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PYRAMID POINTS
CHAPTER 62:
RENAL MEDICATIONS
PYRAMID POINTS
I. Urinary Tract Antiseptics


Description
• Inhibit growth of bacteria in urine
Side effects and nursing considerations
• Cinoxacin (Cinobac)

Dosages should be reduced in clients with renal
impairment.
• Methenamine (Mandelamine, Hiprex, Urex)


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Requires acidic urine with pH of 5.5 or lower
Increasing fluids reduces antibacterial effects
Should not be combined with sulfonamides
Clients should avoid alkalinizing agents, including antacids
ADULT HEALTH:
Renal Medications
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PYRAMID POINTS
I. Urinary Tract Antiseptics (continued)

Nalidixic acid (NegGram)
• May produce intracranial hypertension in pediatric clients
• Can intensify effects of orally administered
anticoagulants

Nitrofurantoin (Furadantin, Macrodantin,
Macrobid)
• May cause pulmonary reactions, including dyspnea,
chest pain, alveolar infiltrates
• May produce harmless brown color in urine
• Contraindicated in clients with renal impairment
ADULT HEALTH:
Renal Medications
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PYRAMID POINTS
II. Fluoroquinolones

Description
• Suppress bacterial growth by inhibiting an enzyme
necessary for DNA synthesis
• Are active against a broad spectrum of microbes

Side effects and nursing considerations
• Administer with full glass of water
• Ensure maintenance of urine output of at least 1200 to
1500 mL/day
• Advise client to report dizziness, visual disturbances,
photophobia, feelings of depression
• Instruct client of signs of hepatic, renal toxicity; if they
occur, report to physician
ADULT HEALTH:
Renal Medications
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PYRAMID POINTS
III. Sulfonamides


Description
• Suppress bacterial growth
• Are active against a broad spectrum of microbes
• Are used primarily to treat acute urinary tract infections
Side effects and nursing considerations
• Should be discontinued if rash is noted
• Instruct client to complete entire course of antibiotics
prescribed
• Adults should maintain urine output of 1200 mL/day
• IV doses should be administered over
60 to 90 minutes, not mixed with other medications
ADULT HEALTH:
Renal Medications
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PYRAMID POINTS
IV. Urinary Tract Analgesic



Description
• Administered with an antibiotic
Side effects
• Nausea
• Headache
• Vertigo
Nursing considerations
• Instruct client that urine will turn red or orange
ADULT HEALTH:
Renal Medications
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PYRAMID POINTS
V. Anticholinergics and Antispasmodics

Description
• Relax smooth muscles of the urinary tract
• Decrease bladder muscle spasms
• Reduce urinary incontinence, urgency, and frequency by
controlling bladder contractions


Side effects
• Anticholinergic effects
• Dizziness
• Drowsiness
Nursing considerations
• Do not administer oxybutynin (Ditropan) to clients with known
hypersensitivity, gastrointestinal or genitourinary obstruction,
glaucoma, severe colitis, myasthenia gravis
• Monitor for signs of toxicity
ADULT HEALTH:
Renal Medications
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PYRAMID POINTS
VI. Cholinergic Medications
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
Description
• Increase bladder tone and function
Side effects
• Headache
• Hypotension
• Flushing and sweating
• Abdominal cramps
• Urinary urgency
Nursing considerations
• Do not administer if client has urinary stricture or obstruction
• Monitor intake and output
• Monitor for cholinergic overdose (excessive salivation,
sweating, involuntary urination and defecation, bradycardia,
and severe hypotension)
ADULT HEALTH:
Renal Medications
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PYRAMID POINTS
VII. Medications for Prevention of Organ
Rejection

Include immunosuppressants, corticosteroids,
cytoxic medications, antibodies
ADULT HEALTH:
Renal Medications
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PYRAMID POINTS
VII. Medications for Prevention of Organ Rejection
(continued)

Cyclosporine (Sandimmune, Gengraf, Neoral)
• Most common adverse effects are nephrotoxicity, infection,
hypertension, tremor, hirsutism
• Client should be instructed to monitor for early signs of
infection; report immediately
• Instruct client to dispense oral liquid medication into glass
container using specially calibrated pipette, mix well, drink
immediately, rinse glass container with diluent, drink to ensure
ingestion of complete dose
• Instruct client to mix medication with milk, chocolate milk,
orange juice just before administration
ADULT HEALTH:
Renal Medications
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PYRAMID POINTS
VII. Medications for Prevention of Organ
Rejection (continued)

Sirolimus (Rapamune)
• Increases risk of infection, renal injury, lymphocele,
raises cholesterol, triglyceride levels
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Tacrolimus (Prograf)
• Adverse effects include nephrotoxicity, infection,
hypertension, tremor, neurotoxicity, hyperkalemia
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
Prednisone (Deltasone)
• Hyperglycemia, hypokalemia can occur
Azathioprine (Imuran)
• Can cause neutropenia, thrombocytopenia
ADULT HEALTH:
Renal Medications
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PYRAMID POINTS
VII. Medications for Prevention of Organ Rejection
(continued)

Mycophenolate mofetil (CellCept)
• Major adverse effects include diarrhea, severe neutropenia,
vomiting, sepsis
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
Daclizumab (Zenapax), basiliximab (Simulect)
• Contraindicated in clients with allergy to protein
Antithymocyte globulin, equine (Atgam)
• Before first infusion, client should undergo intradermal skin test
for hypersensitivity

Muromonab-CD3 (Orthoclone OKT3)
• Adverse reactions include fever, chills, dyspnea, chest pain
ADULT HEALTH:
Renal Medications
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PYRAMID POINTS
VIII. Hematopoietic Growth Factors
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
Erythropoietic growth factors
• Major side effect is hypertension
Leukopoietic growth factors
• Can cause bone pain, leukocytosis, elevation of plasma
uric acid, lactate dehydrogenase, alkaline phosphatase
levels

Thrombopoietic growth factor
• Adverse effects include fluid retention, cardiac
dysrhythmias, conjunctival infections, visual blurring,
papilledema
ADULT HEALTH:
Renal Medications
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A client must begin medication therapy with mycophenolate
mofetil (CellCept) to prevent organ rejection following renal
transplantation. The nurse plans to teach the client which of the
following teaching points?
1.
2.
3.
4.
Notify the physician if a fever develops.
Take the medication with an aluminum-based antacid.
Take the dose following meals.
Open the capsule and mix with food before use.
ADULT HEALTH:
Renal Medications
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62-14