Transcript Drug List Please Indicate Chapter and # of drug

Chapter 15
Urinary System Drugs
Diuretics
• Increase urine excretion
• Categories
– Thiazides
– Loop diuretics
– Potassium-sparing diuretics
– Osmotic agents
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Thiazides
• Most frequently used
• Increase secretion of water, sodium,
chloride, and potassium
• Example
– Hydrochlorothiazide
• Uses
– Edema, heart failure, cirrhosis
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Thiazides
• Side effects
– Dehydration
– Fluid/Electrolyte imbalance
– Hypokalemia (K)
• Arrhythmia, muscle weakness, spasms,
fatigue/lethargy
– Hypochloremia (Cl)
– Postural Hypotension
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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
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Patient Education
• Limit alcohol intake
– Why?
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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)
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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
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Patient Education
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Diet
Notification of side effects
Take with food before 6 P.M.
Rising slowly
Avoid alcohol
Report sudden changes in output
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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
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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)
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Potassium-Sparing Diuretics
• Side effects
– HYPERkalemia
• Cardiac Arrhythmias
– Dehydration
– Fluid/Electrolyte imbalance
– Postural Hypotension
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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
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Osmotic Agents
(Parental Only)
• Used to reduce intracranial or
intraocular pressure
• Other uses
– Renal Failure
• Example
– Mannitol and urea
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Osmotic Agents
• Side effects
– Fluid/Electrolyte imbalance
– CNS Sx’s: HA, Vertigo, Confusion, N/V
– Hypotention
• Extreme caution
• Interactions
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Patient Education
• Report side effects to physician
• Reassure patient that they will be
closely monitored
• Frequent blood work
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• Gout
Medications for Gout
– A form of arthritis in
which uric acid
crystals are deposited
in and around joints,
causing inflammation
and pn.
QuickTime™ and a
TIFF (Uncompressed) decompressor
are needed to see this picture.
QuickTime™ and a
TIFF (Uncompressed) decompressor
are needed to see this picture.
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Medications for Gout
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•
Lower uric acid levels
Medications
1. Uricosuric agents
Ex: probenecid (Benemid)
2. Allopurinol
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Uricosuric Agents
• When used
– Tx for chronic gout (no analgesic or antiinflammatory 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
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Patient Education
• Increase fluid intake
• Take meds after meals
• Stop meds and report rash
immediately
• Avoid alcohol
• Avoid other meds unless prescribed
by physician
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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
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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
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Patient Education
• Report troublesome side effects
– Drowsiness
– Urinary retension/Constipation
• Caution when driving or operating
machinery
• Avoid alcohol or other sedatives
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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
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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
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Patient Education
• Urine will stain orange-red
• Only temporarily effective against
discomfort
– Not effective for infection
• Diagnosis and treatment of underlying
treatment required
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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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QuickTime™ and a
TIFF (Uncompressed) decompressor
are needed to see this picture.
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Drug List
Please Indicate Chapter and # of drug
1.
2.
3.
4.
5.
6.
7.
8.
9.
(probenecid / colchicine)
(allopurinol)
Detrol
Ditropan
(bethanechol)
Pyridium
Proscar
Cardura
Flowmax
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