1. Chapter 15 Urinary System Drugs

2. 2 Diuretics Increase urine excretion Categories –Thiazides –Loop diuretics –Potassium-sparing diuretics –Osmotic agents

3. 3 Thiazides Most frequently used Increase secretion of water, sodium, chloride, and potassium Example –Hydrochlorothiazide Uses –Edema, heart failure, cirrhosis

4. 4 Thiazides Side effects –Dehydration –Fluid/Electrolyte imbalance –Hypokalemia (K) Arrhythmia, muscle weakness, spasms, fatigue/lethargy –Hypochloremia (Cl) –Postural Hypotension

5. 5 Patient Education Diet considerations –Include high K foods (citrus, bananas) –Need for K supplements When to notify physician –Sx? Administer in the morning –Prevents alteration in sleep pattern Rising slowly to prevent postural hypotension

6. 6 Patient Education Limit alcohol intake –Why?

7. 7 Loop Diuretics Site of action: Loop of Henle –Inhibits Na and Cl reabsorption More effective and rapid than thiazides Example –Furosemide (Lasix) –Bumetanide (Bumex) Uses –Edema, renal/hepatic dz, CHF, Pulm. Edema, Ascites, cirrhosis, HTN (if thiazides are ineffective)

8. 8 Loop Diuretics Side effects –Dehydration –Fluid/Electrolyte imbalance –Hypokalemia (K) Arrhythmia, muscle weakness, spasms, fatigue/lethargy –Hypochloremia (Cl) –Postural Hypotension Contraindications or caution –Cross allergy to sulfa

9. 9 Patient Education Diet Notification of side effects Take with food before 6 P.M. Rising slowly Avoid alcohol Report sudden changes in output

10. 10 Patient Education Report abrupt or severe weight loss Limit exposure to sunlight (furosemide) - photosensitivity Do not take other medications or OTC drugs without physician consultation

11. 11 Potassium-Sparing Diuretics Counteract loss of potassium, glucose, and uric acid associated with thiazides Rx’d used when K depletion can be too dangerous. Drug of choice in cirrhosis Example –Spironolactone (Aldactone) –Triamterene (Dyrenium)

12. 12 Potassium-Sparing Diuretics Side effects –HYPERkalemia Cardiac Arrhythmias –Dehydration –Fluid/Electrolyte imbalance –Postural Hypotension

13. 13 Patient Education Avoid potassium-rich foods and salt substitutes Report excess dehydration, GI symptoms (N/V/D) and persistent HA and confusion Monitor weight and report sudden, excessive loss Rising slowly

14. 14 Osmotic Agents (Parental Only) Used to reduce intracranial or intraocular pressure Other uses –Renal Failure Example –Mannitol and urea

15. 15 Osmotic Agents Side effects –Fluid/Electrolyte imbalance –CNS Sx’s: HA, Vertigo, Confusion, N/V –Hypotention Extreme caution Interactions

16. 16 Patient Education Report side effects to physician Reassure patient that they will be closely monitored Frequent blood work

17. 17 Medications for Gout Gout –A form of arthritis in which uric acid crystals are deposited in and around joints, causing inflammation and pn.

18. 18 Medications for Gout Lower uric acid levels Medications 1.Uricosuric agents Ex: probenecid (Benemid) 2. Allopurinol

19. 19 Uricosuric Agents When used –Tx for chronic gout (no analgesic or anti- inflammatory effect) How they work –Act on kidney by blocking reabsorption and promoting urinary excretion of uric acid Side effects –Kidney stones if fluid volume not maintained

20. 20 Patient Education Increase fluid intake Take meds after meals Stop meds and report rash immediately Avoid alcohol Avoid other meds unless prescribed by physician

21. 21 allourinol (Zyloprim) Used for chronic gout Decreases serum and urine levels of uric acid No analgesic/anti-inflammatory effect REMEMBER FROM CHAPTER 21: –Tx for acute gout is colchicine

22. 22 Antispasmodics (anti-cholinergic effect) Block parasympathathetic nerve When used –Reduce the strength and frequency of contractions of the bladder Pro-Banthine –Increases the bladder capacity capacity with neurogenic bladders, preventing incontinence Cytospaz, Levsin –Other chemically similar drugs (Detrol/Ditropan) are used for relief of sx’s of frequency, urgency, nocturia and incontinence

23. 23 Patient Education Report troublesome side effects –Drowsiness –Urinary retension/Constipation Caution when driving or operating machinery Avoid alcohol or other sedatives

24. 24 Cholinergics Stimulate parasympathetic nerve When used –Need to contract bladder –Non-obstructive urinary retention Post-Op/Postpartum Called “pharmacological catherization” Side effects –Sweating/Salivation, Urinary Urgency

25. 25 Oral Urinary Analgesics When used –Need for local anesthetic effect for urinary tract mucosa –Relieve pn, burning associated w/ cystitis –Procedures (cytoscopy/surgery) Side effects –Orange-Red Urine

26. 26 Patient Education Urine will stain orange-red Only temporarily effective against discomfort –Not effective for infection Diagnosis and treatment of underlying treatment required

27. 27 Benign Prostatic Hypertrophy (BPH) Anti-androgens –Action Reduce size of prostate and associated urinary obstruction Ex: Proscar, Avodart –Side effects Impotence, decreased libido, gynecomastia –Cautions Alpha-blockers –Action Relaxes bladder neck and prostate, causing them to relax Ex: Flomax, Cardura –Side effects Dizziness, HA, Nasal Congestion

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29. 29 Drug List Please Indicate Chapter and # of drug 1.(probenecid / colchicine) 2.(allopurinol) 3.Detrol 4.Ditropan 5.(bethanechol) 6.Pyridium 7.Proscar 8.Cardura 9.Flowmax