1. Urinary System Disorders Calculating Doses Chapter 28 Chapter 9

2.  Made up of Organs which form & excrete urine (see Fig.28-1 on pg 585)  (2) Kidneys  (2) Ureters  Bladder  Urethra

3.  Anorexia, Nausea, Vomiting  Fatigue, Lethargy, Malaise  Dysuria, urgency, frequency, hematuria  Pain in lower-back (kidney area), flank (sides)  Fever, disorientation

4.  Drying of secretions  Drowsiness, dizziness, sedation  Rash, hives, ‘urticaria’  GI effects (nausea, vomiting, diarrhea)  Headache  Discoloration of urine (see Table 28-1, p.585)

5.  Reference Textbook Chart page 584  Diuretics – modify kidney function  Electrolytes/Fluids “replacement therapy” (see Table 28-2 page-586) examples …  Sodium  Potassium  Calcium  Magnesium … more detail, next slide

6. Electrolyte levelsymptoms SODIUM high Edema, thirst, high temp, flushing lowStomach-cramps, vomiting, diarrhea POTASSIUM high Abdominal-distension, diarrhea lowParalysis, weakness, muscle function CALCIUM high Anorexia, nausea, coma, weakness lowMuscle-cramp/twitching, numbness/tingling of fingers, toes, lips MAGNESIUM high Flushing, sweating, low temp, cardiac depression lowAbnormal heart rhythms, neurotoxicity

7.  Most common bacterial infection in the U.S.  10 – 20% of females have a UTI during lifetime  E.Coli causes ~90 % of all cultured UTI’s  Upper UTI (kidneys/ureters) - symptoms include> *lower-back/flank pain *fever *headache *nausea/vomiting  Lower UTI (bladder/urethra) - symptoms include> *frequency *urgency *dysuria *hematuria *oliguria *incontinence

8.  Anything that results in urine being ‘held’ in the bladder (more common in females)  If you gotta go … you BETTER go!  Dietary factors – certain foods (see Box 28- 1 p 587)  Enlarged Prostate (males) – constricts the urethra, causing urine to be ‘retained’ in the bladder  Female ‘Plumbing’ – due to the short length of urethra, and the proximity of the urethra, vagina, and the anus

9.  Anti-Bacterials (sulfa-drugs, trimethoprim) kill bacteria, in the urine and systemically  Anti-septics (Macrobid, methenamine) antibiotic activity ONLY in the urine !  Analgesics (Pyridium, AZO-standard otc) by topical and local anesthesia on the lining of the urinary-tract Study --- Table 28-3 on page 589

10.  Sulfonamides (sulfa-drugs) – take on empty-stomach with a full glass of water  Drink plenty of water throughout the day (eight to ten 8-oz glasses if on a sulfa- drug)  If taking sulfa-drug, avoid prolonged exposure to sunlight, unless using a good sunscreen !  Complete entire course of UTI drug treatment … even if symptoms improve

11.  Pyridium (phenazopyridine) – changes urine color to orange-red color! May stain clothing  Cranberry juice, Vit-C, prunes make urine more acidic, making antiseptics more effective  Carbonated drinks, citrus fruits make urine less acidic, making antiseptics less effective !  FEVER after starting the drugs may be a sign of a drug-reaction, not a UTI-symptom

12.  small, spastic-like bladder (‘tiny-tank’) that empties automatically when filled to a certain point  Tofranil (imipramine) – anti-depressant  DDAVP (desmopressin) – an anti- diuretic that actually increases the re-absorption of water ◦ available as a nasal spray or tablet

14.  Oral tablets, capsules  Oral liquids  We will be able to calculate the dose a patient should receive based on the drug order

15.  Remember The Five Steps 1. What are we converting to & from? 2. What is our conversion factor? 3. Set up equation. Start with what you’re given. 4. Solve. Cancel units. 5. Review – does our answer make sense?

