Sweet Glomerulus: A Case of Diabetic Nephropathy

DRUG SITAGLIPTIN (JANUVIA) 25 mg OD

CLASSIFICATION MECHANISM INDICATION CONTRINDICATION/ ADVERSE
OF ACTION SPECIAL EFFECTS
PRECAUTION
Antidiabetic Agent Elevates the Adjunct C: Type I DM Headache
Incretin Modifier level of treatment of Diabetic Ketoacidosis Nasopharyngitis
incretin Type 2 SP: Moderate to URTI
hormones, Diabetis severe renal Peripheral edema
thus Mellitus in impairment Osteoarthritis
increasing combination Renal impairment Anorexia
insulin with exercise Renal failure Dizziness
secretion and and diet. Hemodialysis Hypoglycemia
reducing PREGNANCY
glucagon CATEGORY B
secretion.

NURSING CONSIDERATIONS

Assessment:
Monitor for s/sx of hypoglycemia
Monitor baseline and periodic creatinine clearance, FBS and RBS level
Assess for history of combined medication with insulin or metformin which could have addictive effect.

Pt. and Family Teachings:

Tech pt. that diet and exercise regimen must be followed.
Educate pt regarding Type2 diabetes and its management.
Emphasize that regular daily blood glucose monitoring amd periodic glycosylated hgb test must be done.
Instruct pt. to immediately notify physician if hypoglycemic or hyperglycemic episode occur.
Can be taken with food or meal or an empty stomach

Chapter 6
DRUG STUDY

DRUG AMLODIPINE (NORVASC) 5mg/tab OD

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 Sweet Glomerulus: A Case of Diabetic Nephropathy

CLASSIFICATION MECHANISM INDICATION CONTRINDICATION/ ADVERSE

OF ACTION SPECIAL EFFECTS
PRECAUTION
Calcium Channel Inhibits influx Treatment of C: Hypersensitivity to Palpitations
Blocker of calcium ion hypertension amlodipine Flushing
Antihypertensive across cell and can be Hypotension Tachycardia/
Agent membranes to used as the Severe obstructive Bradycardia
produce sole agent to Coronary Artery Peripheral or
relaxation of control BP Disease facial edema
coronary Severe Aortic Stenosis Chest pain
vascular SP: Hepatic Syncope
smooth muscle Impairment Postural
resulting to PREGNANCY hypotension
decrease blood CATEGORY C Sexual
pressure. Dysfunction
Increase Nocturia
myocardial Dyspnea
oxygen Rash
delivery in pts Cramps
with Headache
vasospastic Dizziness
angina
Peripheral
arterial
vasodilator that
acts directly on
vascular
smooth muscle
causing
reduction in
peripheral
vascular
resistance and
reduction in
blood pressure.

NURSING CONSIDERATIONS

Assessment:
Monitor BP, pulse, respiration
Assess hydration and fluid volume status:
I&O ratio, presence of edema, distended neck veins, lung crackles, adequate pulse and skin turgor

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 Sweet Glomerulus: A Case of Diabetic Nephropathy

Monitor liver function: ALT, AST, Bilirubin

Monitor if platelet count is <150,000/mm3, drug is usually discontinued and another drug started

Pt. and Family Teachings:

Teach pt to use as directed even if feeling better, may be taken with other cardiovascular drug (Nitrate,
Betablocker)
Food helps decrease stomach upset
Advise to report symptoms of chestpain, swelling extremities, irregular pulse, SOB, hypotension

DRUG SIMVASTATIN 10mg/tab OD

CLASSIFICATION MECHANISM INDICATION CONTRINDICATION/ ADVERSE
OF ACTION SPECIAL EFFECTS
PRECAUTION
Lipid regulating Inhibits To reduce LDL, C: Hypersensitivity to Abdominal
drug HMG- COA cholesterol and simvastatin pain
Antihyperlipidemic reductase triglycerides. Active liver disease Constipation
enzyme To increase HDL Hepatic Flatulence
which cholesterol in the encephalopathy Nausea
reduces treatment of Hepatitis Acid
cholesterol hyperlipidemia Jaundice Vomiting
synthesis; including Rhabdomyolysis Diarrhea
this enzyme hypercholesterole SP: History of liver Dyspepsia
is needed for mia disease Headache
cholesterol As prophylaxis to Alcoholic Insomnia
production hypercholesterole Renal Disease/ Rashes
mic pts with impairment Pruritus
ischemic heart Seizure disorder Dizziness
disease PREGNANCY Muscle
Coronary Heart CATEGORY X Cramps
Disease

