Ppt chapter 52-1

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Drugs Affecting the Urinary Tract and the Bladder

Drugs Affecting the Urinary Tract and the Bladder

Chapter 52


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

• Second most common infection in the U.S.

• More common in females

• Patients with indwelling catheters or intermittent catherization are at risk


Signs and Symptoms of a UTISigns and Symptoms of a UTI

• Urinary frequency

• Urgency

• Burning on urination (associated with cystitis)

• Chills, fever, flank pain, and tenderness (associated with acute pyelonephritis)


Treatment for UTIsTreatment for UTIs

• Antibiotics

• Specific agents to sterilize the urinary tract

• Drugs that:

– Block spasms of the urinary tract muscles

– Decrease urinary tract pain

– Protect the cells of the bladder from irritation

– Treat enlargement of the prostate gland in men


Sites of Action of Drugs Acting on the Urinary Tract

Sites of Action of Drugs Acting on the Urinary Tract


Anti-Infectives Used to Treat UTIAnti-Infectives Used to Treat UTI

• Cinoxacin (Cinobac): Interferes with DNA replication in gram-negative bacteria

• Norfloxacin (Noroxin): Effective against even more gram-negative strains than is cinoxacin

• Fosfomycin (Monurol): Has the convenience of only one dose

• Nalidixic Acid (NegGram): Older drug, not effective against as many strains of gram-negative bacteria

• Nitrofurantoin (Furadantin): Older drug with a very short half-life


Anti-Infectives That Acidify the UrineAnti-Infectives That Acidify the Urine

• Methenamine (Hiprex)

– Undergoes metabolism in the liver and is excreted in urine

– Has established dosage guidelines for children and comes in a suspension form

• Methylene Blue (Urolene Blue)

– Is widely distributed, metabolized in the tissues, and excreted in urine, bile, and feces


Anti-InfectivesAnti-Infectives• Actions

– Act specifically within the urinary tract to destroy bacteria

– They act either through direct antibiotic effect or through acidification

• Indications

– Chronic UTI

– Adjunctive therapy in acute cystitis and pyelonephritis

– Prophylaxis with urinary tract anatomical abnormalities and residual urine disorders


Anti-Infectives (cont.)Anti-Infectives (cont.)

• Pharmacokinetics

– Vary with each drug

• Contraindications

– Allergy

• Caution

– Renal dysfunction

– Pregnancy and lactation


Anti-Infectives (cont.)Anti-Infectives (cont.)

• Adverse Effects

– Nausea, vomiting, anorexia, bladder irritation, and dysuria

– Pruitus, urticaria, headache, dizziness, nervousness, and confusion

• Drug-to-Drug Interactions

– Vary with each agent


QuestionQuestion

What type of drugs are used to treat UTIs?

A. Broad spectrum antibiotics

B. Those that protect the cells of the bladder from irritation

C. Quinine-based medications

D. Beta blockers


AnswerAnswer

B. Protect the cells of the bladder from irritation

Rationale: Drugs that: block spasms of the urinary tract muscles; decrease urinary tract pain; protect the cells of the bladder from irritation; treat enlargement of the prostate gland in men


Urinary Tract AntispasmodicsUrinary Tract Antispasmodics

• Actions

– Block the spasms of urinary tract muscles

– Blocking parasympathetic activity

– Relaxing the detrusor and other urinary tract muscles

• Indications

– Bladder spasm and dysuria


Urinary Tract Antispasmodics (cont.)Urinary Tract Antispasmodics (cont.)


– Rapidly absorbed, widely distributes

– Metabolized in the liver and excreted in the urine


– Allergy

– Pyloric or duodenal obstruction

– Recent surgery

– Obstructive urinary tract problems

– Glaucoma, myasthenia gravis, or acute hemorrhage


Urinary Tract Antispasmodics (cont.)Urinary Tract Antispasmodics (cont.)

• Caution

– Renal or hepatic dysfunction


• Adverse Effects

– Related to blocking of the parasympathetic system


– Phenothiazines

– Haloperidol


Urinary Tract AnalgesiaUrinary Tract Analgesia

• Actions

– When phenazopyridine is excreted in urine, it exerts a direct topical analgesic effect on the urinary mucosa

• Indications

– Relieve symptoms related to urinary tract irritation from infection, trauma, or surgery


Urinary Tract Analgesia (cont.)Urinary Tract Analgesia (cont.)