16.  Do not open or divide capsules  Only break or divide scored tablets  Do not crush or divide enteric coated tablets  Do not crush or divide extended or sustained release products unless scored  Check the “Do not crush” list at your facility

17.  Check out the Grains! and Micrograms! Worksheet in Doc Sharing  Grains are the apothecary system of weight measurement  1 grain = 60 mg  Written with gr first and followed quantity ◦ Either a Roman numeral or fraction  The metric and household systems have the quantity followed by the unit

18.  First step is to convert Roman numeral or fraction into a metric number gr ¼ = 0.25 grains gr ss = ½ grains = 0.5 grains gr V = 5 grains Next step is to use conversion factor to convert to mg Remember: 1 grain = 60mg 0.25 gr x 60mg/1gr = ___ gr 0.5 gr x 60mg/1gr = ___ 5 gr x 60mg/1gr = ___

19.  Dr. Stoneage ordered: gr 1/100  On hand: mg ◦ What do we do first? ◦ What is our conversion factor?

20.  Dr. Feelgood ordered: gr 1/100  On hand: mg ◦ First step is to convert gr 1/100 into a metric number  gr 1/100 = 0.01 grains ◦ Our conversion factor is 1 grain = 60mg  0.01 gr x 60mg/1 = 0.6mg

21.  Dr. Worksheetzhelpme ordered: gr ss  On hand: 250mg/5ml  How many ml do we need?  First step?  Second step?  Third step?

22.  Dr. Studeehard ordered: gr ss  On hand: 250mg/5ml  How many ml do we need?  1. gr ss = gr ½ = 0.5 grains  2. 0.5 grains x 60mg/1 grain = 30 mg  3. 30mg x 5ml/250mg = ?

23.  Dr. Mathrulz ordered: gr 1/15  On hand: 5mg/10ml  How many ml do we need? ◦ First step? ◦ Second step? ◦ Third step?

24.  Dr. Urthebest ordered: gr 1/15  On hand: 5mg/10ml  How many ml do we need? ◦ 1. gr 1/15 = 0.066 or 0.067 grains ◦ 2. 0.067 gr x 60mg/1 gr = 3.99 or 4 mg ◦ 4mg x 10ml/5mg =8 ml

25.  Dr. Skoolizfun ordered: Tylenol gr X q8 hr  On hand: Tylenol liquid 160mg/tsp  What is the dose in ml? ◦ 1. gr x = 10 grains ◦ 2. 10gr x 60mg/1gr = 600mg ◦ 3. Also need to convert our conversion factor:  1 tsp = 5ml so 160mg/tsp = 160mg/5ml ◦ 4. 600mg x 5ml/160mg = 18.75 ml

26.  Dr. Knowitall ordered: 250 mcg  On hand: 0.125mg tablets  How many tablets do we need?  What is our first step?  How many micrograms in 1mg?

27.  Dr. Straightas ordered: 250 mcg  On hand: 0.125mg tablets  How many tablets do we need? ◦ 1. 250mcg x 1mg/1000mcg = 0.25mg ◦ 2. 0.25mg x 1tab/0.125mg = 2 tablets  What units cancelled in step 2?

28.  Dr. Useyourquizreview ordered 1g of metformin. We have 500 mg tablets. ◦ 1. 1g x 1000mg/g = 1000mg ◦ 2. 1000mg x 1 tab/500mg = 2 tablets

29.  Dr. Ucandoit ordered keeps changing our patient’s dose. We have azithromycin suspension 100mg/5ml in a 30 ml bottle. ◦ If the patient is to receive 200mg, what is the dose in ml?

30.  Dr. Ucandoit ordered keeps changing our patient’s dose. We have azithromycin suspension 100mg/5ml in a 30 ml bottle. ◦ How many teaspoons is 200mg?  200mg x 5ml/100mg = 10ml  10ml x 1tsp/5ml = 2 tsp

31.  Dr. Ucandoit ordered keeps changing our patient’s dose. We have azithromycin suspension 100mg/5ml in a 30 ml bottle. ◦ If the patient takes 200mg q12h, how many days should the bottle last?  We already calculated 10mg per dose:  10ml x 2 doses/day = 20ml  30ml x 1day/20ml = 1.5 days or 1 and ½ days

32.  Dr. Ucandoit ordered keeps changing our patient’s dose. We have azithromycin suspension 100mg/5ml in a 30 ml bottle.  If the patient takes 100mg daily, how many doses are provided in the bottle?  100mg x 5ml/100mg = 5ml per dose  30ml x 1 dose/5ml = 6 days

33. Happy Studying!