Urinary Tract Infection

Urinary Tract Infection
Chapter 46

Urinary Tract Infection (UTI)
Most common bacterial infection in women At least 20% of women will develop a UTI during their lifetime E. coli is the most common pathogen At least 20% of women develop a UTI during their lifetime. More than 100,000 people are hospitalized annually for UTIs. More than 15% of patients who develop gram-negative bacteremia die, and one third of these cases are caused by bacterial infections originating in the urinary tract.

Bladder and its contents are free of bacteria in majority of healthy persons Minority of healthy individuals have colonizing bacteria in bladder Called asymptomatic bacteriuria and does not justify treatment Asymptomatic bacteriuria does not justify screening or treatment except in pregnant women.

Strep, staph, E. coli, fungal and parasitic infections can cause UTIs Patients at risk Immunosuppressed Diabetic Having undergone multiple antibiotic courses Have traveled to developing countries Although fungal and parasitic infections may also cause UTIs, they are uncommon.

Classification of UTI Upper versus lower Upper urinary tract
Renal parenchyma, pelvis, and ureters Typically causes fever, chills, flank pain Example Pyelonephritis: inflammation of kidney and collecting system Acute and Chronic See figure in future slide.}

Classification of UTI Upper versus lower Lower urinary tract
Usually no systemic manifestations Examples Cystitis: inflammation of bladder Urethritis: inflammation of the urethra Urosepsis is a UTI that has spread systemically and is a life-threatening condition necessitating emergency treatment.

Classification of UTI

Classification of UTI Uncomplicated UTI Complicated UTI
Complicated versus uncomplicated Uncomplicated UTI Occurs in otherwise normal urinary tract Usually involves only the bladder Complicated UTI Coexists with presence of Obstruction, stones Catheters Diabetes/neurologic disease Pregnancy-induced changes Recurrent infection

Etiology and Pathophysiology
Urinary tract above urethra normally sterile Defense mechanisms exist to maintain sterility/prevent UTIs Complete emptying of bladder Ureterovesical junction competence Peristaltic activity Acidic pH High urea concentration Abundant glycoproteins

Alteration of defense mechanisms increases risk of contracting UTI Predisposing factors Factors increasing urinary stasis Examples: BPH, tumor, neurogenic bladder Foreign bodies Examples: catheters, calculi, instrumentation Anatomic factors Examples: obesity, congenital defects, fistula Compromising immune response factors Examples: age, HIV, diabetes Functional disorders Example: constipation Other factors Examples: pregnancy, multiple sex partners (women) A common factor contributing to ascending infection is urologic instrumentation (e.g., catheterization, cystoscopic examinations).

Organisms introduced via the ascending route from urethra and originate in the perineum Less common routes Bloodstream Lymphatic system Gram-negative bacilli normally found in GI tract: common cause Urologic instrumentation allows bacteria to enter urethra and bladder Catheters cystoscopy

Contributing factor: urologic instrumentation Allows bacteria present in opening of urethra to enter urethra or bladder Sexual intercourse promotes “milking” of bacteria from perineum and vagina May cause minor urethral trauma

Rarely results via hematogenous route Kidney infection occurring from hematogenous transmission always preceded by injury to urinary tract Obstruction of ureter Damage from stones Renal scars

Hospital-acquired UTI accounts for 31% of all nosocomial infections Causes Often: E. coli Seldom: Pseudomonas species Catheter-acquired UTIs Bacteria biofilms develop on inner surface of catheter Most often, hospital-acquired UTIs are underrecognized and undertreated, leading to complications such as renal abscesses, arthritis, epididymitis, periurethral gland infections, and bacteremia.

Clinical Manifestations
Symptoms related to either bladder storage or bladder emptying Bladder storage Urinary frequency Abnormally frequent (more often than every 2 hours) Urgency Sudden strong desire to void immediately Incontinence Loss or leakage or urine Lower urinary tract symptoms (LUTS) are experienced in patients who have UTIs of the upper urinary tracts, as well as those confined to the lower tract. The urine may contain grossly visible blood (hematuria) or sediment, which gives it a cloudy appearance. Symptoms are related to either bladder storage or bladder emptying. These symptoms are defined in Table 46-3.

