Diuretics and Medications Used for Urinary System Disorders UNIT 25 Diuretics and Medications Used for Urinary System Disorders

Key Terms Edema Excretion Escherichia coli Nephrotic syndrome Proteus mirabilis

Urinary System Two kidneys Two ureters One bladder One urethra Nephron: functional unit of kidney Two ureters One bladder One urethra

Urinary System Diseases May involve kidneys, ureters, bladder, and urethra 20 million Americans are affected by kidney and urological diseases Leading causes of chronic kidney failure: Diabetes mellitus (Type 2) High blood pressure Glomerulonephritis (continues)

Urinary System Diseases Kidney stones Polycystic kidney disease Cancer UTIs More common in women than men Can lead to nephritis Urinary incontinence Overactive bladder

Urinary System Diseases: Warning Signs Burning or difficulty in urination Nocturia Hematuria Puffiness or swelling (eyes, hands, feet) Pain in small of back Hypertension

Urinary System Diseases: Treatments Diuretics Urinary tract antibacterials Urinary tract antiseptics Miscellaneous agents

Diuretics Decrease reabsorption of sodium chloride by kidneys, increasing salt and water excreted in urine Reduce fluid retention, prevent edema Uses Congestive heart failure, hypertension Nephrotic syndrome, chronic renal failure Idiopathic edema Diabetes insipidus Glaucoma (continues)

Diuretics Types Thiazide Loop Potassium-sparing Osmotic Carbonic anhydrase inhibitors

Thiazide Diuretics Inhibit sodium and chloride reabsorption in distal tubule Block chloride reabsorption in loop of Henle Uses Edema Hypertension Diuresis (continues)

Thiazide Diuretics Contraindications Hypersensitivity Anuria Renal decompensation Pregnancy Lactation Caution with severe renal or liver disease (continues)

Thiazide Diuretics Adverse effects Weakness Hypotension Diarrhea, vomiting, constipation Glycosuria Vertigo Electrolyte imbalance (continues)

Thiazide Diuretics Patient teaching Increase fluid intake to 2–3 liters per day Eat potassium-rich foods Take medicine in morning to avoid nocturia (continues)

Thiazide Diuretics Special considerations May increase blood sugar Should not take with lithium Alcohol, barbiturates, and narcotics increase risk of hypotension

Loop Diuretics Inhibit reabsorption of sodium and chloride in proximal and distal tubules, and in loop of Henle Uses Edema Hypertension Adjunctive therapy for acute pulmonary embolism (continues)

Loop Diuretics Contraindications Hypersensitivity Anuria Electrolyte depletion Hypovolemia Infants Lactation (continues)

Loop Diuretics Adverse effects Weakness Hypotension Diarrhea, vomiting, constipation Glycosuria Vertigo Electrolyte imbalance Thrombophlebitis (continues)

Loop Diuretics Patient teaching Increase fluid intake to 2–3 liters per day Eat potassium-rich foods Take medicine in morning to avoid nocturia (continues)

Loop Diuretics Special considerations May increase blood sugar Should not take with lithium Should not take during pregnancy Additive effect when taken with antihypertensives Alcohol, barbiturates, and narcotics increase risk of hypotension

Potassium-Sparing Diuretics Cause increased amounts of sodium and water to be excreted, while potassium is retained Uses Edema CHF Cirrhosis Hypokalemia Essential hypertension (continues)

Potassium-Sparing Diuretics Contraindications Pregnancy or lactation Anuria Hypersensitivity Acute renal disease Hyperkalemia (continues)

Potassium-Sparing Diuretics Adverse effects Gynecomastia Cramping Drowsiness Urticaria Irregular menses Hirsutism Gastritis (continues)

Potassium-Sparing Diuretics Patient teaching Do not take potassium supplements or eat potassium-rich foods Use caution with salt substitutes because most contain potassium Watch for signs of electrolyte imbalance (continues)

Potassium-Sparing Diuretics Special considerations Excessive potassium intake may cause hyperklemia Increases half-life of digoxin Reduces vascular response to norepinephrine Potentiates effects of other antihypertensive agents and diuretics

Osmotic Diuretics Increase osmolality of plasma, glomerular filtrate, and tubular fluid Increase excretion of water, sodium, chloride, and potassium

Uses for Osmotic Diuretics Prevention of acute renal failure during trauma or prolonged surgery Prevention of increased cerebral, cerebrospinal, or intraocular pressure during trauma, surgery, or disease Reduction of intraocular pressure in acute glaucoma

