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Transcript
Cholinergic-Blocking Drugs Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Definition Drugs that block or inhibit the actions of acetylcholine (ACh) in the parasympathetic nervous system (PSNS) Also known as anticholinergics Chemical Class Natural atropine belladonna hyoscyamine scopolamine Synthetic/Semisynthetic benztropine clidinium dicyclomine glycopyrrolate homatropine ipratropium isopropamide methscopolamine oxybutynin propantheline tolterodine trihexyphenidyl solifenacin GU: Drug Effects/Indication Expected Effect Relaxed detrusor muscle Increased constriction of internal sphincter Result: urinary retention Indication Reflex neurogenic bladder Incontinence Side effects Side Effects Dry Mouth Constipation Urinary Retention Confusion Interactions Antihistamines, phenothiazines, tricyclic antidepressants, MAOIs When given with cholinergic blocking drugs, cause additive cholinergic effects, resulting in increased effects Nursing Implications Assess: Allergies, presence of BPH, glaucoma, tachycardia, MI, HF, hiatal hernia, and GI or GU obstruction Baseline vital signs and systems overview Improved urinary patterns with treatment less hypermotility, increased time between voiding Adverse effects Nursing Implications Treat: Medications should be taken exactly as prescribed to have the maximum therapeutic effect Overdosing can cause life-threatening problems Antidote for atropine overdose is physostigmine Nursing Implications Teach: Patients may experience sensitivity to light and may want to wear dark glasses or sunglasses Blurred vision may cause problems with driving or operating machinery Dry mouth may occur; can be handled by chewing gum, frequent mouth care, and hard candy Nursing Implications Teach: Check with physician before taking any other medication, including over-the-counter medications Teach patients to limit physical exertion and avoid high temperatures and strenuous exercise Emphasize the importance of adequate fluid and salt intake Patients to report the following symptoms to their physician: urinary hesitancy and/or retention, constipation, palpitations, tremors, confusion, sedation or amnesia, excessive dry mouth (especially if they have chronic lung infections or disease), or fever Antibiotics For the GU system Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Antibiotics: Classes Sulfonamides Penicillins Quinolones Aminoglycosides Tetracyclines Glycopepetides Cephalosporins Macrolides Antibiotic Therapy: Mechanism of Action Interference with cell wall synthesis Interference with protein synthesis Interference with DNA replication Acting as a metabolite to disrupt critical metabolic reactions inside the bacterial cell Actions of Antibiotics Bactericidal: kill bacteria Bacteriostatic: inhibit growth of susceptible bacteria, rather than killing them immediately; will eventually lead to bacterial death Antibiotics: Sulfonamides One of the first groups of antibiotics Sulfadiazine Sulfamethoxazole Sulfisoxazole Often combined with another antibiotic Sulfamethoxazole combined with trimethoprim (a nonsulfonamide antibiotic), known as Bactrim, Septra, or co-trimoxazole (SMX-TMP) This combination is used commonly Sulfonamides: Mechanism of Action Bacteriostatic action Prevent synthesis of folic acid required for synthesis of purines and nucleic acid Do not affect human cells or certain bacteria— they can use preformed folic acid Only affect organisms that synthesize their own folic acid Sulfonamides: Indications Effective against both gram-positive and gram-negative bacteria Pneumocystis jirovecii pneumonia (PJP) Co-trimoxazole Upper respiratory tract infections Treatment of UTIs caused by susceptible strains of: Enterobacter spp., Escherichia coli, Klebsiella spp., Proteus mirabilis, Proteus vulgaris, Staphylococcus aureus Sulfonamides: Adverse Effects Body System Blood Integumentary Adverse Effects Hemolytic and aplastic anemia, agranulocytosis, thrombocytopenia exfoliative dermatitis, Stevens- Johnson syndrome, epidermal necrolysis GI Nausea, vomiting, diarrhea, pancreatitis Other Convulsions, crystalluria, toxic nephrosis, headache, peripheral, neuritis, urticaria Nursing Implications Assess: Before beginning therapy, assess drug allergies; renal, liver, and cardiac function; and other lab studies Be sure to obtain thorough patient health history, including immune status Assess for conditions that may be contraindications to antibiotic use or that may indicate cautious use Assess for potential drug interactions Nursing Implications Treat: It is ESSENTIAL to obtain cultures from