– Rapidly absorbed and has a very rapid onset of action

– Widely distributed

– Metabolized in the liver and excreted in the urine


– Allergy and renal dysfunction

• Caution



Urinary Tract Analgesia (cont.)Urinary Tract Analgesia (cont.)

• Adverse Effects

– GI upset, headache, rash, reddish-orange coloring of the urine

– Renal and hepatic toxicity


– Antibacterial agents


Bladder ProtectantsBladder Protectants

• Actions

– Heparin-like compound that has anticoagulant and fibrinolytic effects

– Adheres to the bladder wall mucosal membranes and acts as a buffer to control cell permeability, preventing irritating solutes in the urine from reaching the bladder wall cells

• Indications

– Interstitial cystitis


Bladder Protectants (cont.)Bladder Protectants (cont.)


– Very little of the drug is absorbed

– Metabolized in the liver and spleen, and excreted in the urine


– Condition that involve a risk of bleeding

– Heparin induced thrombocytopenia


Bladder Protectants (cont.)Bladder Protectants (cont.)

• Caution

– Hepatic or splenic dysfunction

– Pregnancy or lactation

• Adverse Effects

– Bleeding that may progress to hemorrhage

– Headache, alopecia, GI disturbances


– Anticoagulants, aspirin, or NSAIDs


Drugs for Treatment of Benign Prostatic Hyperplasia


• Actions

– Varies with drug

• Indications

– Treats benign prostatic hypertrophy




– Allergy




• Cautions

– Hepatic or renal dysfunction

• Adverse Effects


– Headache, fatigue, dizziness, postural dizziness, lethargy, tachycardia, hypotension, GI upset

– Decreased libido, impotence, and sexual dysfunction


– Theophylline


QuestionQuestion

Please answer the following question as true or false.

An adverse effect of a bladder protectant is alopecia.


AnswerAnswer

True

Rationale: Adverse Effects: bleeding that may progress to hemorrhage; headache, alopecia, GI disturbances


Use of Drugs Affecting the Urinary Tract Throughout the Lifespan

Use of Drugs Affecting the Urinary Tract Throughout the Lifespan


Prototype Anti-InfectivesPrototype Anti-Infectives


Prototype Urinary Tract AntihistaminesPrototype Urinary Tract Antihistamines


Prototype Drugs for Treatment of Benign Prostatic Hyperplasia

Prototype Drugs for Treatment of Benign Prostatic Hyperplasia


Nursing Considerations for Anti-InfectivesNursing Considerations for Anti-Infectives

• Assessment: History and Physical Exam

• Nursing Diagnosis

• Implementation

• Evaluation


Nursing Considerations for Urinary Tract Antispasmodics

Nursing Considerations for Urinary Tract Antispasmodics



• Implementation

• Evaluation


Nursing Considerations for Urinary Tract Analgesia

Nursing Considerations for Urinary Tract Analgesia



• Implementation

• Evaluation


Nursing Considerations for Bladder Protectants

Nursing Considerations for Bladder Protectants



• Implementation

• Evaluation


Nursing Considerations for Drugs for Treatment of Benign Prostatic

Hyperplasia

Nursing Considerations for Drugs for Treatment of Benign Prostatic

Hyperplasia



• Implementation

• Evaluation


QuestionQuestion

What is an appropriate nursing diagnoses for a patient taking a urinary anti-infective?

A. Disturbed sensory perception (kinesthetic, tactile, visual)

B. Incontinence

C. Chronic pain

D. Discolored urine


AnswerAnswer

A. Disturbed sensory perception (kinesthetic, tactile, visual)

Rationale: Nursing diagnoses related to drug therapy might include: acute pain related to GI, CNS, or skin effects of drug; disturbed sensory perception (kinesthetic, tactile, visual) related to CNS effects; impaired urinary elimination related to underlying problem necessitating drug therapy; risk for injury related to possible CNS effects; deficient knowledge regarding drug therapy

Ppt chapter 52-1

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