1 Diuretics and Medications Used for Urinary System DisordersUNIT 25 Diuretics and Medications Used for Urinary System Disorders
2 Key Terms Edema Excretion Escherichia coli Nephrotic syndromeProteus mirabilis
3 Urinary System Two kidneys Two ureters One bladder One urethraNephron: functional unit of kidney Two ureters One bladder One urethra
4 Urinary System DiseasesMay involve kidneys, ureters, bladder, and urethra 20 million Americans are affected by kidney and urological diseases Leading causes of chronic kidney failure: Diabetes mellitus (Type 2) High blood pressure Glomerulonephritis (continues)
5 Urinary System DiseasesKidney stones Polycystic kidney disease Cancer UTIs More common in women than men Can lead to nephritis Urinary incontinence Overactive bladder
6 Urinary System Diseases: Warning SignsBurning or difficulty in urination Nocturia Hematuria Puffiness or swelling (eyes, hands, feet) Pain in small of back Hypertension
7 Urinary System Diseases: TreatmentsDiuretics Urinary tract antibacterials Urinary tract antiseptics Miscellaneous agents
8 Diuretics Decrease reabsorption of sodium chloride by kidneys, increasing salt and water excreted in urine Reduce fluid retention, prevent edema Uses Congestive heart failure, hypertension Nephrotic syndrome, chronic renal failure Idiopathic edema Diabetes insipidus Glaucoma (continues)
9 Diuretics Types Thiazide Loop Potassium-sparing OsmoticCarbonic anhydrase inhibitors
10 Thiazide Diuretics Inhibit sodium and chloride reabsorption in distal tubule Block chloride reabsorption in loop of Henle Uses Edema Hypertension Diuresis (continues)
11 Thiazide Diuretics Contraindications Hypersensitivity AnuriaRenal decompensation Pregnancy Lactation Caution with severe renal or liver disease (continues)
12 Thiazide Diuretics Adverse effects Weakness HypotensionDiarrhea, vomiting, constipation Glycosuria Vertigo Electrolyte imbalance (continues)
13 Thiazide Diuretics Patient teachingIncrease fluid intake to 2–3 liters per day Eat potassium-rich foods Take medicine in morning to avoid nocturia (continues)
14 Thiazide Diuretics Special considerations May increase blood sugarShould not take with lithium Alcohol, barbiturates, and narcotics increase risk of hypotension
15 Loop Diuretics Inhibit reabsorption of sodium and chloride in proximal and distal tubules, and in loop of Henle Uses Edema Hypertension Adjunctive therapy for acute pulmonary embolism (continues)
16 Loop Diuretics Contraindications Hypersensitivity AnuriaElectrolyte depletion Hypovolemia Infants Lactation (continues)
17 Loop Diuretics Adverse effects Weakness HypotensionDiarrhea, vomiting, constipation Glycosuria Vertigo Electrolyte imbalance Thrombophlebitis (continues)
18 Loop Diuretics Patient teachingIncrease fluid intake to 2–3 liters per day Eat potassium-rich foods Take medicine in morning to avoid nocturia (continues)
19 Loop Diuretics Special considerations May increase blood sugarShould not take with lithium Should not take during pregnancy Additive effect when taken with antihypertensives Alcohol, barbiturates, and narcotics increase risk of hypotension
20 Potassium-Sparing DiureticsCause increased amounts of sodium and water to be excreted, while potassium is retained Uses Edema CHF Cirrhosis Hypokalemia Essential hypertension (continues)
21 Potassium-Sparing DiureticsContraindications Pregnancy or lactation Anuria Hypersensitivity Acute renal disease Hyperkalemia (continues)
22 Potassium-Sparing DiureticsAdverse effects Gynecomastia Cramping Drowsiness Urticaria Irregular menses Hirsutism Gastritis (continues)
23 Potassium-Sparing DiureticsPatient teaching Do not take potassium supplements or eat potassium-rich foods Use caution with salt substitutes because most contain potassium Watch for signs of electrolyte imbalance (continues)
24 Potassium-Sparing DiureticsSpecial considerations Excessive potassium intake may cause hyperklemia Increases half-life of digoxin Reduces vascular response to norepinephrine Potentiates effects of other antihypertensive agents and diuretics
25 Osmotic Diuretics Increase osmolality of plasma, glomerular filtrate, and tubular fluid Increase excretion of water, sodium, chloride, and potassium
26 Uses for Osmotic DiureticsPrevention of acute renal failure during trauma or prolonged surgery Prevention of increased cerebral, cerebrospinal, or intraocular pressure during trauma, surgery, or disease Reduction of intraocular pressure in acute glaucoma
