Ppt chapter 52-1

Drugs Affecting the Urinary Tract
and the Bladder
Chapter 52
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Urinary Tract Infections (UTIs)
• Second most common infection in the U.S.
• More common in females
• Patients with indwelling catheters or intermittent
catherization are at risk

Signs and Symptoms of a UTI
• Urinary frequency
• Urgency
• Burning on urination (associated with cystitis)
• Chills, fever, flank pain, and tenderness (associated with
acute pyelonephritis)

Treatment for UTIs
• Antibiotics
• Specific agents to sterilize the urinary tract
• Drugs that:
– Block spasms of the urinary tract muscles
– Decrease urinary tract pain
– Protect the cells of the bladder from irritation
– Treat enlargement of the prostate gland in men

Sites of Action of Drugs Acting on the
Urinary Tract

Anti-Infectives Used to Treat UTI
• Cinoxacin (Cinobac): Interferes with DNA replication in
gram-negative bacteria
• Norfloxacin (Noroxin): Effective against even more gram-negative
strains than is cinoxacin
• Fosfomycin (Monurol): Has the convenience of only one
dose
• Nalidixic Acid (NegGram): Older drug, not effective
against as many strains of gram-negative bacteria
• Nitrofurantoin (Furadantin): Older drug with a very short
half-life

Anti-Infectives That Acidify the Urine
• Methenamine (Hiprex)
– Undergoes metabolism in the liver and is excreted in
urine
– Has established dosage guidelines for children and
comes in a suspension form
• Methylene Blue (Urolene Blue)
– Is widely distributed, metabolized in the tissues, and
excreted in urine, bile, and feces

Anti-Infectives
• Actions
– Act specifically within the urinary tract to destroy
bacteria
– They act either through direct antibiotic effect or
through acidification
• Indications
– Chronic UTI
– Adjunctive therapy in acute cystitis and
pyelonephritis
– Prophylaxis with urinary tract anatomical
abnormalities and residual urine disorders

Anti-Infectives (cont.)
• Pharmacokinetics
– Vary with each drug
• Contraindications
– Allergy
• Caution
– Renal dysfunction
– Pregnancy and lactation

Anti-Infectives (cont.)
• Adverse Effects
– Nausea, vomiting, anorexia, bladder irritation, and
dysuria
– Pruitus, urticaria, headache, dizziness, nervousness,
and confusion
• Drug-to-Drug Interactions
– Vary with each agent

Question
What type of drugs are used to treat UTIs?
A. Broad spectrum antibiotics
B. Those that protect the cells of the bladder from
irritation
C. Quinine-based medications
D. Beta blockers

Answer
B. Protect the cells of the bladder from irritation
Rationale: Drugs that: block spasms of the urinary tract
muscles; decrease urinary tract pain; protect the cells of
the bladder from irritation; treat enlargement of the
prostate gland in men

Urinary Tract Antispasmodics
• Actions
– Block the spasms of urinary tract muscles
– Blocking parasympathetic activity
– Relaxing the detrusor and other urinary tract muscles
• Indications
– Bladder spasm and dysuria

Urinary Tract Antispasmodics (cont.)
– Rapidly absorbed, widely distributes
– Metabolized in the liver and excreted in the urine
– Allergy
– Pyloric or duodenal obstruction
– Recent surgery
– Obstructive urinary tract problems
– Glaucoma, myasthenia gravis, or acute hemorrhage

Urinary Tract Antispasmodics (cont.)
• Caution
– Renal or hepatic dysfunction
• Adverse Effects
– Related to blocking of the parasympathetic system
– Phenothiazines
– Haloperidol

Urinary Tract Analgesia
• Actions
– When phenazopyridine is excreted in urine, it exerts
a direct topical analgesic effect on the urinary
mucosa
• Indications
– Relieve symptoms related to urinary tract irritation
from infection, trauma, or surgery

Urinary Tract Analgesia (cont.)
– Rapidly absorbed and has a very rapid onset of
action
– Widely distributed
– Metabolized in the liver and excreted in the urine
– Allergy and renal dysfunction
• Caution

Urinary Tract Analgesia (cont.)
• Adverse Effects
– GI upset, headache, rash, reddish-orange coloring of
the urine
– Renal and hepatic toxicity
– Antibacterial agents

Bladder Protectants
• Actions
– Heparin-like compound that has anticoagulant and
fibrinolytic effects
– Adheres to the bladder wall mucosal membranes and
acts as a buffer to control cell permeability,
preventing irritating solutes in the urine from
reaching the bladder wall cells
• Indications
– Interstitial cystitis

Bladder Protectants (cont.)
– Very little of the drug is absorbed
– Metabolized in the liver and spleen, and excreted in
the urine
– Condition that involve a risk of bleeding
– Heparin induced thrombocytopenia

Bladder Protectants (cont.)
• Caution
– Hepatic or splenic dysfunction
– Pregnancy or lactation
• Adverse Effects
– Bleeding that may progress to hemorrhage
– Headache, alopecia, GI disturbances
– Anticoagulants, aspirin, or NSAIDs

Drugs for Treatment of Benign Prostatic
Hyperplasia
• Actions
– Varies with drug
• Indications
– Treats benign prostatic hypertrophy
– Allergy

Drugs for Treatment of Benign Prostatic
Hyperplasia
• Cautions
– Hepatic or renal dysfunction
• Adverse Effects
– Headache, fatigue, dizziness, postural dizziness,
lethargy, tachycardia, hypotension, GI upset
– Decreased libido, impotence, and sexual dysfunction
– Theophylline

Question
Please answer the following question as true or false.
An adverse effect of a bladder protectant is alopecia.

Answer
True
Rationale: Adverse Effects: bleeding that may progress to
hemorrhage; headache, alopecia, GI disturbances

Use of Drugs Affecting the Urinary Tract
Throughout the Lifespan

Prototype Anti-Infectives

Prototype Urinary Tract Antihistamines

Prototype Drugs for Treatment of Benign
Prostatic Hyperplasia

Nursing Considerations for Anti-Infectives
• Assessment: History and Physical Exam
• Nursing Diagnosis
• Implementation
• Evaluation

Nursing Considerations for Urinary Tract
Antispasmodics
• Implementation
• Evaluation

Nursing Considerations for Urinary Tract
Analgesia
• Implementation
• Evaluation

Nursing Considerations for Bladder
Protectants
• Implementation
• Evaluation

Nursing Considerations for Drugs for
Treatment of Benign Prostatic Hyperplasia
• Implementation
• Evaluation

Question
What is an appropriate nursing diagnoses for a patient
taking a urinary anti-infective?
A. Disturbed sensory perception (kinesthetic, tactile,
visual)
B. Incontinence
C. Chronic pain
D. Discolored urine

Answer
A. Disturbed sensory perception (kinesthetic, tactile,
visual)
Rationale: Nursing diagnoses related to drug therapy might
include: acute pain related to GI, CNS, or skin effects of
drug; disturbed sensory perception (kinesthetic, tactile,
visual) related to CNS effects; impaired urinary
elimination related to underlying problem necessitating
drug therapy; risk for injury related to possible CNS
effects; deficient knowledge regarding drug therapy

Ppt chapter 52-1

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Ppt chapter 52-1