Urinary Medications PDF

Urinary Medications  Medication Considerations Kidneys filter medications from blood Renal disease, changes in pH of urine, and age may impair effectiveness Renal disease patients will be administered reduced doses of medications to minimize further damage or drug toxicity Alteration in u...

Urinary Medications  Medication Considerations Kidneys filter medications from blood Renal disease, changes in pH of urine, and age may impair effectiveness Renal disease patients will be administered reduced doses of medications to minimize further damage or drug toxicity Alteration in urinary pH affect the absorption rate of certain medications  Diuretics Carbonic anhydrase inhibitors  Inhibits the enzyme carbonic anhydrase  Results in excretion of sodium, potassium, bicarbonate, and water  Used to treat glaucoma, altitude sickness, seizures, and heart failure (as diuretic)  Decreases the production of aqueous humor in the eye, which in turn decreases intraocular pressure  Adverse Rxn: rare serious blood d/o, NVD, electrolyte imbalance (Na, K), glucose disturbances, flu-like s/s, parathesias  Contact the primary health care provider immediately if eye pain is not relieved or increases  Diuretics A SU sk a LF bo A a ut Loop diuretics ll e rg y  Increase the excretion of sodium and chloride  Work in loop of Henle  Used with nephrotic syndrome, heart failure, and pulmonary edema  Adverse effects:  Dehydration, hyponatremia, hypochloremia, hypokalemia, hypocalcemia, hypomagnesemia, hypotension  Ototoxicity  Hyperglycmeia  Diuretics Loop Diuretics:  Interactions  Dig toxicity can occur in presence of hypokalemia  Potassium supplements as necessary  Concurrent antihypertensives  Lithium levels can increase leading to toxicity with hyponatremia  NSAIDs decrease blood flow to kidneys decreasing effect  Contraindications  Unless absolutely necessary, don’t use with pregnancy  Anuria  Precaution with CV disease, DM, dehydration, electrolyte imbalances, gout  Clients taking dig, lithium, ototoxic medications, NSAIDs, or antihypertensives  Thiazides and related diuretics  Management of systemic edema and control of mild to moderate hypertension, diabetes insipidus, promote reabsorption of calcium in postmenopausal osteoporosis  Adverse reactions: same as loop, electrolyte imbalances, dehydration, hyperglycemia, hyperuricemia, joint pain  Used cautiously in patients with liver disease, diabetes, lupus erythematosus, or diarrhea  Contraindication: pregnancy, breastfeeding, kidney impairment  Interactions: same as loop but don’t increase hearing loss Ask about SULFA allergy  Diuretics  Potassium-sparing diuretics(Saves K+)  For hypertension and edema, heart failure, blocks action of aldosterone in hyperaldosteronism  Adverse effects: hyperkalemia, endocrine effects in men, deepened voice, impotence, and women’s menstrual irregularities, drowsiness, metabolic acidosis  Interactions: ACE inhibitors, angiotensin receptor blockers, and direct renin inhibitors increase risk of hyperkalemia  Potassium-sparing diuretics: Contraindicated in patients with hyperkalemia; anuria, severe kidney failure; not recommended for children  Emphasize importance of avoiding foods high in potassium and use of salt substitutes containing potassium  Diuretics Osmotic diuretics  Act at the proximal convoluted tubule to increase plasma osmotic pressure, causing redistribution of fluid toward the circulatory vessels. (manage edema, promote diuresis in cerebral edema, decrease intraocular pressure, improve renal function in acute renal failure)  Mannitol: Contraindicated in patients with active intracranial bleeding, anuria, severe pulmonary edema, severe dehydration, and kidney failure  Adverse effects: heart failure, pulmonary edema, rebound increase ICP, fluid and electrolyte imbalances, metabolic acidosis  Diuretics Osmotic Diuretics  Interactions: increases lithium excretion; with cardiac glycosides (dig) increases hypokalemia  Patient with increased intracranial pressure  Monitor the wt, urine output, blood pressure, pulse, and respiratory rate  Perform neurologic assessments at time intervals  Monitor for signs and symptoms indicating decrease in intracranial pressure  Nursing Process: Assessment Pre-administration assessment  Take baseline vital signs and weight  Review laboratory results  Electrolytes  BUN/Creatnine  U/A  If patient has peripheral edema: Inspect the involved areas and record in the patient’s chart the degree and extent of edema (non pitting