ppt chapter 52-1
TRANSCRIPT
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Drugs Affecting the Urinary Tract and the Bladder
Drugs Affecting the Urinary Tract and the Bladder
Chapter 52
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
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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)
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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
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Sites of Action of Drugs Acting on the Urinary Tract
Sites of Action of Drugs Acting on the Urinary Tract
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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
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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
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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
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Anti-Infectives (cont.)Anti-Infectives (cont.)
• Pharmacokinetics
– Vary with each drug
• Contraindications
– Allergy
• Caution
– Renal dysfunction
– Pregnancy and lactation
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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
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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
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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
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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
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Urinary Tract Antispasmodics (cont.)Urinary Tract Antispasmodics (cont.)
• Pharmacokinetics
– Rapidly absorbed, widely distributes
– Metabolized in the liver and excreted in the urine
• Contraindications
– Allergy
– Pyloric or duodenal obstruction
– Recent surgery
– Obstructive urinary tract problems
– Glaucoma, myasthenia gravis, or acute hemorrhage
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Urinary Tract Antispasmodics (cont.)Urinary Tract Antispasmodics (cont.)
• Caution
– Renal or hepatic dysfunction
– Pregnancy and lactation
• Adverse Effects
– Related to blocking of the parasympathetic system
• Drug-to-Drug Interactions
– Phenothiazines
– Haloperidol
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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
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Urinary Tract Analgesia (cont.)Urinary Tract Analgesia (cont.)
• Pharmacokinetics
– Rapidly absorbed and has a very rapid onset of action
– Widely distributed
– Metabolized in the liver and excreted in the urine
• Contraindications
– Allergy and renal dysfunction
• Caution
– Pregnancy and lactation
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Urinary Tract Analgesia (cont.)Urinary Tract Analgesia (cont.)
• Adverse Effects
– GI upset, headache, rash, reddish-orange coloring of the urine
– Renal and hepatic toxicity
• Drug-to-Drug Interactions
– Antibacterial agents
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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
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Bladder Protectants (cont.)Bladder Protectants (cont.)
• Pharmacokinetics
– Very little of the drug is absorbed
– Metabolized in the liver and spleen, and excreted in the urine
• Contraindications
– Condition that involve a risk of bleeding
– Heparin induced thrombocytopenia
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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
• Drug-to-Drug Interactions
– Anticoagulants, aspirin, or NSAIDs
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Drugs for Treatment of Benign Prostatic Hyperplasia
Drugs for Treatment of Benign Prostatic Hyperplasia
• Actions
– Varies with drug
• Indications
– Treats benign prostatic hypertrophy
• Pharmacokinetics
– Varies with drug
• Contraindications
– Allergy
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Drugs for Treatment of Benign Prostatic Hyperplasia
Drugs for Treatment of Benign Prostatic Hyperplasia
• Cautions
– Hepatic or renal dysfunction
• Adverse Effects
– Varies with drug
– Headache, fatigue, dizziness, postural dizziness, lethargy, tachycardia, hypotension, GI upset
– Decreased libido, impotence, and sexual dysfunction
• Drug-to-Drug Interactions
– Theophylline
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QuestionQuestion
Please answer the following question as true or false.
An adverse effect of a bladder protectant is alopecia.
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AnswerAnswer
True
Rationale: Adverse Effects: bleeding that may progress to hemorrhage; headache, alopecia, GI disturbances
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Use of Drugs Affecting the Urinary Tract Throughout the Lifespan
Use of Drugs Affecting the Urinary Tract Throughout the Lifespan
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Prototype Anti-InfectivesPrototype Anti-Infectives
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Prototype Urinary Tract AntihistaminesPrototype Urinary Tract Antihistamines
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Prototype Drugs for Treatment of Benign Prostatic Hyperplasia
Prototype Drugs for Treatment of Benign Prostatic Hyperplasia
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Nursing Considerations for Anti-InfectivesNursing Considerations for Anti-Infectives
• Assessment: History and Physical Exam
• Nursing Diagnosis
• Implementation
• Evaluation
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Nursing Considerations for Urinary Tract Antispasmodics
Nursing Considerations for Urinary Tract Antispasmodics
• Assessment: History and Physical Exam
• Nursing Diagnosis
• Implementation
• Evaluation
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Nursing Considerations for Urinary Tract Analgesia
Nursing Considerations for Urinary Tract Analgesia
• Assessment: History and Physical Exam
• Nursing Diagnosis
• Implementation
• Evaluation
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Nursing Considerations for Bladder Protectants
Nursing Considerations for Bladder Protectants
• Assessment: History and Physical Exam
• Nursing Diagnosis
• Implementation
• Evaluation
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Nursing Considerations for Drugs for Treatment of Benign Prostatic
Hyperplasia
Nursing Considerations for Drugs for Treatment of Benign Prostatic
Hyperplasia
• Assessment: History and Physical Exam
• Nursing Diagnosis
• Implementation
• Evaluation
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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
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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