SE in males: urinary urgency, gynecomastia, frequent erection

Get a baseline ht, wt, and sexual development in children and bone age determination q6mo, monitor serum Ca, cholesterol levels, LFTs, H&H for polycythemia, monitor tumor growth, monitor signs of BPH in older men

Contraindication: androgen-responsive tumors, severe hepatic, cardiac, or renal disease

Action: inhibits an enzyme that converts testosterone into potent androgen DHT by 70% which causes shrinkage in prostate, lower dose used for baldness

SE: decreased libido, impotency, decreased amount of ejaculate

Pregnant women should not handle unless wearing gloves

Prazosin (Minipress) and Terazosin (Hytrin)

nonselective alpha adrenergic blockers to decrease contractility of smooth muscle in bladder and urethra

Action: increases levels cyclic guanosine monophosphate (cGMP), a smooth muscle relaxant, results in inflow of blood and an erection

Indications: erectile dysfunction

Administration: 1hr before sexual activity, not with high fat meal may cause delayed response

SE: HA, nausea, GI distress, facial flushing, nasal congestion, back pain, flu syndrome, arthralgia, allergic reaction, cardiovascular sx, visual changes

Contraindication: concomitant use of organic nitrate (nitroglycerin and nitroprusside)

Teaching: increase fluid intake to prevent UTI, seek tx if CV sx