PHARMACOLOGY SEM 01 | CYC 02

LECTURE AUF – CON

URINARY SYSTEM ANATOMY NEPHRON

KIDNEYS
● Functional unit of the kidney
● Contains glomerular capillaries and collecting
● Located retroperitoneally, with the Right slightly
tubules
lower than the Left
● Glomerulus: knot of capillaries (encapsulated by
○ Right is lower because of the liver (located on the
Bowman’s capsule)
right upper quadrant)
○ Filters substances = filtrate = urine
● Accommodates the position of liver
○ Glomerulus to glomerular (bowman’s) capsule
● Where urine formation takes place
to proximal convoluted tubule, through loop of
● RENAL CORTEX
Henle and distal convoluted tubule to the
○ Outer, lighter region of the kidney (outside)
collecting duct to ureter to bladder to urethra
● RENAL MEDULLA
○ Only filters very small substances, particles, and
○ Deep to the renal cortex, darker region (middle)
water
● RENAL PYRAMIDS
○ Protein, albumin, amino acids, glucose and
○ Triangular regions within the renal medulla
sugar cannot pass through and stays in the
where the bases are towards the cortex while
glomerulus
the tips are pointed towards the inner kidney
○ FILTRATE VOLUME
● RENAL HILUM
● Begins with 100% filtrate, ends with 1% (urine)
○ A region in the kidneys where blood vessels,
excreted and 99% reabsorbed
nerves, and the ureter pass
○ Reason why kaunti lang ‘yung cc/hr ng
○ Also known as indentation: the indented part
urine (30 cc/mL)
● RENAL CALYCES
● Men: 180L/day
○ Cuplike extensions of the renal pelvis that drains
● Women: 150L/day
fluids from the renal pyramids
● Sodium is not reabsorbed
● Anything that is being drained from the renal
pyramids are being collected by the renal calyces
which will be drained into the ureter to the urinary
bladder

Parts of a Nephron

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 MODULE 14: DRUGS ACTING ON THE RENAL SYSTEM

as every day, 180 liter of blood is being filtered by the

kidneys

TUBULAR SECRETION

● Hydrogen, potassium, creatinine and drugs are

secreted from the tubules into the filtrate
● A lot of medication are nephrotoxic

DRUGS ACTING ON THE RENAL SYSTEM

A. DIURETICS
URETERS • Induce an increase in urine production by inhibiting
water and sodium reabsorption from the kidney
● Drains urine from the kidneys to urinary bladder tubules
• 99% of Na filtered during urine formation is
URINARY BLADDER reabsorbed by the kidneys
o 50-55% in the proximal tubules
● Hollow organ made of mostly smooth muscle tissue
o 30-45% in the loop of Henle
that acts as a reservoir for urine
o 5-10% in the distal tubules
o <3% in the collecting tubules
URETHRA

● Passageway of urine from the bladder to the external

body for elimination
● Internal sphincter: involuntary control
● External sphincter: voluntary control

URINE FORMATION

GLOMERULAR FILTRATION

● Water and smaller solutes (sugar, ions) (35%) are

moved out of the capillary walls into the renal tubule
○ Presence of sugar, albumin, and amino acids in
the urine indicates a complication in the
filtration process

