Upload
laura-gosnell
View
499
Download
0
Tags:
Embed Size (px)
Citation preview
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Introduction to Clinical Pharmacology
Chapter 49-Urinary Tract Anti-infectives, Antispasmodics, and Other
Urinary Drugs
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Anti-infectives: Actions and Uses Anti-infectives: Actions and Uses
• Used for UTIs caused by susceptible bacterial microorganisms
• Rapid excretion rate of drugs
• High concentration in urine; Acts by interfering with bacterial multiplication in urine
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Antispasmodics: Actions and UsesAntispasmodics: Actions and Uses
• Cholinergic blocking drugs: Inhibits bladder contractions, delays urge to void
• Relieves symptoms of dysuria, urinary urgency, nocturia, suprapubic pain and frequency, urge incontinence
• Treats bladder instability caused by neurogenic bladder
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Anti-infectives: Adverse Reactions 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
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Antispasmodics: Adverse ReactionsAntispasmodics: Adverse Reactions
• Dry mouth, drowsiness, constipation or diarrhea, decreased production of tears, decreased sweating, GI disturbances, dim vision, urinary hesitancy
• Nausea and vomiting, nervousness, vertigo, headache, rash and mental confusion
• Discolors urine
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Anti-infectives: Contraindications and Precautions 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
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Antispasmodics: Contraindications and PrecautionsAntispasmodics: Contraindications and Precautions• Contraindicated in patients:
– With hypersensitivity to drug, glaucoma
• Used cautiously in patients:
– With GI infections, benign prostatic hypertrophy, urinary retention, hyperthyroidism, hepatic or renal disease, hypertension
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Interactions: Anti-infectives Interactions: Anti-infectives
•Nalidixic acid and Sulfamethoxazole
Interactant Drug Effect of Interaction Oral anticoagulants Increased risk for bleeding
•Nitrofurantoin
Interactant Drug Effect of Interaction
Magnesium trisilicate or magaldrate
Decreased absorption of anti-infective
Anticholinergics Delay in gastric emptying thereby increasing the absorption of nitrofurantoin
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Interactions: Anti-infectives (cont’d)Interactions: Anti-infectives (cont’d)
•Fosfomycin
Interactant Drug Effect of Interaction
Metoclopramide Lowers plasma concentration and urinary tract excretion of fosfomycin
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Interactions: Antispasmodics Interactions: Antispasmodics
Interactant Drug Effect of InteractionAntibiotics/antifungals Decreased effectiveness of
anti-infective drug
Meperidine, flurazepam, phenothiazines
Increased effect of the antispasmodic
Tricyclic antidepressants Increased effect of the antispasmodic
Haloperidol Decreased effectiveness of the antipsychotic drug
Digoxin Increased serum levels of digoxin
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process: Assessment 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
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process: AssessmentNursing Process: Assessment• 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
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process: PlanningNursing 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
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process: ImplementationNursing 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
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process: ImplementationNursing Process: Implementation
• Monitoring and managing patient needs
– Impaired urinary elimination:
•Encourage to drink at least 2000 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
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process: ImplementationNursing Process: Implementation• Monitoring and managing patient needs
(cont’d)
– 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
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process: ImplementationNursing Process: Implementation• Monitoring and managing patient needs
(cont’d)
– Patient needs when taking antispasmodic drugs
•Encourage fluids; Provide high-fiber diet; Provide time for ambulation, exercise; Provide frequent mouth care
•Inform adverse effects: Reddish-orange discoloration of urine; Discoloration of contact lens
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process: ImplementationNursing Process: Implementation• 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 drug
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process: ImplementationNursing Process: Implementation
• Educating the patient and family
– Anti-infectives (cont’d):
•Explain the importance of taking Nitrofurantoin and Nalidixic acid with food or milk
•Explain the importance of avoiding excessive intake of citrus products, milk, milk products when taking methenamine
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process: ImplementationNursing Process: Implementation
• Educating the patient and family
– Anti-infectives (cont’d):
•Emphasize taking Fosfomycin after mixing and along with food
– Antispasmodic and other drugs:
•Explain interventions to prevent dry mouth and importance of frequent mouth care
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process: Implementation Nursing Process: Implementation • Educating the patient and family
– Antispasmodic and other drugs:
•Emphasize avoiding activities that require full mental alertness
•Explain the importance of consuming plenty of fluids and high-fiber diet
•Explain the necessity of contacting the primary health care provider immediately if symptoms occur
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process: EvaluationNursing 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
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
End of Presentation