ppt chapter049

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Introduction to Clinical Pharmacology

Chapter 49-Urinary Tract Anti-infectives, Antispasmodics, and Other

Urinary Drugs


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


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


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


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


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


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


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


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


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


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


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


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


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



• 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


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


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


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



• 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



• 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


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


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


End of Presentation

ppt chapter049

Health & Medicine

urinary drugs

urinary tract antiinfectives

urinary frequency

urinary system

urinary retention

urinary urgency

urinary hesitancy nausea

antiinfectives nalidixic