URINARY TRACT DISORDER DRUGS Upper UTI: Pyelophritis Lower UTI: Cystitis, urethritis, or postatitis (C&S and UA PRIOR

TO TX!) Acute Cystitis: Demographics & S/S I) Urinary Antiseptics/Antiinfectives & Antibiotics A) Nitrofurantoin (Macrodantin) 1) Bacteriostatic AND bacteriocidal (dose dependent) 2) Gram +/3) Indications: Acute & Chronic UTI 4) Adverse reaction: (a) Long time use: RENAL FAILURE (b) Dyspnea (c) Chest pain (d) Cough (e) Fever/chills 5) Nsg. considerations: (a) Peripheral neuropathy (b) Dec. absorption with ANTACIDS (c) Accumulates in serum with urinary dysfunctionits not excreting so it is staying in the body and providing an environment for microorganisms to grow. B) Methenamine (Hiprex) 1) Bactericidal when pH <5.5 2) Gram +/3) Indications of use: Chronic UTI 4) Nsg. considerations: (a) Crystalluria (increase fluids!) with sulfonamides (which are also prescribed for UTIs) (b) Avoid alkaline foods II) Urinary Analgesics A) Pyridium (Phenazopridine) 1) Cinitest: Alters the result 2) S/E & Adverse Rxn: (a) GI (b) Hemolytic anemia (c) Blood dyscrasias (d) Nephrotoxicity (e) Hepatoxicity (f) ***REPORT: N/V/D*** 3) Teaching: (a) Reddish-orange urnine from dye (like Rifampin) (i) May stain contact lenses so pt should wear glasses while on this (ii) Actual UA has to be done because urine will stain dipsticks B) Urinary Analgesic: Azo dye 1) Relieves SYMPTOMS: pain, burning, frequency, urgency III) Urinary Stimulants A) Parasympathomimetics B) Urecholine 1) Inc. bladder tone 2) Produces contraction that stimulates micturition (a.k.a. urination) IV) Urinary Antispasmotics/Antimuscarinics A) Relieve urinary tract spasms direct action on urinary tract smooth muscles B) DMSO, oxybutynin & flavoxate C) Contraindications: GI obstruction; Glaucoma D) S/E: 1) Inc. HR 2) Dizziness 3) GI distention 4) Constipation E) Teaching: 1) Report:

(a) Retention (b) Severe dizziness (c) Blurred vision (d) Palpitations (e) Confusion 2) Avoid prolonged heat exposure (to prevent HR from going up) V) Probenecid & Abx A) When taken with Aspirin & Amoxicillin or Cloxacillin it leads to serum antibacterial levels that are increased B) When adminstered with Cefazolin or Cefaclor it leads to decreased antibiotics excretion which leads to accumulation (toxicity) C) When administered with Ciprofoxacin it leads to increased Cipro effects VI) ADVERSE effects of Antibacterials A) Allergy or hypersensitivity reactionusually within 20 minutes 1) Mild (use antihistimine): (a) Rash (b) Pruritis (c) Hives 2) Severe (use bronchodilator & antihistimine) (a) Laryngeal edema (b) Bronchospasms (c) Cardiac arrest B) Superinfection: 1) Vaginitis 2) C. diff 3) Black furry tongue C) Organ toxicity 1) Liver 2) Kidneys VII) Peak and Trough Review A) Peak 1) Draw at peak (as listed in drug book) 2) Indicates rate of absorption B) Trough 1) Drawn minutes (up to 30 minutes) before drug is administered 2) Indicates rate of drug elimination 3) More important to indicate effectiveness of drug C) E.g., Gentamicin: 1) Peak: 5-10 2) Toxic peak: >12 3) Trough: <2 4) Toxic trough: >2 5) Peak is 30 minutes after IV administration VIII) Liver & Kidney Tests A) CLcrmost accurate lab test in determining renal function B) Creatininespecific indicator (if it is high) of renal function C) BUNdetermines renal functioning or dehydration (high levels) D) LFTs 1) ALT 2) AST 3) Alk Phos IX) Physcial Assessment & Nursing Process: A) Physical assessment: 1) Describe wound/surgical site 2) Monitor