1. Chapter 30 Drugs used to treat urinary system disorders

2. 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

3. **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**

4. 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

5. 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

6. 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

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

8. 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 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

9. 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

10. 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 mg 4x/day for 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

11. 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

12. 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