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Urinary System Disorders Calculating Doses Chapter 28 Chapter 9 Made up of Organs which form & excrete urine (see Fig.28-1 on pg 585) (2) Kidneys (2) Ureters Bladder Urethra Anorexia, Nausea, Vomiting Fatigue, Lethargy, Malaise Dysuria, urgency, frequency, hematuria Pain in lower-back (kidney area), flank (sides) Fever, disorientation Drying of secretions Drowsiness, dizziness, sedation Rash, hives, ‘urticaria’ GI effects (nausea, vomiting, diarrhea) Headache Discoloration of urine (see Table 28-1, p.585) Reference Textbook Chart page 584 Diuretics – modify kidney function Electrolytes/Fluids “replacement therapy” (see Table 28-2 page-586) examples … Sodium Potassium Calcium Magnesium slide … more detail, next Electrolyte level symptoms SODIUM high Edema, thirst, high temp, flushing low Stomach-cramps, vomiting, diarrhea high Abdominal-distension, diarrhea low Paralysis, weakness, muscle function high Anorexia, nausea, coma, weakness low Muscle-cramp/twitching, numbness/tingling of fingers, toes, lips high Flushing, sweating, low temp, cardiac depression low Abnormal heart rhythms, neurotoxicity POTASSIUM CALCIUM MAGNESIUM 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 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 281 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 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 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 sulfadrug) 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 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 small, spastic-like bladder (‘tiny-tank’) that empties automatically when filled to a certain point Tofranil (imipramine) – anti-depressant DDAVP (desmopressin) – an antidiuretic that actually increases the re-absorption of water ◦ available as a nasal spray or tablet Oral tablets, capsules Oral liquids We will be able to calculate the dose a patient should receive based on the drug order 1. 2. 3. 4. 5. Remember The Five Steps What are we converting to & from? What is our conversion factor? Set up equation. Start with what you’re given. Solve. Cancel units. Review – does our answer make sense? 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 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 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 = ___ Dr. Stoneage ordered: gr 1/100 On hand: mg ◦ What do we do first? ◦ What is our conversion factor? 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 Dr. Worksheetzhelpme ordered: gr ss On hand: 250mg/5ml How many ml do we need? First step? Second step? Third step? 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 = ? Dr. Mathrulz ordered: gr 1/15 On hand: 5mg/10ml How many ml do we need? ◦ First step? ◦ Second step? ◦ Third step? 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 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 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? 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? 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 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? 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 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 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 Happy Studying!