Bladder storage Nocturia Waking up two or more times at night to void Nocturnal enuresis Loss of urine during sleep Bladder emptying Weak stream Hesitancy Difficulty starting the urine stream

Bladder emptying Intermittency Interruption of urinary stream during voiding Postvoid dribbling Urine loss after completion of voiding Urinary retention Inability to empty urine from bladder Dysuria Difficulty voiding

Flank pain, chills, and fever indicate infection of upper tract Pyelonephritis In older adults Symptoms often absent Nonlocalized abdominal discomfort rather than dysuria Cognitive impairment possible Fever less likely People with significant bacteriuria may have no symptoms or may have nonspecific symptoms such as fatigue or anorexia.

Diagnostic Studies Urine for culture and sensitivity (if indicated)
Clean-catch sample preferred Specimen by catheterization or suprapubic needle aspiration more accurate Determine bacteria susceptibility to antibiotics Imaging studies CT urography or ultrasonography when obstruction suspected KUB A urine culture is indicated in complicated or HAI UTIs, persistent bacteriuria, or frequently recurring UTIs (more than two to three episodes per year). Urine also may be cultured when the infection is unresponsive to empiric therapy or the diagnosis is questionable. For women, teach them to spread the labia and wipe the periurethral area from front to back, using a moistened, clean gauze sponge (no antiseptic is used because it could contaminate the specimen and cause false-positive results). Then tell them to keep the labia spread and collect the specimen 1 to 2 seconds after voiding starts. For men, instruct them to wipe the glans penis around the urethra. The specimen is collected 1 to 2 seconds after voiding begins. Refrigerate urine immediately on collection.

Collaborative Care Drug Therapy
Antibiotics Selected on therapy or results of sensitivity testing Uncomplicated cystitis Short-term course (1 to 3 days) Complicated UTIs Long-term treatment (7 to 14 days) The collaborative care and drug therapy for cystitis are summarized in Table 46-4. Many residents of long-term care facilities, especially women, have chronic asymptomatic bacteriuria. However, usually only symptomatic UTIs are treated. First-choice drugs to empirically treat uncomplicated or initial UTIs are trimethoprim/sulfamethoxazole (TMP/SMX) (Bactrim, Septra), nitrofurantoin (Macrodantin), and fosfomycin (Monurol).

Antibiotics Trimethoprim/sulfamethoxazole (TMP/SMX) Used to treat uncomplicated or initial UTI Inexpensive, Taken twice a day Nitrofurantoin (Macrodantin) Given three or four times a day Long-acting preparation (Macrobid) is taken twice daily Ampicillin, amoxicillin, cephalosporins Treat uncomplicated UTI

Fluoroquinolones Treat complicated UTIs Example: ciprofloxacin (Cipro, Levaquin) Antifungals Amphotericin or fluconazole UTIs secondary to fungi Although this drug is typically effective in relieving the transient acute discomfort associated with a UTI, the nurse should advise patients to avoid long-term use of phenazopyridine because it can produce hemolytic anemia.

Urinary analgesic Methenamine/phenyl salicylate (Urised, Methylene Blue) Used in combination with antibiotics Used to relieve UTI symptoms Preparations with methylene blue tints urine blue or green Phenazopyridine (Pyridium) Provides soothing effect on urinary tract mucosa Stains urine reddish orange Can be mistaken for blood and may stain underclothing

Nursing Management Nursing Assessment
Health history Previous UTIs, calculi, stasis, retention, pregnancy, STIs, bladder cancer Antibiotics, anticholinergics, antispasmodics Urologic instrumentation Urinary hygiene Nausea, vomiting, anorexia, chills, nocturia, frequency, urgency Suprapubic/lower back pain, bladder spasms, dysuria, burning sensation on urination Subjective and objective data that should be obtained from a patient with a UTI are presented in Table 46-5.

