1. Diuretics and Medications Used for Urinary System Disorders
UNIT 25
Diuretics and Medications Used for Urinary System Disorders

2. Key Terms Edema Excretion Escherichia coli Nephrotic syndrome
Proteus mirabilis

3. Urinary System Two kidneys Two ureters One bladder One urethra
Nephron: functional unit of kidney
Two ureters
One bladder
One urethra

4. Urinary System Diseases
May 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 Diseases
Kidney 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 Signs
Burning or difficulty in urination
Nocturia
Hematuria
Puffiness or swelling (eyes, hands, feet)
Pain in small of back
Hypertension

7. Urinary System Diseases: Treatments
Diuretics
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 Osmotic
Carbonic 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 Anuria
Renal decompensation
Pregnancy
Lactation
Caution with severe renal or liver disease
(continues)

12. Thiazide Diuretics Adverse effects Weakness Hypotension
Diarrhea, vomiting, constipation
Glycosuria
Vertigo
Electrolyte imbalance
(continues)

13. Thiazide Diuretics Patient teaching
Increase 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 sugar
Should 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 Anuria
Electrolyte depletion
Hypovolemia
Infants
Lactation
(continues)

17. Loop Diuretics Adverse effects Weakness Hypotension
Diarrhea, vomiting, constipation
Glycosuria
Vertigo
Electrolyte imbalance
Thrombophlebitis
(continues)

18. Loop Diuretics Patient teaching
Increase 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 sugar
Should 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 Diuretics
Cause increased amounts of sodium and water to be excreted, while potassium is retained
Uses
Edema
CHF
Cirrhosis
Hypokalemia
Essential hypertension
(continues)

21. Potassium-Sparing Diuretics
Contraindications
Pregnancy or lactation
Anuria
Hypersensitivity
Acute renal disease
Hyperkalemia
(continues)

22. Potassium-Sparing Diuretics
Adverse effects
Gynecomastia
Cramping
Drowsiness
Urticaria
Irregular menses
Hirsutism
Gastritis
(continues)

23. Potassium-Sparing Diuretics
Patient 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 Diuretics
Special 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 Diuretics
Prevention 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 Anuria
Acute renal failure
Cardiac dysfunction/CHF
Intracranial hemorrhage
Severe dehydration
Severe pulmonary congestion
(continues)

28. Osmotic Diuretics Adverse reactions Urinary retention Marked diuresis
Thirst
Dizziness
Thrombophlebitis
Hypo- or hypertension
Dehydration
Loss of hearing
(continues)

29. Osmotic Diuretics Patient teaching
Increase fluid intake to 2–3 liters per day
Ice chips or hard candy will help relieve thirst
Monitor weight
(continues)

30. Osmotic Diuretics Special considerations
Do 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 Inhibitors
Promote 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 Inhibitors
Uses
Adjunctive therapy of open-angle glaucoma
Secondary glaucoma
Preoperatively in close-angle glaucoma
(continues)

33. Carbonic Anhydrase Inhibitors
Contraindications
Hypersensitivity
Hepatic insufficiency
Renal failure
Severe pulmonary obstruction
Adrenocortical insufficiency
Hyperchloremic acidosis
(continues)

34. Carbonic Anhydrase Inhibitors
Adverse effects
Anorexia, nausea, and vomiting
Paresthesia
Ataxia
Tremor
Tinnitus
Headache
Urinary frequency
Renal calculi
(continues)

35. Carbonic Anhydrase Inhibitors
Patient 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 Inhibitors
Special considerations
Monitor weight
Monitor I&O
Potassium supplements may be needed
Watch for signs of metabolic acidosis

37. UTI: Cystitis Painful inflammation of bladder
Affects 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 Dysuria
Frequency
Hematuria
(continues)

39. UTI: Cystitis Diagnosis Symptoms Micro U/A Urine C&S Urine dipstick
Gram stain
(continues)

40. UTI: Cystitis Prevention for females Increase PO water intake
Wipe front to back
Urinate after intercourse
Use condoms
Avoid vaginal deodorants, etc.
Wear cotton undergarments
(continues)

41. UTI: Cystitis Treatment Antibiotics Antibacterials Antiseptics
Analgesics

42. UTI: The Older Adult Kidneys lose mass with age
Begin 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 Uses
A 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 Hypersensitivity
Infants under 2 months
Pregnancy
Lactation
Group A beta-hemolytic strep
Adverse effects
Nausea and vomiting, diarrhea
Anorexia, tinnitus
(continues)

46. Sulfonamides Patient teaching
May 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 absorption
May potentiate sulfonylureas
May potentiate anticoagulants
May displace methotrexate from plasma protein-binding sites

48. Urinary Tract Antiseptics
Not 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 Antiseptics
Contraindications
Hypersensitivity
Anuria, renal insufficiency
Severe dehydration
Pregnancy or lactation
Adverse effects
Drug specific
(continues)

50. Urinary Tract Antiseptics
Patient 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 Agents
Used 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