NURSING CONSIDERATIONS

Assessment:
Monitor Creatinine phosphokinase level, serum cholesterol
Monitor for triglyceride, cholesterol baseline throughout treatment
Assess liver function test prior to therapy and periodically thereafter
Evaluate therapeutic response and Adverse reaction on a regular basis

Pt. and Family Teachings:

Instruct pt to take drug with evening meal- enhances absorption and increases cholesterol biosynthesis
Teach about proper dietary management of cholesterol and triglycerides. Recommend wt. control,
exercise and smoking cessation program.

26
 Sweet Glomerulus: A Case of Diabetic Nephropathy

Tell pt to notify physician if adverse reaction occur.

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 Sweet Glomerulus: A Case of Diabetic Nephropathy

DRUG SODIUM BICARBONATE 650mg/tab TID

CLASSIFICATION MECHANISM INDICATION CONTRINDICATION/ ADVERSE
OF ACTION SPECIAL EFFECTS
PRECAUTION
Anti- ulcer agent Increases Treatment of Metabolic or Edema
Alkalinizing agent plasma metabolic respiratory alkalosis Flatulence
Fluid and bicarbonate acidosis Hypocalcemia Gastric
Electrolyte which excess Use to Excessive chloride distension
Replacement buffers alkalinize loss Metabolic
Solution Hydrogen ion urine and Severe abdominal alkalosis
concentrations promote pain of unkown cause Hypernatremia
reverses excretion of esp if associated with Hypocalcemia
metabolic certain drugs fever Hypokalemia
acidosis in over SP; pts with CHF Sodium and
Neutralizes dosage Children with diabetic water retention
gastric acid situations ketoacidosis because tetany
which forms Used as taking sodium
NaCl, CO2, antacid bicarbonate increase
raises blood the riskof cerebral
pH edema

NURSING CONSIDERATIONS

Assessment:
Asses for alkalosis by monitoring the client for confusion, irritability, paresthesia, tetany and altered
breathing pattern
Pt. should be assessed for :
HYPERNATREMIA- edema, weight gain, hypertension, tachycardia, fever, flushed ski9n and mental
irritability
HYPOKALEMIA-weakness, fatigue, arrhythmis, polyuria and polydipsia
Monitor clients serum calcium, sodium, potassium, bicarbonate concentration, serum osmolarity, acid
base balance and renal function before and throughout the therapy
For peptic ulcer treatment, administer 1 hour before and 3hours after meal

DRUG CALCITRIOL (ROCALTROL) 0.25mg/tab OD

CLASSIFICATION MECHANISM INDICATION CONTRINDICATION/ ADVERSE
OF ACTION SPECIAL EFFECTS
PRECAUTION
Vitamin D Analog Stimulates Management of Hypercalcemia Low
Dietary/ absorption of hypocalcemia in pts. Hypersensitivity incidence
Nutritional calcium of the undergoing chronic Pts. known to suffer of skin

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 Sweet Glomerulus: A Case of Diabetic Nephropathy

preparation GI tract, renal dialysis from aberrant calcium irritation

promotes Post menopausal metabolism
secretion from osteoporosis PREGNANCY
bones to hypoparathyroidism CATEGORY C
blood
Increase renal
tubular
resorption of
phosphate

NURSING CONSIDERATIONS

Assessment:
Determine baseline and periodic levels of serum calcium, phosphorous, alkaline phosphatase, creatinine
Monitor for hypercalcemia
Withhold calcitriol and calcium supplement and notify physician if hypercalcemia develops

Pt. and Family Teachings:

Do not use any other source of vitamin D during therapy, since calcitriolis the most potent form of
vitamin D to void possibility of hypercalcemia
Oral dose can be taken with food or meal or an empty stomach
Capsule should be protected from heat, light and moisture. Store in tightly closed container