Nursing Management Nursing Assessment
Objective data Fever Hematuria, foul-smelling urine, tender, enlarged kidney Leukocytosis, positive findings for bacteria, WBCs, RBCs, pyuria, ultrasound, CT scan, IVP

Nursing Management Nursing Implementation
Health promotion Recognize individuals at risk Debilitated persons, Older adults Underlying diseases (HIV, diabetes) Taking immunosuppressive drug or corticosteroids Emptying bladder regularly and completely Evacuating bowel regularly Wiping perineal area front to back Drinking adequate fluids (person’s weight in pounds/2) Twenty percent of fluid comes from food

Health promotion Cranberry juice or cranberry tablets may reduce the number of UTIs Avoid unnecessary catheterization and early removal of indwelling catheters Aseptic technique must be followed during instrumentation procedures Wash hands before and after contact Wear gloves for care of urinary system Routine and thorough perineal care for all hospitalized patients Avoid incontinent episodes by answering call light and offering bedpan at frequent intervals It is thought that enzymes found in cranberries inhibit attachment of urinary pathogens (especially E. coli) to the bladder epithelium.

Health promotion Acute intervention Adequate fluid intake Patient may think condition will worsen because of discomfort Dilutes urine, making bladder less irritable Flushes out bacteria before they can colonize Avoid caffeine, alcohol, citrus juices, chocolate, and highly spiced foods Potential bladder irritants Emphasize taking full course of antibiotics despite disappearance of symptoms Second or reduced dosage of a drug may be ordered after initial course in susceptible patients

Acute intervention Instruct patient to monitor for signs of improvement and decrease in or cessation of symptoms Counsel on persistence of lower tract symptoms beyond treatment or onset of flank pain or fever: should be reported immediately Ambulatory and home care Emphasize importance of compliance with drug regimen Take as ordered Maintain adequate fluids Regular voiding (every 3 to 4 hours) Void after intercourse

Case Study Jupiterimages/Photos.com/Thinkstock E.L. is a 27-year-old woman who complains of urgency to urinate, frequent urination, and urethral burning sensation during urination. Symptoms began 48 hours ago. She has a history of recurring urinary tract infections since age 22, when she got married. E.L. is allergic to penicillin. Vital signs are as follows: Temperature 98.6° F orally Blood pressure 114/64 Dipstick urinalysis indicates WBCs and bacteria. We will now walk through a case study of a patient with UTI. What type of UTI does she probably have? Complicated cystitis What is the most likely reason she has recurring UTIs? Sexual intercourse {See next slides.}

Case Study Urinalysis results: Color: dark yellow pH: 6.5
Jupiterimages/Photos.com/Thinkstock Urinalysis results: Color: dark yellow pH: 6.5 Nitrates: positive WBCs: large amount Occult blood: trace Urine culture: positive for E. coli Sensitivity to ampicillin, nitrofurantoin, ciprofloxacin, cephalexin, TMP-SMX Given her history, what would be

Case Study Jupiterimages/Photos.com/Thinkstock E.L. states that because of her penicillin allergy, she has taken Cipro for 7- day courses in the past. She asks about what could be causing the recurring infections. Given her history, what is the likely course of treatment? Ciprofloxacin (Cipro) because of the complicated nature of her UTI. How will her treatment differ from an uncomplicated UTI? The course of therapy will be longer. See next slides.

Acute Pyelonephritis

Inflammation of renal parenchyma and collecting system Most commonly caused by bacteria Fungi, protozoa, or viruses can also infect kidneys

Acute Pyelonephritis Cortical surface shows grayish white areas of inflammation and abscess formation (arrow).

Urosepsis Systemic blood infection from urologic source (instrumentation) Prompt diagnosis/treatment critical Can lead to septic shock and death Septic shock: outcome of unresolved bacteremia involving gram- negative organism Usually begins with colonization and infection of lower tract via ascending urethral route Frequent causes Escherichia coli Proteus Klebsiella Enterobacter

Preexisting factor usually present Vesicoureteral reflux Backward movement of urine from lower to upper urinary tract Dysfunction of lower urinary tract Obstruction from BPH Stricture Urinary stone Recurring episodes lead to scarred, poorly functioning kidney and chronic pyelonephritis For residents of long-term care facilities, urinary tract catheterization is a common cause of pyelonephritis and urosepsis.

