1. Drugs Used to Treat Disorders of the Urinary System Chapter 42 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

2. Slide 2 Chapter 42 Lesson 42.1 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

3. Slide 3 Objectives Develop a health teaching plan for an individual who has repeated urinary tract infections Analyze Table 42-1 and identify specific portions of a urinalysis report that would indicate proteinuria, dehydration, infection, or renal disease Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

4. Slide 4 Urinary Tract Infections (UTIs) 11 million people treated every year Second most common cause of death from infection Urinalysis results  White and cloudy – infection  Dark yellow to amber – dehydration  Foul smell – infection  Foamy or frothy – proteins present  Casts – dehydration Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

5. Slide 5 Causes of UTIs Gram-negative aerobic bacilli from the GI tract  Escherichia coli Other organisms  Staphylococcus saprophyticus  Klebsiella pneumoniae  Enterobacter  Proteus mirabilis  Pseudomonas aeruginosa Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

6. Patient Education for Repeated UTIs Determine ways to reduce frequency of infection  Personal hygiene practices  Pattern of urination  Pattern of pain  Medication history  Maintaining adequate fluid intake Slide 6 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

7. Slide 7 Chapter 42 Lesson 42.2 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

8. Slide 8 Objectives Identify essential components involved in planning patient education that will enhance compliance with the treatment regimen Explain the major action and effects of drugs used to treat disorders of the urinary tract Identify the symptoms, treatment, and medication used for overactive bladder syndrome Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

9. Objectives (cont’d) Identify important nursing assessments and interventions associated with the drug therapy and treatment of diseases of the urinary system Identify baseline data the nurse should collect on a continuous basis for comparison and evaluation of drug effectiveness Slide 9 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

10. Slide 10 Objectives (cont’d) Prepare a chart of antimicrobial agents used to treat urinary tract infections. Give the drug names, the organisms treated, and special considerations (e.g., the need for acidic urine, changes in urine color, and effect on urine tests). Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

11. Slide 11 Baseline Data Collection Urine frequency, amount, odor, color Urine acidity – check pH Burning or pain on urination Vital signs Skin color History of UTIs History of GI complaints Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

12. Drug Class: Fosfomycin Antibiotics Drug: fosfomycin (Monurol) Actions  Inhibit bacterial cell wall synthesis, reduce bacteria’s adherence to the urinary tract Uses  Single dose treatment for UTI Common adverse effects  Nausea, diarrhea, abdominal cramps, flatulence Serious adverse effects  Perineal burning, dysuria Slide 12 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

13. Drug Class: Quinolone Antibiotics Actions  Inhibit DNA gyrase enzymes needed for DNA replication in bacteria Uses  Treat recurrent UTIs caused by E. coli, P. mirabilis, and others Common adverse effects  Nausea, vomiting, anorexia, abdominal cramps, flatulence, drowsiness, visual disturbance, photosensitivity Serious adverse effects  Hematuria, perineal burning, urticaria, hives, headache, dizziness, photophobia, tinnitus Slide 13 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

14. Other Urinary Antibacterial Agents Drug: methenamine mandelate (Mandelamine) Actions  Form formaldehyde in presence of acidic urine, suppressing growth of bacteria Uses  Treat chronic, recurrent UTIs Common adverse effects  Nausea, vomiting, belching Serious adverse effects  Hives, pruritus, rash; bladder irritation, dysuria, frequency Slide 14 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

15. Other Urinary Antibacterial Agents (cont’d) Drug: nitrofurantoin (Furadantin, Macrodantin) Actions  Interfere with several bacterial enzyme systems Uses  Treat UTIs Common adverse effects  Nausea, vomiting, anorexia, urine discoloration Serious adverse effects  Dyspnea, chills, fever, rash, pruritus, neuropathies, secondary infection Slide 15 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

16. Drug Class: Anticholinergic Agents for Overactive Bladder Syndrome Actions  Block the cholinergic receptors of the bladder, causing relaxation Uses  Reduce urgency and frequency of bladder contractions in patients with overactive bladder (OAB) Common adverse effects  Dry mouth, urinary hesitancy, retention, constipation, bloating, blurred vision Serious adverse effects  Intensification of any of the above symptoms Slide 16 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

17. Miscellaneous Urinary Agents Drug: bethanechol chloride (Urecholine) Actions  Stimulation of the parasympathetic nerve that causes contraction in the bladder Uses  Restore bladder tone and urination in nonobstructive urinary retention Common adverse effects  Flushing of skin, headache Serious adverse effects  Nausea, vomiting, sweating, colicky pain, abdominal cramps, diarrhea, belching, involuntary defecation Slide 17 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

18. Miscellaneous Urinary Agents (cont’d) Drug: neostigmine (Prostigmin) Actions  Increase tone of bladder muscles by blocking cholinesterase, preventing the breakdown of acetylcholine Uses  Prevent and treat postoperative bladder distention and retention Therapeutic outcome  Prevention or treatment of postoperative or postdelivery urinary retention Slide 18 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

19. Miscellaneous Urinary Agents (cont’d) Drug: phenazopyridine hydrochloride (Pyridium) Actions  Produce local anesthetic effect on ureters and bladder Uses  Relieve burning, pain, urgency, frequency associated with UTIs Common adverse effects  Reddish orange urine color Serious adverse effects  Yellow sclera or skin Slide 19 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.