1. Introduction to Clinical Pharmacology Chapter 48 Urinary Tract Anti-Infectives and Other Urinary Drugs

2. Anti-Infectives: Actions and Uses
Used for UTIs caused by susceptible bacterial microorganisms
Rapid excretion rate of drugs
High concentration in urine; act by interfering with bacterial multiplication in urine

3. Anti-Infectives: Adverse Reactions
Gastrointestinal disturbances:
Anorexia; nausea; vomiting; diarrhea
Abdominal pain or stomatitis
Generalized body system reactions:
Drowsiness; headache; blurred vision; peripheral neuropathy
Rash; pruritus; photosensitivity reactions; leg cramps

4. Anti-Infectives: Contraindications and Precautions
Contraindicated in patients:
With hypersensitivity to the drugs
During pregnancy and lactation
Used cautiously in patients:
With renal or hepatic impairment

5. Interactions: Anti-Infectives
Nalidixic acid and sulfamethoxazole
Interactant drug
Effect of interaction
Oral anticoagulants
Increased risk for bleeding
Nitrofurantoin
Magnesium trisilicate or magaldrate
Decreased absorption of anti-infective
Anticholinergics
Delay in gastric emptying, thereby increasing the absorption of nitrofurantoin

6. Interactions: Anti-Infectives (cont.)
Fosfomycin
Interactant drug
Effect of interaction
Metoclopramide
Lowers plasma concentration and urinary tract excretion of fosfomycin

7. Nursing Process: Assessment
Preadministration assessment:
Question the patient regarding the symptoms of infection before instituting therapy
Record color, appearance of urine
Record vital signs
Assess and document pain, urinary frequency, bladder distension, other symptoms associated with urinary system

8. Nursing Process: Assessment (cont.)
Ongoing assessment:
Monitor vital signs every 4 hours or as ordered by the primary health care provider
Monitor patient’s response to therapy daily
Monitor patient for reduction in symptoms identified in preadministration assessment

9. Nursing Process: Diagnosis
Impaired Urinary Elimination related to discomfort of urinary tract infection
Ineffective Breathing Pattern related to adverse reaction to drug

10. Nursing Process: Planning
Expected outcomes:
Optimal response to drug therapy
Support patient needs related to management of adverse reactions
Understanding of and compliance with prescribed therapeutic regimen

11. Nursing Process: Implementation
Promoting an optimal response to therapy:
Give urinary tract anti-infectives with food to prevent GI upset
Administer drug immediately after dissolving it in water
Note visual disturbances

12. Nursing Process: Implementation (cont.)
Monitoring and managing patient needs
Impaired urinary elimination:
Encourage patient to drink at least mL of fluid daily to dilute urine and decrease pain on voiding
Offer fluids, preferably water, at hourly intervals
Monitor fluid intake and urine output

13. Nursing Process: Implementation (cont.)
Monitoring and managing patient needs (cont.)
Ineffective breathing pattern:
Monitor for signs and symptoms of acute pulmonary reaction:
Dyspnea, chest pain, cough, fever, chills
Monitor for signs of chronic pulmonary reaction

14. Nursing Process: Implementation (cont.)
Educating the patient and family
Anti-infectives:
Explain the importance of taking the drug at prescribed time intervals and as directed
Explain the possible adverse effects and necessary interventions required
Emphasize the importance of avoiding alcoholic beverages and nonprescription drugs

15. Nursing Process: Implementation (cont.)
Educating the patient and family (cont.)
Anti-infectives (cont.):
Explain the importance of taking nitrofurantoin and nalidixic acid with food or milk
Explain the importance of avoiding excessive intake of citrus products, milk, and milk products when taking methenamine

16. Nursing Process: Implementation (cont.)
Educating the patient and family (cont.)
Anti-infectives (cont.):
Emphasize the importance of taking fosfomycin after mixing and along with food
Antispasmodic and other drugs:
Explain interventions to prevent dry mouth and importance of frequent mouth care

17. Nursing Process: Evaluation
Therapeutic effect is achieved
Adverse reactions are identified, reported, and managed successfully
Patient and family demonstrate understanding of drug regimen
Patient verbalizes the importance of complying with prescribed therapeutic regimen

18. Question Is the following statement true or false?
Urinary tract infections are caused by pathogenic microorganisms of one or more structures of the urinary tract.

19. Answer
True
Urinary tract infections are caused by pathogenic microorganisms of one or more structures of the urinary tract.

20. Question Is the following statement true or false?
Because the female urethra is considerably shorter than the male urethra, women are affected by UTIs much more frequently than men.

21. Answer
True
Because the female urethra is considerably shorter than the male urethra, women are affected by UTIs much more frequently than men. The most common structure affected is the bladder.