Mild fatigue Chills, Fever Nausea, Vomiting Flank pain Lower urinary tract symptoms characteristic of cystitis Costovertebral tenderness usually present on affected side Manifestations usually subside in a few days, even without therapy Bacteriuria and pyuria still persist

Diagnostic Studies History & Physical examination
Palpation for CVA pain Laboratory tests Urinalysis Urine for culture and sensitivity CBC with differential Blood culture (if bacteremia is suspected) Ultrasonography CT urography Urinalysis results indicate pyuria, bacteriuria, and varying degrees of hematuria. WBC casts may be found in the urine, indicating involvement of the renal parenchyma. A complete blood cell count will show leukocytosis and a shift to the left with an increase in immature neutrophils (bands).

Diagnostic Studies If bacteremia is a possibility, close observation and vital sign monitoring are essential Prompt recognition and treatment of septic shock may prevent irreversible damage or death Hospitalization for patients with severe infections and complications Such as nausea and vomiting with dehydration Signs/symptoms typically improve within 48 to 72 hours after therapy starts Reinfections treated as individual episodes or managed with long-term therapy Prophylaxis may be used for recurrent infection

Audience Response Question
The nurse identifies that the patient with the greatest risk for a urinary tract infection is A 37-year-old man with renal colic associated with kidney stones. A 26-year-old pregnant woman who has a history of urinary tract infections. A 69-year-old man who has urinary retention caused by benign prostatic hyperplasia. A 72-year-old woman hospitalized with a stroke who has a urinary catheter because of urinary incontinence. Answer: d Rationale: A common source of urinary tract infections is hospital-acquired infrections. Catheter-acquired urinary tract infections are the most common hospital-acquired infections.

Urinary Tract Calculi

Nephrolithiasis Highest in the southeast, southwest
Affects 500,000 people per year many of whom are hospitalized 20-55 y/o, more common in men Affects Caucasians more than African Americans Occurs more often in the summer months 50% patients experience a recurrence

Etiology Multi-factorial process Metabolic Dietary (inc protein)
Genetic Climatic (heat) Lifestyle Occupational

Pathophysiology Crystals when in supersaturated concentration can precipitate and form a stone Urinary pH, solute load, and inhibitors affect the formation of stones Keep urine free-flowing Higher pH: calcium and phosphate are less soluble Lower the pH: uric acid and cystine are less soluble

Types of stones Calcium phosphate, Calcium oxalate
most common Uric acid, Cystine, Struvite caused from magnesium and ammonia phosphate Can be anywhere in urinary tract Kidney stone dance

Symptoms Severe abdominal pain depends on location of stone (Renal colic) CVA tenderness (flank pain) Hematuria Nausea and vomiting

Diagnostics UA Urine culture (C&S) IVP Ultrasound
Measurement of serum calcium, phosphate, oxalate, uric acid Renal function tests KUB

Collaborative Care Management of acute attack Narcotic pain relief
Treat infections proximal to obstruction Immediate drainage with Percutaneous Nephrostomy tube or ureteral stent Removal by endo-urologic procedures Ureteroscopy Nephrolithotomy Lithotripsy (ESWL extracorporeal shock wave laser)

Collaborative Care Prevent further stone formation
Adequate hydration (3L/day to produce urine output of 2L/day) Dietary sodium restrictions Dietary changes Medications to minimize formation Control infection

Nutrition therapy Calcium oxalate: reduce dietary oxalate spinach,
rhubarb, asparagus, cabbage, tomatoes, beets, nuts, celery, chocolate, cocoa, caffeine

Nutrition therapy Uric acid stones: reduce dietary purine
High: sardines, herring, mussels, liver, kidney, goose, venison, meat soups, sweetbreads Moderate: chicken, salmon, crab, veal, mutton, bacon, pork, beef, ham