TUBULAR REABSORPTION
• Drugs acting on the tubules closes to the glomeruli
● Water (65%), glucose, amino acids and certain ions has the greatest effect in natriuresis or sodium loss
are reabsorbed from the filtrate back into capillary in the urine
blood • Diuretics are used primarily for two main purposes:
● It is against homeostasis if all of the fluids and o Decrease Hypertension (decreases plasma
solutes that the kidneys, specifically the glomerular volume; promoting sodium and water loss)
filters, are going to be excreted = no fluid will be left
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o Decrease peripheral and pulmonary edema in • Onset: 5 mins (IV/IM) that lasts for 2 hours
heart failure or renal disorders • PO – diuresis begins in 60 mins and lasts for 8 hours
• Indications: rapid or massive mobilization of fluid
1. Thiazides (PO) o Pulmonary edema with CHF
• Act on the distal convoluted renal tubule, beyond the o Edema – hepatic, cardiac, renal in nature
loop of Henle, to promote Na, Cl, and water excretion o Hypertension
• Not indicated for rapid diuresis required in patients • WOF: Hypotension (Dizziness); Hypokalemia
with severe renal dysfunction (Dysrhythmias); Ototoxicity (SIVP – slow IV push)
• The drug effectiveness greatly drops if the patient’s
creatinine clearance is <30 cc/hr 3. Osmotic Diuretics (IV)
• Na, K, and Mg wasting but promotes Ca • These drugs increase the osmolality (concentration)
reabsorption and Na reabsorption in the proximal tubule and the
• Hypercalcemia is a possible side effect loop of Henle
• Thiazides affect glucose tolerance requiring the • Only osmotic diuretic
need for cautious use in diabetic patients • Mainly indicated for decreasing cerebral edema and
• Examples: Chlorothiazide (first thiazide introduced increased intraoptic pressure.
in 1957), hydrochlorothiazide, methyclothiazide • Example: Mannitol - most commonly prescribed
• Route: PO (12.5 mg cap; 12.5, 25, 50 mg tabs) osmotic diuretic
• Diuresis begins about 2 hours after oral o Mannitol has a high tendency to crystalize on
administration; peak within 4-6 hours; persists up to stock. Slowly warm preparation to
12 hours temperature prior to administration to
• Indications: essential hypertension (first choice), dissolve crystals
and edema (mild to moderate heart failure) • Administer an IV bolus through a large-bore needle
o Combination with antihypertensives • Water excretion rather than sodium secretion
o Micardis Plus (Telmisartan +
hydrochlorothiazide) 4. Carbonic Anhydrase Inhibitors (PO/IV)
• WOF: hyponatremia, hypochloremia, dehydration, • Act at proximal convoluted tubules
hypokalemia • These drugs inhibit the enzyme carbonic anhydrase
which is needed to maintain the body’s acid-base
2. Loop Diuretics/Potassium Wasting Diuretics balance. When this enzyme is inhibited, Na, K, and
(PO/IV) HC03 excretion is promoted
• Also known as high-ceiling diuretics o There is risk of metabolic acidosis because of
• These diuretics act on the ascending loop of Henle increased plasma acidity
• MOA: Block reabsorption of sodium and chloride – • Primarily used to decreased intraoptic pressure in
precents passive reabsorption of water open angle glaucoma
• Can produce profound diuresis • Example: acetazolamide, methazolamide
• Potent water, K, Na, Ca, and Mg, wasting
• May increase serum glucose and uric acid levels 5. Potassium-Sparing Diuretics (PO)
• Induce rapid diuresis within 30 minutes of • These drugs are weaker than thiazide or loop
administration diuretics
• Examples: furosemide (Lasix), bumetanide, o Produce modest increase in urine production
torsemide o Produce substantial decrease in potassium
• Route: IV/IM (20-30 mg), PO (20-80 mg) excretion
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• MOA: blocks the action of aldosterone – acts to • Cells Shrink

