Introduction to Clinical Pharmacology Chapter 48 Urinary Tract Anti-Infectives and Other Urinary Drugs

Anti-Infectives: Actions and Uses Used for UTIs caused by susceptible bacterial microorganisms Rapid excretion rate of drugs High concentration in urine; act by interfering with bacterial multiplication in urine

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

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

Interactions: Anti-Infectives Nalidixic acid and sulfamethoxazole Interactant drug Effect of interaction Oral anticoagulants Increased risk for bleeding Nitrofurantoin Magnesium trisilicate or magaldrate Decreased absorption of anti-infective Anticholinergics Delay in gastric emptying, thereby increasing the absorption of nitrofurantoin

Interactions: Anti-Infectives (cont.) Fosfomycin Interactant drug Effect of interaction Metoclopramide Lowers plasma concentration and urinary tract excretion of fosfomycin

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: Assessment (cont.) 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: Diagnosis Impaired Urinary Elimination related to discomfort of urinary tract infection Ineffective Breathing Pattern related to adverse reaction to drug

Nursing 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: 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

Nursing Process: Implementation (cont.) Monitoring and managing patient needs Impaired urinary elimination: Encourage patient 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: Implementation (cont.) Monitoring and managing patient needs (cont.) 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: Implementation (cont.) 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 drugs

Nursing Process: Implementation (cont.) Educating the patient and family (cont.) Anti-infectives (cont.): Explain the importance of taking nitrofurantoin and nalidixic acid with food or milk Explain the importance of avoiding excessive intake of citrus products, milk, and milk products when taking methenamine

Nursing Process: Implementation (cont.) Educating the patient and family (cont.) Anti-infectives (cont.): Emphasize the importance of 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: 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

Question Is the following statement true or false? Urinary tract infections are caused by pathogenic microorganisms of one or more structures of the urinary tract.

Answer True Urinary tract infections are caused by pathogenic microorganisms of one or more structures of the urinary tract.

Question Is the following statement true or false? Because the female urethra is considerably shorter than the male urethra, women are affected by UTIs much more frequently than men.

Answer True Because the female urethra is considerably shorter than the male urethra, women are affected by UTIs much more frequently than men. The most common structure affected is the bladder.