Ppt chapter 42

Chapter 42
Drugs Treating Urinary Tract
Infections
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question
• What population is at greatest risk of having a UTI?
– A. Women of childbearing age and children
– B. Elderly and postmenopausal women
– C. Males and elderly
– D. Women aged 15 to 65 years

Answer
• B. Elderly and postmenopausal women
• Rationale: Elderly and postmenopausal women produce
less mucin and therefore are at a higher risk for UTI.

Physiology
• Normally, several host defenses protect a person from
UTI.
• The urinary bladder is lined with a mucin layer that acts
as a barrier against bacterial invasion.
• This layer also secretes protective substances that
eventually become part of the mucin layer.
• Elderly and postmenopausal women produce less mucin
and therefore are at a higher risk for UTI.
• Another host defense is the washout phenomenon.
• Immune mechanisms provide another host defense.

Pathophysiology
• Urinary tract infections are generally classified as
complicated or uncomplicated.
• UTIs can be acute, recurrent, or chronic.
• Asymptomatic bacteriuria: no symptoms of UTI
• Cystitis: infection of the lower urinary tract
• Urethritis: associated with sexual transmitted disease
• Prostatitis: associated with urethritis or cystitis
• Acute pyelonephritis: infection of the kidneys and renal
pelvis

Urinary Tract

Question
• Asymptomatic bacteriuria is common during pregnancy.
– A. True
– B. False

Answer
• A. True
• Rationale: Asymptomatic bacteriuria is common
during pregnancy. It is important to identify in
pregnant women because it increases the risk of
pyelonephritis during the second and third trimesters.
Additionally, untreated UTI is associated with an
increased risk of miscarriage.

Diagnosis of UTI
• Diagnosis of UTI is frequently based on the patient’s
subjective description of symptoms and a positive urine
dipstick test.
• The dipstick test is recommended for nonpregnant women
at low risk for recurrent infection and without symptoms
suggesting other problems, such as vaginitis.
• A urinalysis (UA) is required for women who are pregnant
or over the age of 55, men with urinary symptoms, and
patients with recurrent symptoms.
• A successful UA requires a midstream or clean-catch urine
specimen.
• When obtaining urine for a UA from a catheterized patient,
the urine must be withdrawn from the proximal port on the
catheter tubing and not from the urine collection bag.

Sulfonamides
• Sulfonamides have been the mainstay of treatment for
UTIs for many years.
• Unfortunately, the incidence of sulfonamide-resistant
bacteria has steadily increased.
• Prototype drug: sulfamethoxazole/trimethoprim (SMZ-TMP)
(Bactrim DS, Cotrimoxazole, Septra DS)

Sulfamethoxazole-Trimethoprim: Core
Drug Knowledge
• Pharmacotherapeutics
– Uncomplicated UTIs and systemic infections
• Pharmacokinetics
– Administered: oral. Metabolism: liver. Peak: 4 hours.
• Pharmacodynamics
– Interferes with the synthesis of folic acid (folate)

Drug Knowledge (cont.)
• Contraindications and precautions
– Hypersensitivity, deficiency of G6PD or folate
• Adverse effects
– Nausea, vomiting, diarrhea, hematologic effects
(e.g., anemia), allergic reactions, and crystalluria
• Drug interactions
– Interacts with other protein-bound drugs

Patient Variables
• Health status
– Assess for contraindications to drug therapy.
• Life span and gender
– Evaluate pregnancy or breast-feeding status.
• Lifestyle, diet, and habits
– Ask about dietary intake and alcohol use.
• Environment
– Photosensitivity may occur.

Sulfamethoxazole-Trimethoprim: Nursing
Diagnoses and Outcomes
• Pain related to altered comfort level (nausea, vomiting,
diarrhea, dizziness, or headache) from adverse effects of
SMZ-TMP
– Desired outcome: The patient will develop
strategies to cope with pain and take the drug as
directed for the full course of therapy.
• Risk for Injury related to drug-induced hypersensitivity
reactions, liver or kidney dysfunction, or blood dyscrasias
– Desired outcome: By the end of therapy, the
patient will be free from avoidable drug therapy–
related injuries and infection.

Sulfamethoxazole-Trimethoprim: Nursing
Diagnoses and Outcomes (cont.)
• Risk for Impaired Tissue Integrity related to drug-induced
photosensitivity
– Desired outcome: The patient will take measures to
protect his or her skin from prolonged sun exposure.

Sulfamethoxazole-Trimethoprim: Planning
and Interventions
• Maximizing therapeutic effects
– Administer SMZ-TMP 1 hour before or 2 hours after a
meal with a full glass of water to enhance the
absorption of the drug.
• Minimizing adverse effects
– Administer SMZ-TMP with a full glass of water.
– Fluid intake should increase by 1.5 L/day.

Sulfamethoxazole-Trimethoprim:
Teaching, Assessment, and Evaluations
• Patient and family education
– Teach patients the optimal way to take SMZ-TMP.
– Teach interventions to decrease the risk for adverse
effects.
• Ongoing assessment and evaluation
– Monitor patients for signs of hematologic dysfunction,
such as sore throat, fever, bruising, or bleeding.

Question
• SMZ-TMP should be given with food to increase
absorption.
– A. True
– B. False

Answer
• B. False
• Rationale: Administer SMZ-TMP 1 hour before or 2
hours after a meal with a full glass of water to
enhance the absorption of the drug.

Urinary Tract Antiseptics
• Urinary tract antiseptics are drugs that work by local
action because high serum levels are not achievable.
• Methenamine (Hiprex, Urex)
– Indicated for suppressing or eliminating bacteriuria
(bacteria in urine) associated with chronic cystitis
and other chronic UTIs
– Contraindicated in patients with hepatic dysfunction

Urinary Tract Antiseptics (cont.)
• Nitrofurantoin (Furadantin, Macrodantin, Macrobid)
– Is presumed to interfere with several bacterial
enzyme systems
– Although nitrofurantoin has a broad spectrum of
activity, it is not an effective systemic drug because
it is rapidly excreted by the kidneys.
– Contraindicated in patients with renal impairment

Urinary Tract Analgesic
• Phenazopyridine (Pyridium) is used frequently for UTIs
but does not itself have any antibacterial activity.
• It is excreted in the urine, where it exerts a topical
analgesic effect.
• It is indicated for the symptomatic relief of pain, burning,
frequency, and urgency.
• The precise mechanism of action is not known.
• Contraindicated for patients with known hypersensitivity
or renal insufficiency.
• Adverse reactions include headache, rash, pruritus, and
GI disturbances.

Question
• It is important to teach the patient receiving
phenazopyridine that his or her urine will appear
– A. Orange
– B. Red
– C. Dark brown
– D. Both A and B

Answer
• D. Both A and B
• Rationale: Phenazopyridine is an azo dye, which
colors the patient’s urine orange or red. It is
important to inform the patient to expect this change
in urine color.

Ppt chapter 42

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