promote sodium excretion in exchange for • Examples: D5 0.3 NaCl (Light Blue), D5 LRS (Pink), D5
potassium retention 0.9 NaCl (Yellow)
• These drugs act primarily on the collecting renal
tubules and distal tubules to promoted Na and water 2. Hypotonic
loss as well as K retention • Lesser osmotic pressure than the extracellular fluids,
• Hyperkalemia may develop when used with resulting to fluid shifting into the cells
potassium supplementation commonly used with • Excessive infusion of hypotonic solutions may cause
thiazides and loop diuretics cell lysis and decrease in blood pressure
• K level = 3.5 to 5.0 mEq/L • Indication: Treat or avoid dehydration
• Example: spironolactone (Aldactone), amiloride HCl, • Cells Swell
eplerenone • Examples: 0.45 NaCl, 0.33 NaCl
• Route: PO (25 mg, 50 mg, 100 mg/tab)
• Delayed; 48 hours to develop 3. Isotonic
• Indications: Hypertension and edema; heart failure • Exhibit osmotic equilibrium resulting to minimal fluid
• WOF: Hyperkalemia – above 5.0 mEq/L (fatal shifting between the intra and extracellular spaces
dysrhythmias) • Used primarily to expand blood volume
• Adverse Effects: Endocrine effects (gynecomastia; • Indication: Increase intravascular volume; treat
menstrual irregularities, impotence, deepening of nausea and vomiting; resuscitation; for
the voice) administration of blood and blood products;
hypovolemia
NURSING RESPONSIBILITIES • No Changes in Cell
• Vital Signs – blood pressure; monitor breath sounds • Examples: D5W (Red), PLRS (Dark Blue), PNSS/0.9
• Wright – baseline and daily weight same time, same NaCl (Green)
scale, AM before eating
• Intake and Output – balance; notify if oliguria or C. ELECTROLYTE REPLACEMENTS
anuria 1. Sodium (IV)
• Serum Electrolytes – imbalance; potassium (restrict • Used to correct hyponatremia and mainly
intake for K sparing) administered through IV fluid infusion as sodium
• Edema – presence and degree chloride
• Time – given AM; if BID (8 am & 2 pm) – to avoid • Na: 135 to 145 mEq/L
nocturia
2. Sodium Bicarbonate (IV)
B. PARENTERAL FLUIDS • Used mainly in resuscitation to correct acidosis as
1. Hypertonic well as other metabolic acidosis which may occur in
• Greater osmotic pressure than the extracellular severe renal disease, diabetes, uncontrolled
fluids, resulting to a higher solute concentration than diabetes, circulatory insufficiency due to shock or
the serum severe dehydration or cardiac arrest
• Pull liquids from the interstitial spaces via osmosis • Administered via IV bolus in resuscitation
into the blood stream to be eliminated in the urine
• Indication: Hyponatremia, volume resuscitation, 3. Potassium Chloride (IV/PO)
brain injury – to increase intravascular fluid volume; • Used to correct hypokalemia
to reduce intracranial pressure
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• PO: Dosages for prevention range from 16 to 24 REFERENCE:

mEg/day. For deficiency, 40 to 100 mEg/day CI: Michelle Kho-Enriquez, RN, MNc
• GI irritant – should be taken with meals or a full glass November 18, 2023
of water
• IV: diluted, infused slowly
o NEVER IV PUSH – can cause cardiac arrest
• Vesicant, avoid extravasation
• K: 3.5 to 5.0 mEq/L

4. Magnesium Sulfate (IV/PO)

• Used to correct hypomagnesemia and
management of certain seizure disorders
• Low levels of Mg due to variety of causes (diarrhea,
hemodialysis, chronic alcoholic patients, diabetes,
pancreatitis.)
• They may also have hypocalcemia and
hypokalemia
• Hypomagnesemia can increase muscle excitability
to the point of spasm
• Can cause disorientation, psychosis
• Mg: 1.5 to 2.5 mEq/L

5. Calcium Gluconate (IV)

• Used to correct hypocalcemia
• Management of beta-blocker or CCB toxicity
• Antidote MsS04 (Magnesium Sulfate) toxicity
• Ca: 9 to 11 mg/dL

NURSING RESPONSIBILITIES
• Assess baseline vital signs
• Monitor serum electrolyte levels to evaluate
effectiveness of therapy
• Electrolyte replacements would typically be
provided for patient taking potent diuretics
• Assess patient’s past and current drug history
• Ensure that the patient is receiving the right amount
aligned with electrolyte replacement
• Patients with renal dysfunctions are at risk for
developing electrolyte imbalances
• Most IV electrolytes are vesicants or blood vessel
irritants. Ensure patency and placement of
intravenous catheter prior to administration.

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