Download Drugs Used to Treat Urinary System Disorders

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Urinary tract infections (UTIs) are common
infection in one area can involve entire system
microbes enter system through urethra
common causes:
 catheterization
 urological exams
 intercourse
 poor perineal hygiene
 immobility
 poor fluid intake
UTI is a common healthcare associated infection (HAI),
this is an infection that develops in a person cared for in
any setting where healthcare is given, infection is related
to receiving healthcare
women at high risk for UTIs, also men with enlarged
prostate
 UTIs include:
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cystitis: inflammation of bladder
pyelonephritis: inflammation of kidney pelvis
prostatitis: inflammation of prostate
urethritis: inflammation of urethra
over-active bladder (OAB): known as urge syndrome, major
symptoms:
○ frequency: need to void 8+ times/day
○ nocturia is common (need to void at night)
○ urgency: sudden or compelling desire to pass urine that is hard
to ignore
○ incontinence: inability to control urine from passing from bladder
**see box 30-1(p. 367) for urinary system review**
Drug Therapy for Urinary Tract Infections:
urinary anti-microbial agents: substances that
have an antiseptic effect on urine and urinary
tract
 drug ordered depends on pathogen causing
infection
 person should have fluid intake of 2000mL daily
 length of treatment depends on many factors:
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 if the infection is acute, chronic or re-current
 the pathogen
 the drug ordered
Fosfomycin antibiotics:
Example: fosfomycin (Monurol)
 drug affects the cell walls of bacteria, it reduces
the ability of bacteria to adhere to the urinary
tract
 drug is used as a single dose to treat
uncomplicated acute cystitis in women
 goal of therapy: resolve UTI
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Assisting With the Nursing Process
fosfomycin (Monurol):
ASSESSMENT: note amount, color, clarity and odor of urine; ask
about urgency, burning, pain or problems; measure vital signs;
ask about GI complaints
PLANNING: dose form is 3mg packets of granules
IMPLEMENTATION: pour entire contents of single-dose packet
of granules into 3-4 oz of water, stir to dissolve, do NOT use
hot water; have person take drug once granules dissolve, may
be taken with/without food
EVALUATION: report and record:
 nausea, diarrhea, abdominal cramps, flatulence: mild, tend to
resolve
 perineal burning, dysuria: burning with voiding may be due to
infection, symptoms should improve 2-3 days after taking drug
 Quinolone Antibiotics:
prevent bacteria from reproducing
 effective in treating initial and re-current UTIs
 goal of therapy: to resolve UTI
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Assisting With the Nursing Process
quinolone antibiotics:
ASSESSMENT: note amount, color, clarity and odor of urine; ask about
urgency, burning, pain or problems; measure vital signs; ask about GI
complaints, ask about vision problems: color perception, problems focusing,
double vision
PLANNING: see table 30-1 (p. 368) “Oral Dose Forms”
IMPLEMENTATION: see table 30-1 (p. 368) “Adult Dose Range”
EVALUATION: report and record:
 nausea, diarrhea, abdominal cramps, flatulence: mild, tend to resolve
 drowsiness, headache, dizziness: mild, tend to resolve, provide for safety
 visual problems- color perception, problems focusing, double vision: may
occur shortly after each dose is given during first few days, provide for
safety
 photo-sensitivity: sensitivity to sunlight/ UV lights, sunscreen, long sleeves
 hematuria (blood in urine): person should drink 8-12 8 glasses of water daily
 itching, rash, hives, perineal burning: may signal an allergic reaction, tell
nurse at once. Do NOT give dose unless approved by nurse
 headache, ringing in ears (tinnitus), dizziness, tingling sensations, photosensitivity, require medical attention
Other Urinary Anti-bacterial agents:
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methenamine mandelate (Mandelamine): suppresses growth and
multiplication of bacteria that may cause re-current infection, used
for chronic, re-current UTIs
Assisting With the Nursing Process
methenamine mandelate (Mandelamine):
ASSESSMENT: note amount, color, clarity and odor of urine; ask about
urgency, burning, pain or problems; measure vital signs
PLANNING: oral dose forms are 500mg and 1g enteric-coated tablets
IMPLEMENTATION: adult dosage: 1g 4x/day with meals, bedtime, do
NOT crush tablets
EVALUATION: report and record:
 nausea, diarrhea, belching: mild, tend to resolve
 hives, itching, rash: may signal allergic reaction, do NOT give next
dose unless nurse approves
 bladder irritation, dysuria, frequency: may signal another UTI
Other Urinary Anti-bacterial agents:
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nitrofurantoin (Macrodantin and Furadantin): interfere with several bacterial
enzyme systems, not effective against microbes in blood or tissues outside
urinary tract
Assisting With the Nursing Process
nitrofurantoin (Macrodantin and Furadantin):
ASSESSMENT: note amount, color, clarity and odor of urine; ask about
urgency, burning, pain or problems; measure vital signs, ask about GI
complications, ask about numbness/tingling in extremities
PLANNING: oral dose forms are 25, 50, 100mg capsules
25mg/5mL suspension
IMPLEMENTATION: adult dosage: is 50-100mg 4x/day for 10-14 days, give
with food/milk, given every 6 hours to maintain adequate concentrations
EVALUATION: report and record:
 nausea, vomiting, anorexia: give drug with food/milk to reduce
 rust brown to yellow-colored urine: harmless
 dyspnea, chills, rash, itching: signal allergic reaction, tell nurse at once, do
NOT give next dose unless approved by nurse
 numbness/tingling in extremities: drug needs to be discontinued
 dysuria, foul-smelling urine, fever: signal second infection
Drug Therapy for Over-Active Bladder (OAB)
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anti-cholinergic drugs are the treatment of choice for OAB
(aka: urinary anti-spasmodic agents)
relax outer muscle layer of bladder
involuntary bladder contractions decrease
bladder can hold more urine, urinary frequency and
urgency are reduced
desire to void is delayed
goals of therapy:
 decrease frequency by increasing amount voided
 decrease urgency
 reduce incidents of incontinence
Assisting With the Nursing Process
anti-cholinergic agents for OAB:
ASSESSMENT: note amount, color, clarity and odor of urine; ask
about urgency, burning, pain or problems; measure vital signs
PLANNING: see table 30-2 (p. 370) for “Dose Forms”
IMPLEMENTATION: see table 30-2 (p. 370) for “Adult Dosage
Range”
EVALUATION: report and record:
 dry mouth, urinary hesitancy, urinary retention: usually dose
related, nurse may allow person to chew gum or suck on
hard candy and ice chips
 constipation, bloating: follow care plan for diet and fluid intake
 blurred vision: person should not drive or operate machinery,
provide for safety