Nursing management Preventive measures Immobility Urinary stasis
Acute phase Stone retrieval-strain all urine Forcing fluids if not contraindicated Ambulation Narcotics for pain relief

Interstitial Cystitis
Chronic painful inflammation of bladder characterized by urgency, frequency, pain in bladder or pelvic region. Odorous urine, hematuria. Neurosensitivity of lower UTS. Bladder wall is constantly irritated, becomes inflamed and scarred. Pain-mod to severe. Glomerulations form. (ulcerations in mucosa with pinpoint bleeds) Relieved by urination. Often misdiagnosed as UTI

Incontinence Involuntary leakage of urine, more common in older women
Stress and urge incontinence Bladder pressure exceeds urethral closure pressure Therapy- Kegel exercises Drugs- Atropine, dries bladder mucosa, inhibits secretions, relaxes GU tract (parasympathetic) Surgery- (abdominal) sling for bladder neck

Benign Prostatic Hypertrophy
Most common reason for UI in men, enlarged prostate gland Frequency, urgency, dysuria, difficulty voiding Bladder calculi can develop TURP- transurethral resection of prostate is a possible treatment Removes prostate cystoscopically After surgery 3 way indwelling catheter is constantly irrigated to prevent mucus or blood clots from clogging urethra

Pediatric Epispadias- urethra is dorsal, on top of glans. Rare and associated with bladder extrophy Hypospadias- incomplete development of urethra in utero. Congenital anomaly. Opening of urethra in on the bottom of the glans. Commonly associated with undescended testes and increased risk for inguinal hernia. Enuresis- nighttime bedwetting. Dec bladder capacity, neuro abnormalities , constipation, diabetes, emotional factors or abuse are some causes. Most kids outgrow this.

Pediatric Vesicoureteral reflux-
junction of bladder and ureter causes reflux of urine back up into ureters. Can be grade of I-V. I is reflux into lower ureter and V is gross dilation of ureter, possible UTI if backs up into the kidney. Grades I-III are treated with antbx. Grades IV-V have surgery to re-implant ureter into bladder

Diuretics Act on Different Segments of the Renal Tube.
Kidney Function Diuretics produce increased urine output by inhibiting sodium and water reabsorption from the kidney tubules. Diuretics Act on Different Segments of the Renal Tube. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Types of Diuretics Thiazide and thiazide-like Loop or high-ceiling
Osmotic Carbonic anhydrase inhibitor Potassium-sparing Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Thiazide and Thiazide-Like Diuretics
Chlorothiazide (Diuril) Hydrochlorothiazide (HCTZ) Bendroflumethiazide with nadolol (Corzide) Methyclothiazide (Enduron) Chlorthalidone (Thalitone) Indapamide (Lozol) Metolazone (Zaroxolyn) Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Serum chemistry abnormalities with thiazides Hypokalemia Hypomagnesemia Hypercalcemia Hypochloremia Hyperuricemia Hyperglycemia Hyperlipidemia Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Side effects and adverse reactions Electrolyte imbalances Hyperglycemia Hyperuricemia Others–dizziness, headache, nausea, vomiting, constipation, urticaria, and blood dyscrasias Contraindications Renal failure Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Nursing Process: Thiazides
Assessment Nursing diagnoses Planning Nursing interventions Patient teaching Cultural considerations Evaluation Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Loop Diuretics Loop diuretics: furosemide (Lasix), bumetanide (Bumex)
Laboratory changes: Hypokalemia, hyponatremia, hypocalcemia, hypomagnesemia, hypochloremia Hyperglycemia possible in diabetic pts Hyperuricemia Elevated BUN and creatinine Elevated lipids Thrombocytopenia, leukopenia