appropriate sites BEFORE beginning antibiotic therapy All oral antibiotics are absorbed better if taken with at least 6 to 8 ounces of water For safety reasons, check the name of the medication carefully because there are many drugs that sound alike or have similar spellings Nursing Implications Teach: Patients to take antibiotics exactly as prescribed and for the length of time prescribed; they should not stop taking the medication early when they feel better Assess for signs and symptoms of superinfection: fever, perineal itching, cough, lethargy, or any unusual discharge Aminoglycosides gentamicin (Garamycin) neomycin (Neo-fradin) tobramycin (Nebcin) amikacin (Amikin) kanamycin streptomycin Aminoglycosides Natural and semisynthetic Produced from Streptomyces Poor oral absorption; no PO forms Very potent antibiotics with serious toxicities Bactericidal; prevent protein synthesis Kill mostly gram-negative bacteria; some gram-positive also Antibiotic Therapy: Toxicities Ototoxicity Nephrotoxicity Temporary or permanent hearing loss, balance problems Varying degrees of reduced renal function Rising serum creatinine may indicate reduced creatinine clearance Monitor trough levels every 5 to 7 days while on therapy or as ordered Monitor serum creatinine levels at least every 3 days as an index of renal function Aminoglycosides: Adverse Effects Cause serious toxicities Nephrotoxicity (renal damage) Ototoxicity (auditory impairment and vestibular impairment [eighth cranial nerve]) Must monitor drug levels to prevent toxicities Aminoglycosides: Adverse Effects Ototoxicity and nephrotoxicity are the most significant Headache Paresthesia Fever Superinfections Vertigo Skin rash dizziness Quinolones ciprofloxacin (Cipro) norfloxacin (Noroxin) levofloxacin (Levaquin) moxifloxacin (Avelox) Quinolones: Mechanism of Action Bactericidal Alter DNA of bacteria, causing death Do not affect human DNA Quinolones: Indications Gram-negative bacteria such as pseudomonas Respiratory infections Bone and joint infections GI, GU infections Skin infections Sexually transmitted diseases Anthrax Fluoroquinolones: Adverse Effects Body System CNS Adverse Effects Headache, dizziness, fatigue, depression, restlessness, insomnia GI Nausea, vomiting, diarrhea, constipation, thrush, increased liver function studies, Cardiac Prolonged QT interval Integumentary Rash, pruritus, urticaria, flushing, photosensitivity (with lomefloxacin) Other Fever, chills, blurred vision, tinnitus Black box warning: increased risk of tendonitis and tendon rupture Other Antibiotics nitrofurantoin (Macrodantin) Primarily used for UTIs (E. coli, S. aureus, Klebsiella spp., Enterobacter spp.) Use carefully if renal function is impaired Drug concentrates in the urine May cause fatal hepatotoxicity Usually well-tolerated if patient is kept wellhydrated Bladder analgesics Phenazopyridine Reduces bladder pain and dysuria 3 x a day Nursing Implications Monitor for therapeutic effects Improvement of signs and symptoms of infection Return to normal vital signs Negative culture and sensitivity tests Disappearance of fever, lethargy, drainage, and redness Monitor for adverse reactions BPH Androgens Stimulate the normal growth/development of the male sex organs (primary sex characteristics) development and maintenance of the secondary sex characteristics Result in weight gain and an increase in muscular strength. Stimulate the production of erythropoietin by the kidney, which leads to enhanced erythropoiesis (red blood cell synthesis; 41 5-Alpha-Reductase Inhibitors Finasteride (Proscar) and dutasteride (Avodart) Block the effects of endogenous androgens Results Easier in alleviation of symptoms of BPH passage of urine May also be used for treatment of malepattern baldness (minoxidil) Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 42 Alpha1-Adrenergic Blockers Used for symptomatic relief of obstruction caused by BPH doxazosin (Cardura) tamsulosin (Flomax) terazosin (Hytrin) alfuzosin (Uroxatral) silodosin (Rapaflo) Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 43 Nursing Implications Assessment should include complete history, including medication history, urinary elimination problems, potential contraindications Obtain baseline vital signs, weight, height, serum electrolyte levels Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 44 Nursing Implications (cont’d) Assess renal and liver function Assess PSA level and perform digital rectal examination (DRE) before beginning any drugs for treatment of prostate disease Assess current medications for potential interactions Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
