Download Urinary_Pharm

Urinary Pharmacology
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
1
Diuretics

Purposes of diuretics
Lowered blood pressure
Decreased edema
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
2
Kidney Function
Diuretics Act on Different Segments of the Renal Tube.
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
3
Types of Diuretics
Thiazide and thiazide-like
 Loop or high-ceiling
 Osmotic
 Carbonic anhydrase inhibitor
 Potassium-sparing

Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
4
Thiazide and Thiazide-Like
Diuretics
Chlorothiazide (Diuril)
 Hydrochlorothiazide (HCTZ)
 Bendroflumethiazide with nadolol
(Corzide)
 Methyclothiazide (Enduron)
 Chlorthalidone (Thalitone)
 Indapamide (Lozol)
 Metolazone (Zaroxolyn)

Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
5
Thiazide and Thiazide-Like
Diuretics

Serum chemistry abnormalities with
thiazides
Hypokalemia
Hypomagnesemia
Hypercalcemia
Hypochloremia
Hyperuricemia
Hyperglycemia
Hyperlipidemia
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
6
Thiazide and Thiazide-Like
Diuretics



Side effects and adverse reactions
 Electrolyte imbalances
 Hyperglycemia
 Hyperuricemia
 Others–dizziness, headache, nausea,
vomiting, constipation, urticaria, and blood
dyscrasias
Contraindications
 Renal failure
Drug interactions
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
7
Nursing Process: Thiazides
Assessment
 Nursing diagnoses
 Planning
 Nursing interventions
Patient teaching
Cultural considerations
 Evaluation

Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
8
Loop Diuretics

Loop diuretics: furosemide (Lasix),
bumetanide (Bumex)
 Laboratory changes:
• Hypokalemia, hyponatremia,
hypocalcemia, hypomagnesemia,
hypochloremia
• Hyperglycemia possible in diabetic pts
• Hyperuricemia
• Elevated BUN and creatinine
• Elevated lipids
• Thrombocytopenia, leukopenia
9
Loop Diuretics

Side effects and adverse reactions
Fluid and electrolyte imbalances
Hypochloremic metabolic
alkalosis
Orthostatic hypotension
Thrombocytopenia
Skin disturbances
Transient deafness
Thiamine deficiency
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
10
Nursing Process: Loop Diuretics
Assessment
 Nursing diagnoses
 Planning
 Nursing interventions
Patient teaching
Cultural considerations
 Evaluation

Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
11
Osmotic Diuretics

Osmotic diuretics: mannitol
Use: Prevent kidney failure, decrease
ICP, and decrease IOP
Side effects/adverse reactions: fluid
and electrolyte imbalance, pulmonary
edema, N&V, tachycardia, and
acidosis
Crystallization of mannitol
Contraindications: Heart failure, renal
failure
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
12
Potassium-Sparing Diuretics

Potassium-sparing diuretics:
spironolactone (Aldactone), amiloride
(Midamor), triamterene (Dyrenium),
and eplerenone (Inspra)
Action
Hyperkalemia
Effects when given with ACE
inhibitors
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
13
Drugs for Urinary Tract Disorders
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
14
Urinary Tract Infections (UTIs)

Upper UTI
Acute pyelonephritis
• Usually female patients
• Symptoms
Chills, fever, flank pain
Painful urination,
frequency, urgency, pyuria
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
15
Urinary Tract Infections

Lower UTI
 Acute cystitis
• Frequently in females
• E. coli, Staph, Klebsiella,
Pseudomonas
• Symptoms
Pain and burning on urination,
frequency, urgency
 Urethritis, prostatitis
• Same symptoms
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
16
Treatment of UTIs






Nitrofurantoin (Macrodantin)
Trimethoprim-sulfamethoxazole
(Bactrim, Septra)
Fluoroquinolones such as nalidixic
acid (NegGram)
Norfloxacin (Noroxin)
Ciprofloxacin (Cipro)
Fosfomycin tromethamine (Monurol):
single dose
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
17
Treatment of UTIs

Other agents:
Oral amoxicillin/clavulanic acid
(Augmentin)
Oral third-generation
cephalosporins (cefixime,
cefpodoxime proxetil, or ceftibuten)
For severe UTIs, IV drug therapy
followed by oral drug therapy is
usually recommended.
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
18
Urinary Antiseptics/Antiinfectives
and Antibiotics

Nitrofurantoin (Macrodantin)
Bacteriostatic or bactericidal
depending on the drug dosage
Effective against many grampositive and gram-negative
organisms, especially E. coli.
Side effects/adverse reactions
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
19
Urinary Antiseptics/Antiinfectives
and Antibiotics

Methenamine hippurate (Hiprex)
 Treats chronic UTIs
 Effective for E. coli and P. aeruginosa
 Bactericidal when urine is acidic
 Caution
• Not to be taken with sulfonamides (may
cause crystalluria)
 Patient teaching
• Consume acidic foods and fluids
• Side effects/adverse reactions
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
20
Urinary Antiseptics/Antiinfectives
and Antibiotics

Trimethoprim and trimethoprim
sulfamethoxazole
 Trimethoprim (Proloprim): can be used
alone for the treatment of UTIs; usually
used in combination with a
sulfonamide, sulfamethoxazole
(Bactrim, Septra)
 Used in the treatment and prevention
of acute and chronic UTIs
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
21
Urinary Antiseptics/Antiinfectives
and Antibiotics

Fluoroquinolones
Nalidixic acid (NegGram),
norfloxacin (Noroxin),
ciprofloxacin hydrochloride
(Cipro), ofloxacin (Floxin), and
lomefloxacin (Maxaquin)
Treats lower UTIs
Side effects/adverse reactions
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
22
Urinary Analgesics

Phenazopyridine (Pyridium)
Action
• Relieves pain, burning sensation,
frequency, urgency
Side effects/adverse reactions
• GI upset
• Red-orange urine
• Blood dyscrasia
• Nephrotoxicity, hepatotoxicity
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
23
Urinary Stimulants

Urinary stimulants
 Bethanechol (Urecholine)
 Treat hypotonic bladder: neurogenic,
spinal cord injury, or severe head injury
 Action
• Increases bladder tone
 Contraindication
• Peptic ulcer
 Side effects/adverse reactions
• GI distress, dizziness, fainting
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
24
Urinary Antispasmodics/
Antimuscarinics

Oxybutynin (Ditropan) and flavoxate (Urispas)
 Action
• Direct action on smooth muscles to relieve
spasms
 Side effects/adverse reactions
• Drowsiness, tachycardia, dizziness, fainting,
blurred vision, dry mouth, constipation
 Patient assessment
• Avoid in glaucoma, GI or urinary obstruction
• Use cautiously with history of cardiac, renal,
hepatic, prostate problems
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
25
Urinary Antispasmodics/
Antimuscarinics

Tolterodine tartrate (Detrol)
Used to control an overactive
bladder, which causes
frequency in urination
Decreases urge and urinary
incontinence
Same side effects as
antispasmodics/anticholinergics
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
26