Loop Diuretics Side effects and adverse reactions
Fluid and electrolyte imbalances Hypochloremic metabolic alkalosis Orthostatic hypotension Thrombocytopenia Skin disturbances Transient deafness Thiamine deficiency Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Nursing Process: Loop Diuretics
Assessment Nursing diagnoses Planning Nursing interventions Patient teaching Cultural considerations Evaluation Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Osmotic Diuretics Osmotic diuretics: mannitol
Use: Prevent kidney failure, decrease ICP, and decrease IOP Side effects/adverse reactions: fluid and electrolyte imbalance, pulmonary edema, N&V, tachycardia, and acidosis Crystallization of mannitol Contraindications: Heart failure, renal failure Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Potassium-Sparing Diuretics
Potassium-sparing diuretics: spironolactone (Aldactone), amiloride (Midamor), triamterene (Dyrenium), and eplerenone (Inspra) Action Hyperkalemia Effects when given with ACE inhibitors Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Urinary Tract Infections (UTIs)
Upper UTI Acute pyelonephritis Usually female patients Symptoms Chills, fever, flank pain Painful urination, frequency, urgency, pyuria Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Urinary Tract Infections
Lower UTI Acute cystitis Frequently in females E. coli, Staph, Klebsiella, Pseudomonas Symptoms Pain and burning on urination, frequency, urgency Urethritis, prostatitis Same symptoms Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Treatment of UTIs Nitrofurantoin (Macrodantin)
Trimethoprim-sulfamethoxazole (Bactrim, Septra) Fluoroquinolones such as nalidixic acid (NegGram) Norfloxacin (Noroxin) Ciprofloxacin (Cipro) Fosfomycin tromethamine (Monurol): single dose Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Treatment of UTIs Other agents:
Oral amoxicillin/clavulanic acid (Augmentin) Oral third-generation cephalosporins (cefixime, cefpodoxime proxetil, or ceftibuten) For severe UTIs, IV drug therapy followed by oral drug therapy is usually recommended. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Urinary Antiseptics/Antiinfectives and Antibiotics
Nitrofurantoin (Macrodantin) Bacteriostatic or bactericidal depending on the drug dosage Effective against many gram-positive and gram-negative organisms, especially E. coli. Side effects/adverse reactions Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Methenamine hippurate (Hiprex) Treats chronic UTIs Effective for E. coli and P. aeruginosa Bactericidal when urine is acidic Caution Not to be taken with sulfonamides (may cause crystalluria) Patient teaching Consume acidic foods and fluids Side effects/adverse reactions Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Trimethoprim and trimethoprim sulfamethoxazole Trimethoprim (Proloprim): can be used alone for the treatment of UTIs; usually used in combination with a sulfonamide, sulfamethoxazole (Bactrim, Septra) Used in the treatment and prevention of acute and chronic UTIs Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Fluoroquinolones Nalidixic acid (NegGram), norfloxacin (Noroxin), ciprofloxacin hydrochloride (Cipro), ofloxacin (Floxin), and lomefloxacin (Maxaquin) Treats lower UTIs Side effects/adverse reactions Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Urinary Analgesics Phenazopyridine (Pyridium) Action
Relieves pain, burning sensation, frequency, urgency Side effects/adverse reactions GI upset Red-orange urine Blood dyscrasia Nephrotoxicity, hepatotoxicity Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Urinary Stimulants Urinary stimulants Bethanechol (Urecholine)
Treat hypotonic bladder: neurogenic, spinal cord injury, or severe head injury Action Increases bladder tone Contraindication Peptic ulcer Side effects/adverse reactions GI distress, dizziness, fainting Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Urinary Antispasmodics/ Antimuscarinics
Oxybutynin (Ditropan) and flavoxate (Urispas) Action Direct action on smooth muscles to relieve spasms Side effects/adverse reactions Drowsiness, tachycardia, dizziness, fainting, blurred vision, dry mouth, constipation Patient assessment Avoid in glaucoma, GI or urinary obstruction Use cautiously with history of cardiac, renal, hepatic, prostate problems Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Urinary Antispasmodics/ Antimuscarinics
Tolterodine tartrate (Detrol) Used to control an overactive bladder, which causes frequency in urination Decreases urge and urinary incontinence Same side effects as antispasmodics/anticholinergics Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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