Chapter 15

Urinary System Drugs

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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

• 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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Medications for Gout• Gout

– A form of arthritis in which uric acid crystals are deposited in and around joints, causing inflammation and pn.

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Medications for Gout

• Lower uric acid levels

• Medications1. Uricosuric agents

Ex: probenecid (Benemid)

2. Allopurinol

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Uricosuric Agents

• When used– Tx for chronic gout (no analgesic or anti-

inflammatory 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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CholinergicsStimulate 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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Drug ListPlease Indicate Chapter and # of drug

1. (probenecid / colchicine)2. (allopurinol)3. Detrol4. Ditropan5. (bethanechol)6. Pyridium7. Proscar8. Cardura9. Flowmax