Chapter 30 Drugs used to treat urinary system disorders

Urinary tract infections (UTIs) are common infection in one area can involve entire system microbes enter system through urethra common causes: catheterization urological exams intercourse poor perineal hygiene immobility poor fluid intake UTI is a common healthcare associated infection (HAI), this is an infection that develops in a person cared for in any setting where healthcare is given, infection is related to receiving healthcare

**see box 30-1(p. 367) for urinary system review** women at high risk for UTIs, also men with enlarged prostate UTIs include: cystitis: inflammation of bladder pyelonephritis: inflammation of kidney pelvis prostatitis: inflammation of prostate urethritis: inflammation of urethra over-active bladder (OAB): known as urge syndrome, major symptoms: frequency: need to void 8+ times/day nocturia is common (need to void at night) urgency: sudden or compelling desire to pass urine that is hard to ignore incontinence: inability to control urine from passing from bladder **see box 30-1(p. 367) for urinary system review**

Drug Therapy for Urinary Tract Infections: urinary anti-microbial agents: substances that have an antiseptic effect on urine and urinary tract drug ordered depends on pathogen causing infection person should have fluid intake of 2000mL daily length of treatment depends on many factors: if the infection is acute, chronic or re-current the pathogen the drug ordered

Fosfomycin antibiotics: Example: fosfomycin (Monurol) drug affects the cell walls of bacteria, it reduces the ability of bacteria to adhere to the urinary tract drug is used as a single dose to treat uncomplicated acute cystitis in women goal of therapy: resolve UTI

Assisting With the Nursing Process fosfomycin (Monurol): ASSESSMENT: note amount, color, clarity and odor of urine; ask about urgency, burning, pain or problems; measure vital signs; ask about GI complaints PLANNING: dose form is 3mg packets of granules IMPLEMENTATION: pour entire contents of single-dose packet of granules into 3-4 oz of water, stir to dissolve, do NOT use hot water; have person take drug once granules dissolve, may be taken with/without food EVALUATION: report and record: nausea, diarrhea, abdominal cramps, flatulence: mild, tend to resolve perineal burning, dysuria: burning with voiding may be due to infection, symptoms should improve 2-3 days after taking drug

Quinolone Antibiotics: prevent bacteria from reproducing effective in treating initial and re-current UTIs goal of therapy: to resolve UTI

Assisting With the Nursing Process quinolone antibiotics: ASSESSMENT: note amount, color, clarity and odor of urine; ask about urgency, burning, pain or problems; measure vital signs; ask about GI complaints, ask about vision problems: color perception, problems focusing, double vision PLANNING: see table 30-1 (p. 368) “Oral Dose Forms” IMPLEMENTATION: see table 30-1 (p. 368) “Adult Dose Range” EVALUATION: report and record: nausea, diarrhea, abdominal cramps, flatulence: mild, tend to resolve drowsiness, headache, dizziness: mild, tend to resolve, provide for safety visual problems- color perception, problems focusing, double vision: may occur shortly after each dose is given during first few days, provide for safety photo-sensitivity: sensitivity to sunlight/ UV lights, sunscreen, long sleeves hematuria (blood in urine): person should drink 8-12 8 glasses of water daily itching, rash, hives, perineal burning: may signal an allergic reaction, tell nurse at once. Do NOT give dose unless approved by nurse headache, ringing in ears (tinnitus), dizziness, tingling sensations, photo-sensitivity, require medical attention

methenamine mandelate (Mandelamine): Other Urinary Anti-bacterial agents: methenamine mandelate (Mandelamine): suppresses growth and multiplication of bacteria that may cause re-current infection, used for chronic, re-current UTIs Assisting With the Nursing Process methenamine mandelate (Mandelamine): ASSESSMENT: note amount, color, clarity and odor of urine; ask about urgency, burning, pain or problems; measure vital signs PLANNING: oral dose forms are 500mg and 1g enteric-coated tablets IMPLEMENTATION: adult dosage: 1g 4x/day with meals, bedtime, do NOT crush tablets EVALUATION: report and record: nausea, diarrhea, belching: mild, tend to resolve hives, itching, rash: may signal allergic reaction, do NOT give next dose unless nurse approves bladder irritation, dysuria, frequency: may signal another UTI

nitrofurantoin (Macrodantin and Furadantin): Other Urinary Anti-bacterial agents: nitrofurantoin (Macrodantin and Furadantin): interfere with several bacterial enzyme systems, not effective against microbes in blood or tissues outside urinary tract Assisting With the Nursing Process nitrofurantoin (Macrodantin and Furadantin): ASSESSMENT: note amount, color, clarity and odor of urine; ask about urgency, burning, pain or problems; measure vital signs, ask about GI complications, ask about numbness/tingling in extremities PLANNING: oral dose forms are 25, 50, 100mg capsules 25mg/5mL suspension IMPLEMENTATION: adult dosage: is 50-100mg 4x/day for 10-14 days, give with food/milk, given every 6 hours to maintain adequate concentrations EVALUATION: report and record: nausea, vomiting, anorexia: give drug with food/milk to reduce rust brown to yellow-colored urine: harmless dyspnea, chills, rash, itching: signal allergic reaction, tell nurse at once, do NOT give next dose unless approved by nurse numbness/tingling in extremities: drug needs to be discontinued dysuria, foul-smelling urine, fever: signal second infection

Drug Therapy for Over-Active Bladder (OAB) anti-cholinergic drugs are the treatment of choice for OAB (aka: urinary anti-spasmodic agents) relax outer muscle layer of bladder involuntary bladder contractions decrease bladder can hold more urine, urinary frequency and urgency are reduced desire to void is delayed goals of therapy: decrease frequency by increasing amount voided decrease urgency reduce incidents of incontinence

anti-cholinergic agents for OAB: Assisting With the Nursing Process anti-cholinergic agents for OAB: ASSESSMENT: note amount, color, clarity and odor of urine; ask about urgency, burning, pain or problems; measure vital signs PLANNING: see table 30-2 (p. 370) for “Dose Forms” IMPLEMENTATION: see table 30-2 (p. 370) for “Adult Dosage Range” EVALUATION: report and record: dry mouth, urinary hesitancy, urinary retention: usually dose related, nurse may allow person to chew gum or suck on hard candy and ice chips constipation, bloating: follow care plan for diet and fluid intake blurred vision: person should not drive or operate machinery, provide for safety