Renal & Urinary Medications — NCLEX Pharmacology for Antiseptics, Immunosuppressants, and Growth Factors | Chapter 52: Saunders NCLEX-PN Review

Renal & Urinary Medications — NCLEX Pharmacology for Antiseptics, Immunosuppressants, and Growth Factors | Chapter 52: Saunders NCLEX-PN Review

Chapter 52 of Saunders Comprehensive Review for the NCLEX-PN® Examination (7th Edition) by Linda Anne Silvestri and Angela E. Silvestri delivers a complete pharmacology guide to medications used in renal and urinary care. From urinary tract antiseptics and antibiotics to transplant immunosuppressants and hematopoietic growth factors, this chapter prepares NCLEX-PN candidates to administer medications safely, recognize adverse effects, and provide critical patient education.

Watch the lecture above and use the study notes below to master renal and urinary medication safety for both the NCLEX exam and clinical practice.

Saunders NCLEX-PN Examination Review book cover

Urinary Tract Antiseptics

  • Fosfomycin, methenamine, nitrofurantoin: Used for UTIs, require proper urine pH; contraindicated in renal impairment and certain liver conditions.
  • Nursing points: Take with food to reduce GI upset, monitor for pulmonary reactions with nitrofurantoin, advise hydration.

Fluoroquinolones

  • Ciprofloxacin, levofloxacin: Broad-spectrum coverage for urinary infections.
  • Risks: CNS toxicity, tendon rupture, QT prolongation, crystalluria—encourage fluids.

Sulfonamides

  • Trimethoprim-sulfamethoxazole (TMP-SMX): Effective against many urinary pathogens.
  • Adverse effects: Stevens-Johnson syndrome, bone marrow suppression, photosensitivity.
  • Interactions: Potentiates warfarin and oral hypoglycemics—monitor INR and glucose.

Urinary Tract Analgesics

  • Phenazopyridine: Relieves dysuria and frequency; causes harmless orange/red urine discoloration.
  • Cautions: Avoid in renal disease; may interfere with urine tests.

Anticholinergic-Antispasmodics

  • Oxybutynin, tolterodine: Reduce bladder muscle spasms in overactive bladder.
  • Side effects: Dry mouth, constipation, blurred vision, urinary retention.
  • Contraindications: Narrow-angle glaucoma, GI obstruction.

Cholinergics

  • Bethanechol: Stimulates bladder contraction in urinary retention.
  • Toxicity signs: Salivation, sweating, abdominal cramps; atropine is the antidote.

Immunosuppressants for Kidney Transplant

  • Cyclosporine: Nephrotoxicity, hirsutism; avoid grapefruit juice; monitor drug levels.
  • Tacrolimus: More potent; risk of neurotoxicity, hyperglycemia—monitor glucose closely.
  • Sirolimus: Hyperlipidemia, delayed wound healing, rash.
  • Azathioprine, mycophenolate: Bone marrow suppression, GI upset, infection risk.
  • Biologic agents: Basiliximab, antithymocyte globulin—monitor for infusion reactions.

Hematopoietic Growth Factors

  • Epoetin alfa: Treats CKD-related anemia; monitor hemoglobin and blood pressure.
  • Filgrastim: Increases WBC count; watch for bone pain and splenomegaly.
  • Oprelvekin: Stimulates platelet production; risk of fluid retention and dysrhythmias.

NCLEX Nursing Priorities

  • Assess for drug allergies and contraindications before administration.
  • Monitor labs—CBC, electrolytes, drug levels, renal and liver function.
  • Teach patients about medication timing, side effects, and when to seek care.
  • Encourage hydration to reduce crystalluria and renal toxicity risks.
  • Maintain infection precautions for immunosuppressed patients.

Conclusion

Renal and urinary medications require close monitoring and careful patient education to ensure safety and therapeutic success. Chapter 52 equips NCLEX-PN candidates with the pharmacology knowledge and nursing interventions needed to manage renal drug therapy effectively.

Subscribe to Last Minute Lecture for more NCLEX-focused lectures and pharmacology tips.

View the full Saunders Comprehensive Review for the NCLEX-PN® Examination (7th Edition) playlist here: Complete NCLEX-PN Review Playlist

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