vs. pitting)  Nursing Process: Assessment Ongoing assessment  Measure and record fluid intake and output  Don’t give late in the day  If hypokalemic, watch ECG  Report to the primary health care provider any marked decrease in the fluid output  Weigh the client daily  Lightheadedness, dizziness, GI distress or weakness may indicate hypokalemia or hypovolemia  Eat foods high in potassium if on potassium wasting  Watch glucose and electrolyte levels  Tinnitus and hearing loss (with loops)  Monitor B/P  Change positions slowly  Nursing Process: Implementation  Indications of Effectiveness:  Adequate kidney function  UO at least 30 ml/hr  Creatinine 0.6-1.3 mg/dl  BUN 10-20  Wt loss  Decrease in ICP and IOP  Nursing Process: Implementation  Patient with renal compromise  Monitor renal function periodically  Monitor serum uric acid concentrations and serum glucose concentration periodically  Monitor for any joint pain or discomfort (indicates possible gout attack)  Nursing Process: Implementation Educating the client and family  Advise about the importance of completing the entire course of treatment  Explain the importance of taking the drug at prescribed time intervals and as directed  Do not reduce fluid intake to reduce the need to urinate. Give at 8 and 2  Emphasize the importance of taking the drug with food or milk  Instruct patient to avoid alcohol, nonprescription drugs  Emphasize observing caution while driving or performing hazardous tasks Nursing Process: Implementation Educating the client and family-cont’d:  Explain necessary interventions if dizziness or weakness occurs (slowly rise or sit up; call for assistance)  Change positions slowly to decrease postural hypotension  Weigh at least weekly or as recommended (same conditions)  Self monitor wt and b/p w/log  Explain the importance of avoiding exposure to sunlight or ultraviolet light (sunburn; photosensitivty)  Explain to patients with diabetes mellitus and who take loop or thiazide diuretics to contact health care provider if increase in blood glucose level (check more often)  Nursing Interventions  Monitor for s/s fluid overload  Changes in pulse, respirations, cardiac sounds, and lung fields  Daily morning weights  I&O  VS QID until regulated  Reinforce position changes and adverse effects to report  BUN, electrolytes, and urine are assessed as ordered  Avoid overuse of salt  Potassium sources  Baked potatoes, bananas, apricots, navel oranges, dates, tomatoes, and tomato juice, sweet potatoes, kale, raisins, etc.  Loop Diuretics  bumetanide – Bumex  furosemide – Lasix  torsemide – Demadex  Thiazides and Related diuretics  Chlorothiazide – Diuril  hydrochlorothiazide – Microzide  indapamide – Lozol  metaloazone – Zaroxolyn  Potassium sparing diuretics  amiloride HCl – Midamor  spironolactone – Aldactone Osmotic Diuretics  osmitrol – Mannitol Carbonic Anhydrase Inhibitors  acetazolamide – Diamox  Anti-infectives: Actions and Uses Used for acute or chronic UTIs caused by susceptible bacterial microorganisms Rapid excretion rate of drugs High concentration in urine; acts by interfering with bacterial multiplication in urine  Nursing Process: Assessment Pre-administration assessment  Question the patient regarding the symptoms of infection before instituting therapy  Record color, appearance of urine  Record vital signs  Assess and document  Pain  urinary frequency  bladder distension  other symptoms associated with urinary system  Allergies to Sulfa, ASA, thiazides, sulfonylureas  Kidney/liver impairment, pregnancy, lactation  Anti-infectives: Adverse Reactions Gastrointestinal disturbances  Anorexia; NVD  Abdominal pain or stomatitis Generalized body system reactions  Drowsiness; headache; blurred vision; peripheral neuropathy  Rash; pruritus; photosensitivity reactions; leg cramps; fever; chills; superinfection  Anti-infectives: Contraindications and Precautions  Contraindicated in patients with hypersensitivity to the drugs; during pregnancy and lactation  Used cautiously in patients with renal or hepatic impairment  Teaching  Give urinary tract anti-infectives with food to prevent GI upset  Note visual disturbances  S/S of Steven Johnson Syndrome (w/sulfonamides)  Interactions: Anti-infectives Interactant drug Effect of interaction Sulfamethoxazole with Increased risk for bleeding oral anticoagulants Nitrofurantoin with Delay in gastric emptying, anticholinergics thereby increasing the absorption of nitrofurantoin  Nursing Interventions for clients receiving antibiotics for UTIs.  