HillcrestLPNPharmacology

Renal Urinary
Date: 5/3/2006
To: Senior Pharmacology
From: Sylvester
Drugs to Know
Answer this for all these drugs as they relate to the Renal and urinary system
DrugsLasixAldactoneDiurilMannitol
Lanoxin
Cardizem
HeparinCoumadinMorphine sulfate
fluconazole
methylprednisolone
ElavilUsesAdverseEffectsPrecautionsInterventionsEducation UsesAdverseEffectsPrecautionsInterventionsEducationUsesAdverseEffectsPrecautionsInterventionsEducation
UsesAdverseEffectsPrecautionsInterventionsEducation
BUN:CREATININE RATIO
BUN:creatinine ratio is usually >20:1 in prerenal and postrenal azotemia, and <12:1 in acute tubular necrosis. Other intrinsic renal disease characteristically produces a ratio between these values
CRETININE
Creatinine 0.6-1.3 Increase in serum creatinine is seen any renal functional impairment. Because of its insensitivity in detecting early renal failure, the creatinine clearance is significantly reduced before any rise in serum creatinine occurs. The renal impairment may be due to intrinsic renal lesions, decreased perfusion of the kidney, or obstruction of the lower urinary tract.
Creatine Clearance(140-AGE) Wt kg/72Serum Creatine
POTASSIUM
Potassium K Normal - 3.5-5.0 Increase in serum potassium is seen in states characterized by excess destruction of cells, with redistribution of K+ from the intra- to the extracellular compartment, as in massive hemolysis, crush injuries, hyperkinetic activity, and malignant hyperpyrexia. Decreased renal K+ excretion is seen in acute renal failure, some cases of chronic renal failure, Addison's disease, and other sodium-depleted states. Hyperkalemia due to pure excess of K+ intake is usually iatrogenic.
Drugs causing hyperkalemia include amiloride, aminocaproic acid, antineoplastic agents, epinephrine, heparin, histamine, indomethacin, isoniazid, lithium, mannitol, methicillin, potassium salts of penicillin, phenformin, propranolol, salt substitutes, spironolactone, succinylcholine, tetracycline, triamterene, and tromethamine. Spurious hyperkalemia can be seen when a patient exercises his/her arm with the tourniquet in place prior to venipuncture. Hemolysis and marked thrombocytosis may cause false elevations of serum K+ as well. Failure to promptly separate serum from cells in a clot tube is a notorious source of falsely elevated potassium.
Decrease in serum potassium is seen usually in states characterized by excess K+ loss, such as in vomiting, diarrhea, villous adenoma of the colorectum, certain renal tubular defects, hypercorticoidism, etc. Redistribution hypokalemia is seen in glucose/insulin therapy, alkalosis (where serum K+ is lost into cells and into urine), and familial periodic paralysis. Drugs causing hypokalemia include amphotericin, carbenicillin, carbenoxolone, corticosteroids, diuretics, licorice, salicylates, and ticarcillin.
RBC (Red Blood Cell) COUNT
The RBC count is most useful as raw data for calculation of the erythrocyte indices MCV and MCH [see below]. Decreased RBC is usually seen in anemia of any cause with the possible exception of thalassemia minor, where a mild or borderline anemia is seen with a high or borderline-high RBC. Increased RBC is seen in erythrocytotic states, whether absolute (polycythemia vera, erythrocytosis of chronic hypoxia) or relative (dehydration, stress polycthemia), and in thalassemia minor [see "Hemoglobin," below, for discussion of anemias and erythrocytoses].
HEMOGLOBIN, HEMATOCRIT, MCV (Mean Corpuscular Volume), MCH (Mean Corpuscular Hemoglobin), MCHC (Mean Corpuscular Hemoglobin Concentration)
SODIUM
Increase in serum sodium is seen in conditions with water loss in excessof salt loss, as in profuse sweating, severe diarrhea or vomiting,polyuria (as in diabetes mellitus or insipidus), hypergluco- ormineralocorticoidism, and inadequate water intake. Drugs causingelevated sodium include steroids with mineralocorticoid activity,carbenoxolone, diazoxide, guanethidine, licorice, methyldopa,oxyphenbutazone, sodium bicarbonate, methoxyflurane, and reserpine.
Decrease in sodium is seen in states characterized by intake of free water or hypotonic solutions, as may occur in fluid replacement following sweating, diarrhea, vomiting, and diuretic abuse. Dilutional hyponatremia may occur in cardiac failure, liver failure, nephrotic syndrome, malnutrition, and SIADH. There are many other causes of hyponatremia, mostly related to corticosteroid metabolic defects or renal tubular abnormalities. Drugs other than diuretics may cause hyponatremia, including ammonium chloride, chlorpropamide, heparin,aminoglutethimide, vasopressin, cyclophosphamide, and vincristine
BUN (UREA NITROGEN)
Blood Urea Nitrogen 7-18 Serum urea nitrogen (BUN) is increased in acute and chronic intrinsic renal disease, in states characterized by decreased effective circulating blood volume with decreased renal perfusion, in postrenal obstruction of urine flow, and in high protein intake states.
Decreased serum urea nitrogen (BUN) is seen in high carbohydrate/low protein diets, states characterized by increased anabolic demand (late pregnancy, infancy, acromegaly), malabsorption states, and severe liver damage.
URIC ACID
Increase in serum uric acid is seen idiopathically and in renal failure, disseminated neoplasms, toxemia of pregnancy, psoriasis, liver disease, sarcoidosis, ethanol consumption, etc. Many drugs elevate uric acid, including most diuretics, catacholamines, ethambutol, pyrazinamide, salicylates, and large doses of nicotinic acid.
Decreased serum uric acid level may not be of clinical significance. It has been reported in Wilson's disease, Fanconi's syndrome, xanthinuria, and (paradoxically) in some neoplasms, including Hodgkin's disease, myeloma, and bronchogenic carcinoma.