DRUG EPOETIN ALFA 4,000 IU SQ every 10 days

CLASSIFICATION MECHANISM INDICATION CONTRINDICATION/ ADVERSE
OF ACTION SPECIAL EFFECTS
PRECAUTION
Blood Former, Mimics effect of Management of Uncontrolled Hypertension
Hematopoietic erythropoietin anemia hypertension and Tachycardia
Growth Factor which functions associated with known hypersensitivity Clotted VA
Antianemic Human as a CRF in dialysis to ammalian cell- Headache
Erythropoietin differentiating and predialysis derived products and Seizure
factor, pt. may reduce albumin Nausea and
enhancing RBC or obviate the SP: vomiting
production need for blood Pregnancy category C

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 Sweet Glomerulus: A Case of Diabetic Nephropathy

transfusion in During HD, pt. may

these patients need to increase
May also be anticoagulation to
used to its pts. prevent clotting of VA
with moderate
anemia before
elective surgery

NURSING CONSIDERATIONS

Assessment:
Control BP prior to initiation of therapy and closely monitor and control during therapy. Hypertension an
adverse effect must be controlled.
Monitor closely for thrombotic event. Pts may require additional heparin during dialysis to prevent
clotting of VA.

Pt. and Family Teachings:

Instruct to comply with antihypertensive medication and dietary restrictions.
Understand that headache is a common adverse effect. Report if severe or persistent, may indicate
developing hypertension
Do not shake solution. Shaking may denature glycoprotein rendering it biologically inactive.
Inspect solution for particulate matter prior to use. Do not use if solution is discolored.
Use only one dose per vial and do not reenter vial or pre filled syringe.

DRUG TRAMADOL 50mg/cap TID

CLASSIFICATION MECHANISM INDICATION CONTRINDICATION/ ADVERSE
OF ACTION SPECIAL EFFECTS
PRECAUTION
Narcotic Centrally Managem Hypersensitivity Increase
Analgesic acting opiate ent to severe Acute intoxicaton creatinine,
Opiate receptor pain with alcohol, proteinuria
Agonist agonist that hypnotic, Decrease
inhibits the psychotropic agent hgb
uptake of PREGNANCY Increase
norepinephrin CATEGORY C liver enyzymes
e and Pts with Visual
serotonin, intracranial pressure disturbances
suggesting or head trauma Diarrhea
both opioid Not Pruritus
recommended pts who Sweating
and non opioid
are opioid dependent Nausea
mechanisms of
and vomiting
pin relief
Sleep
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 Sweet Glomerulus: A Case of Diabetic Nephropathy

May disorder
produce opioid Anaphylac
like effect but tic reaction
causes less Seizure
respiratory
depression
than
morphine
Effective
agent for
control of
moderate to
moderately
severe pain

NURSING CONSIDERATIONS

Assessment:
Assess for level of pain relief and administer PRN dose as needed but not to exceed recommended total
daily dose
Discontinue drug and notify physician if S&S of hypersensitivity occur
Increase creatinine, liver enzymes, decrease hgb, proteinuria

DRUG SEVELAMER HYDROCHLORIDE (RENVELA) 800mg TID

CLASSIFICATI MECHANISM INDICATION CONTRINDICATI ADVERSE EFFECTS
ON OF ACTION ON/ SPECIAL
PRECAUTION

Electrolyte and Polymer that Reduction CI: Body as a

Water Water binds of serum phosp Hypophosphatemi Whole: Headache,
Balance Agent intestinal horus in a infection, pain.
Phosphate phosphate; patients with hypersensitivity CV: Hypertension,
Binder
interacts with end-stage to sevelamer HCl hypotension,
phosphate by kidney disease. fecal impaction thrombosis.
way of ion- bowel obstruction GI: Diarrhea, dyspepsia,
exchange and hypophosphatemi vomiting, nausea, consti
hydrogen a; appendicitis pation, flatulence.
binding. dysphagia Respiratory: Increased co
Advantageous GI bleeding, ugh.
ly, does not major GI surgery;
contain SP:
aluminum or GI motility
calcium in
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 Sweet Glomerulus: A Case of Diabetic Nephropathy

treating disorders
hyperphospha vitamin
temia in end deficiencies (espe
stage kidney cially vitamins D,
failure. E, and K and folic
Indicated by acid).
a serum phosp Pregnancy
hate level Category: C
6.0 mg/dL.

NURSING CONSIDERATIONS

Assessment:
Lab tests: Obtain frequent serum phosphate levels.
Patient & Family Education
Do not use capsules after printed expiration date.
Take daily multivitamin supplement approved by physician.

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