The document discusses drugs used for urinary system issues. It covers urinary antiseptics like nitrofurantoin and methanamide; analgesics like phenazopyridine; and acidifiers/alkalinizers like sodium citrate. It also discusses various antibiotics used for urinary tract infections like cotrimoxazole, fluoroquinolones, cephalosporins, and penicillins. Treatment regimens and considerations for patients with renal impairment are provided. Drugs for prophylaxis of UTIs are also mentioned.

2. DRUGS FOR URINARY
SYSTEM
 Urinary antiseptics
 Urinary analgesics
 Urinary acidifiers
 Urinary alkalinizers
 Urinary antibiotics

3. Urinary antiseptics -
Nitrofurantoin
 Bacteriostatic normally
 Cidal at higher concentration
 Resistance develops slowly and no cross
resistance with any other antibiotics
 Contraindicated in renal failure, pregnancy and
neonates
 Adverse effects are nausea, diarrhoea,
epigastric pain, hemolytic anemia in G-6-P-D
deficiency, peripheral neuritis.
 Used as prophylaxis during intrumentation

4. Methanamide
 Acts by releasing formaldehyde in acidic
medium and kills the bacteria
 Adverse effects are gastritis due to
formaldehyde release in stomach,
chemical cystitis, hematuria.
 Contraindicated in renal failure

5. Urinary analgesic
 Phenazopyridine an orange dye affords
symptomatic relief of burning sensation,
dysuria and urgency
 Devoid of antibacterial property.

6. Urinary acidifiers & alkalinizers
 Sodium citrate, potassium citrate,
tartaric acid
 Sodium bicarbonate, acetazolamide
Acidic Alkaline pH immaterial
Nitrofurantoin Cotrimoxazole Chloramphenicol
Methanamine Aminoglycosides Ampicillin
Tetracyclines Cephalosporins
Cloxacillin Fluoroquinolones

7. Antibiotics for urinary tract infections
 In acute cystitis Cotrimoxazole 4 tablets
given as a single dose
 In upper / lower UTI a course of 3-
10days
 Fluoroquinolones and cotrimoxazole are
contraindicated in pregnant women.

8. Cotrimoxazole:
 Coliform bacteria including E-coli and
Proteus mirabilis are susceptible
 Acute but uncomplicated cases respond
rapidly
 A course of 5-10 days is effective mostly
 Single dose therapy only in case of
acute cystitis

9. Fluoroquinolones:
 1st generation fluoroquinolones are commonly
used
 Norfloxacin among the other 1st generation
drugs are concentrated more in urinary tract,
genital tract and git.
 Pseudomonas and gram positive cocci doesn’t
respond to norfloxacin.
 Ofloxacin a better action against gram positive
organisms and chlamydia and mycoplasma.
 Ciprofloxacin is used commonly for git
infections

10. Cephalosporins:
 Cephelexin, cefixime and cefpodoxime
proxetil are commonly used in urinary
tract infections
 They are excreted unchanged by kidney
and hence preferred in urinary tract
infections
 Effective against gram positive
organisms (cocci and bacilli)
 Preferred in pregnant women presenting
with UTI

11. Penicillins & Penicillin +
Clavulanic acid
 Used in case of susceptible gram
positive infection after culture sensitivity
report
 Commonly used drugs are amoxicillin,
ampicillin, etc,.
 In case of pyelonephritis pipericillin is
effective when sensitive organisms are
causative.

12. Antimicrobial regimens for acute
UTI(given orally for 3-5 days)
 Norfloxacin 400mg 12th hourly
 Ciprofloxacin 250-500mg 12th hourly
 Ofloxacin 200-400mg 12th hourly
 Cotrimoxazole 960mg 12th hourly
 Cephalexin 250-500mg 6th hourly
 Cefpodoxime proxetil 200mg 12th hourly
 Amoxicillin + Clavulanic acid (500+125mg)
8th hourly
 Nitrofurantoin 50mg 8th hrly or 100mg 12th
hrly for 5-7 days.

13. Cont….
 Cloxacillin in pencillinase producing staph
infections
 Piperacillin / Carbenicillin in serious
Pseudomonas infection.
 Gentamicin for Pseudomonas infection and
combined with co-amoxiclav.
 Cephalosporins for recurrent cystitis when
women likely to get pregnant.
 Chloramphenicol restricticed to pyelonephritis
and with positive sensitive report
 Tetracyclines in Ch.trachomatis cystitis.

14. Urinary infection in patients with
renal impairment
Drugs contraindicated and avoided in renal failure
 Methenamine
 Tetracyclines
 Cephalosporins
 Nitrofurantoin
 Nalidixic acid
 Aminoglycosides
 Potassium salts and acidifying agents
Bacteriological testing and follow up cultures are a must
to select the appropriate drug and to ensure
eradication of the pathogen.

15. Prophylaxis for UTI
 Women of child bearing age have
recurrent cystitis
 Catheterization or Instrumentation
 Indewelling catheters are placed
 Uncorrectable abnormalities of the
urinary tract
 Inoperable prostate enlargement

16. Drugs for Prophylaxis of UTI
The following drugs are given once daily at
bed time
 Cotrimoxazole 480mg
 Nitrofurantoin 100mg
 Norfloxacin 400mg
 Cephalexin 250mg

17. Thank you

18. Laxatives , Purgatives , Cathartics
Mechanism of Action
 Laxatives modify the fluid dynamics of
the mucosal cell and may cause fluid
accumulation in gut lumen by
 Inhibiting NaKATPase of villous cells
 Stimulating adenylyl cyclase in crypt cell
 Enhancing PG and NO synthesis
 Structural injury to absorbing intestinal
mucosal cells

19. Purgatives MOA
 Hydrophilic and osmotic action, retaining
water and electrolytes in the lumen,
increase volume of colonic content and
make it easily propelled
 Reduces absorption and enhanced
transit in intestine
 Primary action is to increase propulsive
activity

20. Classification of drugs
 Bulk forming
Dietary fibre: Bran, Ispaghula, Psyllium
 Stool softner
Liquid paraffin, Docusates
 Stimulant purgatives
Diphenylmethanes, anthraquinones, 5-
HT4 antagonist(Prucalopride), Fixed Oil
 Osmotic purgatives
Magnesium & sodium salts, Lactulose

21. Choice & Use of Purgatives
 Functional constipation
 Bedridden patients
 To avoid straining at stools
 Preparation of bowel for surgery,
colonoscopy, abdominal x-ray
 After certain antihelmintics
 Food / drug poisoning

22. Purgative abuse
 Flairing of intestinal pathology, rupture of
inflammed appendix
 Fluid and electrolyte imbalance,
especially hypokalaemia
 Steatorrhoea, Malabsorption syndrome
 Protein losing enteropathy
 Spastic colitis