Renal Failure Patients who are prescribed drugs to tx HTN or HF

[BSN_Studnt]

On my pharm exam review it says to review "Renal failure in relation to giving drugs for HTN or HF" Which drugs in particular are ok with pt's that have renal failure that dont contraindicate with the prior existing dx of HTN or HF? Any nursing considerations/interventions to keep in mind in these kinds of patients/situations? Any help is much appreciated. Thanks!

[offlabel]

I think it's more of question of knowing medical management of HTN and or heart failure that is caused by the kidney disease, not which drugs are OK with kidney disease. They're trying to differentiate treatment of these conditions caused by renal function as opposed to the treatment of these conditions due to other causes such as cardiovascular disease.

For example a patient with HTN 2/2 his renal disease would likely be on what kind of anti-hypertensives? Likewise, what might the medical management of heart failure 2/2 renal failure be?

[loving2024, BSN, RN]

You need to know the patho and what to expect in terms of symptoms, electrolyte imbalance, protein, diet, fluid retention and restriction, dialysis and drugs to give before or during dialysis.

Once you know that then you will know when to give HF/HTN drugs, because sometimes you dont give it, depending on the situation.

One thing you need to remember when answering this type of question on exam is that, diuretics, HF meds/and anti hypertensive meds cause vasodilation. So if you are trying to dilate the vessels to increase blood flow to systemic circulation, know that it will reduce blood pressure but it may cause peripheral edema which will worsen it because the kidney is not working.

There are many considerations and interventions, you just have to start from the pathophysiology of renal failure

Drugs that are mostly contraindicated in RF are:

NSAID

diuretic: depending on the stage of RF or if the patient is on dialysis

gentamicin/nephrototoxic meds

Hypertensive drugs: can worsen RF due to low perfusion to the kidneys

there are many but those are the ones I remember for now.

Know when to use kayexylate,diuretic, dialysis

Goodluck

On my pharm exam review it says to review "Renal failure in relation to giving drugs for HTN or HF" Which drugs in particular are ok with pt's that have renal failure that dont contraindicate with the prior existing dx of HTN or HF? Any nursing considerations/interventions to keep in mind in these kinds of patients/situations? Any help is much appreciated. Thanks!

[HouTx, BSN, MSN, EdD]

Hmm - since most of these questions are designed to trigger "critical thinking", the answer will most probably be related to the underlying concepts outlined by PPs. One high-priority issue to keep in mind is the method of metabolism/excretion for the drug. If a pt has been taking something for HTN and now begins to suffer from renal complications/insufficiency, any drug that is primarily excreted through the kidneys could quickly cause problems as the level of the drug increases.

Renal insufficiency is a common comorbidity in multi-system disease processes, so this is knowledge that will be valuable in your nursing practice.