1. 1 Copyright © 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. Urinary Medications

2. 2 Copyright © 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. Urinary Tract Infections (cont’d)  Lower UTI  Acute cystitis Frequently in females E. coli, Staph, Klebsiella, Pseudomonas Symptoms  Pain and burning on urination, frequency, urgency  Urethritis, prostatitis Same symptoms

3. 3 Copyright © 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. Urinary Analgesics  Phenazopyridine (Pyridium)  Dose is usually 100 mg PO BID X 7 – 10 days  Action Relieves pain, burning sensation, frequency, urgency  Side effects/adverse reactions GI upset Red-orange urine Blood dyscrasia Nephrotoxicity, hepatotoxicity

4. 4 Copyright © 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. Urinary Antispasmodics  Oxybutynin (Ditropan)  Usual dose is 5 mg PO BID or TID  Extended release dose is 5 – 10 mg daily  Action Direct action on smooth muscles to relieve spasms  Side effects/adverse reactions Drowsiness, tachycardia, dizziness, fainting, blurred vision, dry mouth, constipation  Caution Avoid in narrow-angle glaucoma, cardiac, renal, hepatic, prostate problems

5.  Nonprescription antiemetics  Antihistamines  Diphenhydramine (Benadryl)  Side effects (similar to anticholinergics):  Drowsiness, dry mouth, constipation, urinary retention, risk for falls  Bismuth subsalicylate (Pepto-Bismol)  Action  Acts directly on gastric mucosa to suppress vomiting  Will turn stools black  In diarrhea, it adsorbs and slows GI motility Antiemetics (cont’d)

6.  Serotonin receptor antagonist  Ondansetron (Zofran) – covered previously  Dose is 4 – 8 mg PO BID or q6h as needed for nausea  Action  Blocks serotonin receptors in the gut and afferent vagal nerve terminals in chemoreceptor zones in the brain  Use  Post-operative nausea, chemotherapy, general nausea  Side effects  Headache (most common side effect), diarrhea, dizziness, fatigue. If neurological changes occur, STOP THE DRUG!  Please treat the nausea before it progresses to vomiting!

7. Antiemetics (cont’d)  Glucocorticoids  Dexamethasone (Decadron) – covered already KNOW THE SIDE EFFECTS  Dose is 2 – 10 mg PO BID  Cannabinoids YOU WILL NOT BE TESTED ON THIS ONE BUT YOU NEED TO KNOW IT  Dronabinol (Marinol) This is synthetic THC; this is used in health care settings in place of medicinal marijuana  Side effects  Drowsiness, dizziness, dry mouth, impaired thinking, euphoria, mood changes, headaches, confusion, depersonalization, nightmares, incoordination, memory lapse, anxiety

8.  Nursing interventions  Provide mouth care.  Monitor vital signs, bowel sounds.  Monitor for dehydration.  Warn client not to consume alcohol when taking an antiemetic.  Warn pregnant clients to avoid antiemetics.  Avoid driving motor vehicles. Antiemetics (cont’d)

9. Diarrhea  Causes  Spoiled foods or excessively spicy foods  Bacteria (Escherichia coli), virus, toxins  Drug reactions  Fecal impaction, laxative abuse  Malabsorption disorders, bowel tumor, inflammatory bowel disease  Stress, anxiety

10. Antidiarrheals (cont’d) Loperamide (Imodium) Dose is usually 2 – 4 mg (1 to 2 capsules) four times a day as needed Do not exceed 8 capsules in a day – this can cause significant bowel injury

11. Antidiarrheals (cont’d)  Nursing interventions  Monitor BP, R.  Report more than 10 to 15 mm Hg decrease in BP.  Monitor frequency of bowel movements and bowel sounds.  Assess for evidence of dehydration.  Monitor electrolytes.  Avoid fried foods, milk, and sedatives.  If diarrhea persists after 48 hours, notify healthcare provider.

12. Constipation  Causes  Bowel obstruction, fecal impaction  Chronic laxative use, ignoring urge to defecate  Neurologic disorders  Side effect of drugs  Lack of exercise  Insufficient consumption of fiber and/or water

13. Constipation (cont’d)  Laxatives  Laxatives: soft stool  Cathartics: soft to watery stool with cramping  Purgatives: watery stool with cramping  Types of laxatives  Osmotic (saline)  Stimulant (irritants)  Bulk-forming  Emollient (stool softeners)

14. Stimulant (Irritant) Laxatives  Bisacodyl (Dulcolax)  Dose is 5 – 10 mg po daily as needed  Action  Increase peristalsis by irritating sensory nerve endings in intestinal mucosa  Results  Orally 6 to 12 hours, suppository (rectal) 15 to 60 minutes  Side effects  Abdominal cramps, weakness, reddish brown urine, diarrhea  There is also a bisocodyl that is a softener as well

15. Emollients (Stool Softeners)  Docusate (Colace)  Dose is 100 mg PO BID  Action  Lowers surface tension  Promotes water accumulation in intestine  Emulsifies and lubricates feces for easier passage  Used whenever someone is on opioids  Use with caution around children. It looks like a jelly bean and children have eaten them!

16. Emollients (Stool Softeners) (cont’d)  Use  Prevent constipation  Reduce straining post surgery or myocardial infarction  Side effects  Abdominal cramping, nausea, vomiting, diarrhea