Osmotic Diuretics Contraindications Hypersensitivity Anuria Acute renal failure Cardiac dysfunction/CHF Intracranial hemorrhage Severe dehydration Severe pulmonary congestion (continues)

Osmotic Diuretics Adverse reactions Urinary retention Marked diuresis Thirst Dizziness Thrombophlebitis Hypo- or hypertension Dehydration Loss of hearing (continues)

Osmotic Diuretics Patient teaching Increase fluid intake to 2–3 liters per day Ice chips or hard candy will help relieve thirst Monitor weight (continues)

Osmotic Diuretics Special considerations Do not add whole blood to IV lines for mannitol Do not mix with any other drug or solution Mannitol crystallizes at low temps

Carbonic Anhydrase Inhibitors Promote reabsorption of sodium and bicarbonate from proximal tubules Block action of carbonic anhydrase, reversing hydration of carbon dioxide Increases excretion of water, sodium, and potassium (continues)

Carbonic Anhydrase Inhibitors Uses Adjunctive therapy of open-angle glaucoma Secondary glaucoma Preoperatively in close-angle glaucoma (continues)

Carbonic Anhydrase Inhibitors Contraindications Hypersensitivity Hepatic insufficiency Renal failure Severe pulmonary obstruction Adrenocortical insufficiency Hyperchloremic acidosis (continues)

Carbonic Anhydrase Inhibitors Adverse effects Anorexia, nausea, and vomiting Paresthesia Ataxia Tremor Tinnitus Headache Urinary frequency Renal calculi (continues)

Carbonic Anhydrase Inhibitors Patient teaching Increase fluids to 2–3 liters per day Eat potassium-rich foods Report any eye pain immediately Take medication in morning to avoid nocturia (continues)

Carbonic Anhydrase Inhibitors Special considerations Monitor weight Monitor I&O Potassium supplements may be needed Watch for signs of metabolic acidosis

UTI: Cystitis Painful inflammation of bladder Affects 10 million people per year In women, most commonly caused by E. coli In men, usually secondary to epididymitis, prostatitis, kidney stones, or STDs (continues)

UTI: Cystitis Symptoms Urgency Pyuria Chills and fever Dysuria Frequency Hematuria (continues)

UTI: Cystitis Diagnosis Symptoms Micro U/A Urine C&S Urine dipstick Gram stain (continues)

UTI: Cystitis Prevention for females Increase PO water intake Wipe front to back Urinate after intercourse Use condoms Avoid vaginal deodorants, etc. Wear cotton undergarments (continues)

UTI: Cystitis Treatment Antibiotics Antibacterials Antiseptics Analgesics

UTI: The Older Adult Kidneys lose mass with age Begin to decrease in size during 40s By 80s, kidneys have shrunk 30% Lose proportionate amount of function Risk of nephrotoxicity due to polypharmacy

UTI: The Child Higher risk of renal trauma due to less padding than adults Infants more prone to dehydration UTIs common in children Symptoms are age related Some children have no symptoms of UTI

Sulfonamides Urinary tract antibacterial Uses A drug of choice for treatment of acute, uncomplicated UTI Ear infection Meningococcal meningitis Inclusion conjunctivitis Bacteriostatic effect on both gram-positive and gram-negative bacteria (continues)

Sulfonamides Contraindications Adverse effects Hypersensitivity Infants under 2 months Pregnancy Lactation Group A beta-hemolytic strep Adverse effects Nausea and vomiting, diarrhea Anorexia, tinnitus (continues)

Sulfonamides Patient teaching May decrease effectiveness of oral contraceptives Take with 8 oz water Avoid direct sunlight Avoid aspirin or OTC vitamin C May discolor urine (continues)

Sulfonamides Special considerations May decrease digoxin absorption May potentiate sulfonylureas May potentiate anticoagulants May displace methotrexate from plasma protein-binding sites

Urinary Tract Antiseptics Not drugs of first choice for UTIs Uses For those who are intolerant or unresponsive to first-choice meds Control of chronic urinary infections Inhibit growth of bacteria

Urinary Tract Antiseptics Contraindications Hypersensitivity Anuria, renal insufficiency Severe dehydration Pregnancy or lactation Adverse effects Drug specific (continues)

Urinary Tract Antiseptics Patient teaching Increase PO fluids Take medicine until completely gone Proper hygiene Special considerations Obtain C&S prior to treatment Take medication at equal intervals Perform C&S after treatment

Miscellaneous Urologic Agents Used for disorders of lower urinary tract Stimulate, inhibit, or relax smooth muscle activity Help control involuntary contractions of bladder muscle Used to treat conditions such as bladder spasms, incontinence, and for pain management See Table 25-4 for specific drugs