Drugs Used to Treat Disorders of the Urinary System

Chapter 42Chapter 42

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Chapter 42

Lesson 42.1

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ObjectivesObjectives

• Develop a health teaching plan for an individual who has repeated urinary tract infections

• Analyze Table 42-1 and identify specific portions of a urinalysis report that would indicate proteinuria, dehydration, infection, or renal disease

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Urinary Tract Infections (UTIs)Urinary Tract Infections (UTIs)

• 11 million people treated every year• Second most common cause of death from

infection • Urinalysis results

White and cloudy – infection Dark yellow to amber – dehydration Foul smell – infection Foamy or frothy – proteins present Casts – dehydration

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Causes of UTIsCauses of UTIs

• Gram-negative aerobic bacilli from the GI tract Escherichia coli

• Other organisms Staphylococcus saprophyticus Klebsiella pneumoniae Enterobacter Proteus mirabilis Pseudomonas aeruginosa

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Patient Education for Repeated UTIsPatient Education for Repeated UTIs

• Determine ways to reduce frequency of infection Personal hygiene practices Pattern of urination Pattern of pain Medication history Maintaining adequate fluid intake

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Chapter 42

Lesson 42.2

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ObjectivesObjectives

• Identify essential components involved in planning patient education that will enhance compliance with the treatment regimen

• Explain the major action and effects of drugs used to treat disorders of the urinary tract

• Identify the symptoms, treatment, and medication used for overactive bladder syndrome

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Objectives (cont’d)Objectives (cont’d)

• Identify important nursing assessments and interventions associated with the drug therapy and treatment of diseases of the urinary system

• Identify baseline data the nurse should collect on a continuous basis for comparison and evaluation of drug effectiveness

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Objectives (cont’d)Objectives (cont’d)

• Prepare a chart of antimicrobial agents used to treat urinary tract infections. Give the drug names, the organisms treated, and special considerations (e.g., the need for acidic urine, changes in urine color, and effect on urine tests).

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Baseline Data CollectionBaseline Data Collection

• Urine frequency, amount, odor, color• Urine acidity – check pH• Burning or pain on urination• Vital signs• Skin color• History of UTIs• History of GI complaints

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Drug Class: Fosfomycin AntibioticsDrug Class: Fosfomycin Antibiotics

• Drug: fosfomycin (Monurol)• Actions

Inhibit bacterial cell wall synthesis, reduce bacteria’s adherence to the urinary tract

• Uses Single dose treatment for UTI

• Common adverse effects Nausea, diarrhea, abdominal cramps,

flatulence

• Serious adverse effects Perineal burning, dysuria

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Drug Class: Quinolone AntibioticsDrug Class: Quinolone Antibiotics

• Actions Inhibit DNA gyrase enzymes needed for DNA

replication in bacteria

• Uses Treat recurrent UTIs caused by E. coli, P.

mirabilis, and others

• Common adverse effects Nausea, vomiting, anorexia, abdominal cramps,

flatulence, drowsiness, visual disturbance, photosensitivity

• Serious adverse effects Hematuria, perineal burning, urticaria, hives,

headache, dizziness, photophobia, tinnitusSlide 13Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Other Urinary Antibacterial AgentsOther Urinary Antibacterial Agents

• Drug: methenamine mandelate (Mandelamine)• Actions

Form formaldehyde in presence of acidic urine, suppressing growth of bacteria

• Uses Treat chronic, recurrent UTIs

• Common adverse effects Nausea, vomiting, belching

• Serious adverse effects Hives, pruritus, rash; bladder irritation, dysuria,

frequency

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Other Urinary Antibacterial Agents Other Urinary Antibacterial Agents (cont’d)(cont’d)

• Drug: nitrofurantoin (Furadantin, Macrodantin)• Actions

Interfere with several bacterial enzyme systems

• Uses Treat UTIs

• Common adverse effects Nausea, vomiting, anorexia, urine discoloration

• Serious adverse effects Dyspnea, chills, fever, rash, pruritus,

neuropathies, secondary infection

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Drug Class: Anticholinergic Agents Drug Class: Anticholinergic Agents for Overactive Bladder Syndromefor Overactive Bladder Syndrome

• Actions Block the cholinergic receptors of the bladder,

causing relaxation

• Uses Reduce urgency and frequency of bladder

contractions in patients with overactive bladder (OAB)

• Common adverse effects Dry mouth, urinary hesitancy, retention,

constipation, bloating, blurred vision

• Serious adverse effects Intensification of any of the above symptoms

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Miscellaneous Urinary AgentsMiscellaneous Urinary Agents

• Drug: bethanechol chloride (Urecholine)• Actions

Stimulation of the parasympathetic nerve that causes contraction in the bladder

• Uses Restore bladder tone and urination in nonobstructive

urinary retention

• Common adverse effects Flushing of skin, headache

• Serious adverse effects Nausea, vomiting, sweating, colicky pain, abdominal

cramps, diarrhea, belching, involuntary defecation

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Miscellaneous Urinary Agents Miscellaneous Urinary Agents (cont’d)(cont’d)

• Drug: neostigmine (Prostigmin)• Actions

Increase tone of bladder muscles by blocking cholinesterase, preventing the breakdown of acetylcholine

• Uses Prevent and treat postoperative bladder

distention and retention

• Therapeutic outcome Prevention or treatment of postoperative or

postdelivery urinary retention

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Miscellaneous Urinary Agents Miscellaneous Urinary Agents (cont’d)(cont’d)

• Drug: phenazopyridine hydrochloride (Pyridium)• Actions

Produce local anesthetic effect on ureters and bladder

• Uses Relieve burning, pain, urgency, frequency

associated with UTIs

• Common adverse effects Reddish orange urine color

• Serious adverse effects Yellow sclera or skin

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