Check for drug interactions  Hydrate the patient to produce daily urine output of 2000ml, unless contraindicated.  Instruct the patient to take all the medication, even though the symptoms may subside quickly.  Soothe skin irritations with cornstarch or bath of bicarbonate of soda or dilute vinegar  Acid ash diet to maintain urine pH of 5.5  (↑acidity of urine-meats, whole grains, eggs, cheese, cranberries, prunes, plums)  Monitor for allergic response.  Report s/s of continued infection.  Anti-infectives amoxicillin – Amoxil nitrofurantoin – Macrobid, Macrodantin trimethoprim and sulfamethoxazole – Bactrim, Bactrim DS Review from Antibiotic section  Meds for Urinary Tract Infections Quinolone – Nalidixic acid  used to treat UTIs by gram neg microbes. Methenamine mandelate - Hiprex  suppresses fungi and gram neg and gram pos organisms.  Must have acidification of urine with acid-ash diet.  Chronic, recurrent urinary tract infections as prophylaxis Fluoroquinolone - Norfloxacin (Noroxin)  gram pos and neg for UTIs, gonorrhea, and gonococcal urethritis. Give with glass of water  Antispasmodics: Actions and Uses Cholinergic blocking drugs (anticholinergics): Inhibits bladder contractions, delays urge to void Relieves symptoms of dysuria, urinary urgency, nocturia, suprapubic pain and frequency, urge incontinence Treats bladder instability caused by neurogenic bladder  Antispasmodics: Adverse Reactions Dry mouth, drowsiness, constipation or diarrhea, decreased production of tears, decreased sweating, GI disturbances, dim vision, urinary hesitancy (anticholinergic) Nausea and vomiting, nervousness, vertigo, headache, rash, mental confusion Discolors urine  Antispasmodics: Contraindications and Precautions Contraindicated in patients with hypersensitivity to drug, glaucoma Used cautiously in patients with GI infections, benign prostatic hypertrophy, urinary retention, hyperthyroidism, hepatic or renal disease, hypertension  Interactions: Antispasmodics Interactant Drug Effect of Interaction Antibiotics/antifungals Decreased effectiveness of anti-infective drug Meperidine, flurazepam, Increased effect of the phenothiazines antispasmodic Tricyclic antidepressants Increased effect of the antispasmodic Haloperidol Decreased effectiveness of the antipsychotic drug Digoxin Increased serum levels of digoxin  Nursing Process: Implementation Monitoring and managing patient needs  Encourage to drink at least 2000 mL of fluid daily  dilute urine and decrease pain on voiding  Offer fluids, preferably water, at hourly intervals  Monitor fluid intake and urine output  Monitor for signs and symptoms of acute pulmonary reaction  Dyspnea, chest pain, cough, fever, chills  Monitor for signs of chronic pulmonary reaction  Nursing Process: Implementation  Patient needs when taking antispasmodic drugs  Encourage fluids  provide high-fiber diet  provide time for ambulation, exercise  provide frequent mouth care  Inform patient of adverse effects:  Reddish-orange discoloration of urine; discoloration of contact lens  Drugs Spasmolytic (antispasmodic)  Flavoxate – Urispas – (relieve nocturia, incontinence, dysuria)  Oxybutynin – Ditropan Antimuscarinic medications (type of anticholinergics)  Solifenacin – Vesicare  Tx: ↓ bladder contractions  Tolterodine – Detrol, Detrol LA  Tx: overactive bladder w/symptoms of urgency/frequency in incontinence  once daily as extended release capsules Anesthetic (Analgesic)  Phenazopyridine – Pyridium  (anesthetic on mucosa of urinary tract-↓ pain) Changes color of urine; stains  Urogesic blue  More Urinary Related Medications  finasteride (Proscar)  Reduces prostate size  Tx: benign prostatic hyperplasia (BPH)  A/E: May decrease libido and ED  Interactions: none noted  Precaution: females handle with caution  tamsulosin (Contiflo XL)  Reduces prostate size and bladder neck; vasodilates  Tx: BPH, urinary hesitancy/urinary retention (women)  A/E: Hypotension, dizziness, faintness, sleepiness  Interactions:  cimetidine decreases elimination of tamsulosin; anhti- hypertensives  Precaution/Implementation:  Monitor b/p, rise/change positions slowly; females handle with caution  More Urinary Related Medications bethanechol chloride (Urecholine)  urinary bladder stimulant for postpartum and postop nonobstructive urinary retention caused by neurogenic bladder– assess for hypotension nortriptyline (Pamelor) contains anticholinergic effects that can relive urinary incontinence  May cause dizziness, monitor bp and watch for orthostatic hypotension