27 Osmotic Diuretics Contraindications Hypersensitivity AnuriaAcute renal failure Cardiac dysfunction/CHF Intracranial hemorrhage Severe dehydration Severe pulmonary congestion (continues)
28 Osmotic Diuretics Adverse reactions Urinary retention Marked diuresisThirst Dizziness Thrombophlebitis Hypo- or hypertension Dehydration Loss of hearing (continues)
29 Osmotic Diuretics Patient teachingIncrease fluid intake to 2–3 liters per day Ice chips or hard candy will help relieve thirst Monitor weight (continues)
30 Osmotic Diuretics Special considerationsDo not add whole blood to IV lines for mannitol Do not mix with any other drug or solution Mannitol crystallizes at low temps
31 Carbonic Anhydrase InhibitorsPromote reabsorption of sodium and bicarbonate from proximal tubules Block action of carbonic anhydrase, reversing hydration of carbon dioxide Increases excretion of water, sodium, and potassium (continues)
32 Carbonic Anhydrase InhibitorsUses Adjunctive therapy of open-angle glaucoma Secondary glaucoma Preoperatively in close-angle glaucoma (continues)
33 Carbonic Anhydrase InhibitorsContraindications Hypersensitivity Hepatic insufficiency Renal failure Severe pulmonary obstruction Adrenocortical insufficiency Hyperchloremic acidosis (continues)
34 Carbonic Anhydrase InhibitorsAdverse effects Anorexia, nausea, and vomiting Paresthesia Ataxia Tremor Tinnitus Headache Urinary frequency Renal calculi (continues)
35 Carbonic Anhydrase InhibitorsPatient teaching Increase fluids to 2–3 liters per day Eat potassium-rich foods Report any eye pain immediately Take medication in morning to avoid nocturia (continues)
36 Carbonic Anhydrase InhibitorsSpecial considerations Monitor weight Monitor I&O Potassium supplements may be needed Watch for signs of metabolic acidosis
37 UTI: Cystitis Painful inflammation of bladderAffects 10 million people per year In women, most commonly caused by E. coli In men, usually secondary to epididymitis, prostatitis, kidney stones, or STDs (continues)
38 UTI: Cystitis Symptoms Urgency Pyuria Chills and fever DysuriaFrequency Hematuria (continues)
39 UTI: Cystitis Diagnosis Symptoms Micro U/A Urine C&S Urine dipstickGram stain (continues)
40 UTI: Cystitis Prevention for females Increase PO water intakeWipe front to back Urinate after intercourse Use condoms Avoid vaginal deodorants, etc. Wear cotton undergarments (continues)
41 UTI: Cystitis Treatment Antibiotics Antibacterials AntisepticsAnalgesics
42 UTI: The Older Adult Kidneys lose mass with ageBegin to decrease in size during 40s By 80s, kidneys have shrunk 30% Lose proportionate amount of function Risk of nephrotoxicity due to polypharmacy
43 UTI: The Child Higher risk of renal trauma due to less padding than adults Infants more prone to dehydration UTIs common in children Symptoms are age related Some children have no symptoms of UTI
44 Sulfonamides Urinary tract antibacterial UsesA drug of choice for treatment of acute, uncomplicated UTI Ear infection Meningococcal meningitis Inclusion conjunctivitis Bacteriostatic effect on both gram-positive and gram-negative bacteria (continues)
45 Sulfonamides Contraindications Adverse effects HypersensitivityInfants under 2 months Pregnancy Lactation Group A beta-hemolytic strep Adverse effects Nausea and vomiting, diarrhea Anorexia, tinnitus (continues)
46 Sulfonamides Patient teachingMay decrease effectiveness of oral contraceptives Take with 8 oz water Avoid direct sunlight Avoid aspirin or OTC vitamin C May discolor urine (continues)
47 Sulfonamides Special considerations May decrease digoxin absorptionMay potentiate sulfonylureas May potentiate anticoagulants May displace methotrexate from plasma protein-binding sites
48 Urinary Tract AntisepticsNot drugs of first choice for UTIs Uses For those who are intolerant or unresponsive to first-choice meds Control of chronic urinary infections Inhibit growth of bacteria
49 Urinary Tract AntisepticsContraindications Hypersensitivity Anuria, renal insufficiency Severe dehydration Pregnancy or lactation Adverse effects Drug specific (continues)
50 Urinary Tract AntisepticsPatient teaching Increase PO fluids Take medicine until completely gone Proper hygiene Special considerations Obtain C&S prior to treatment Take medication at equal intervals Perform C&S after treatment
51 Miscellaneous Urologic AgentsUsed for disorders of lower urinary tract Stimulate, inhibit, or relax smooth muscle activity Help control involuntary contractions of bladder muscle Used to treat conditions such as bladder spasms, incontinence, and for pain management See Table 25-4 for specific drugs