NUR 219: Renal and Urologic Drugs

Purdue pathopharmacology 2025 with Swartzel and Renbarger

urinary tract disorders

can be cause by gram -/+ bacteria, degree of illness depends on microbe and virulence, most are caused by UTIs

upper UTI

pyelonephritis

lower UTI

cystitis, urethritis, protatitis

urinary antiseptics/ antiinfectives

group of drugs which prevent bacterial growth in kidneys and bladder, not effective for systemic infections, low doses are bacteriostatic, high doses are bactericidal

acute cystitis

lower UTI, common in females (especially those sexually active, older females, you females, caused by e. coli, culture needed before diagnosis, in males more likely prostatitis with symptoms like cystitis

acute cystitis symptoms

pain and burning on urination, frequency and urgency

acute pyelonephritis

upper UTI, seen in women, E. coli is most common cause, bacterial count in urine is 100,000 bacteria/mL, may need to be hospitalized for IV antibiotics (aminoglycoside or pieracillin-tazobactam)

acute pyelonephritis S/S

chills, high fever, flank pain, pain during urination, frequency and urgency, pyuria

nitrofurantoin and TMP-SMZ

treatment is 3-7 days; 7-14 days

1-5th generation cephalosporins

treat UTIs

fluoroquinolones (ofloxacin, ciprofloxacin)

for uncomplicated UTIs, levoflaxacin may be used when options are not available

urinary antiseptics/ antiinfectives and antibiotics

limited to treatment of UTIs, drug action occurs in renal tubule and bladder where it reduces growth, UA and C&C performed before starting drugs, drugs are bactericidal and can cause superinfections

TMP-SMX

SMZ combined to prevent resistance to TMP, used to treat acute and chronic UTIs, amount of drug is 2-3x greater in prostatic fluid than the vascular fluid

TMP-SMZ pharmacokinetics

well absorbed in GI tract, may be taken with food, water milk, can cause GI distress and crystalluria

TMP-SMZ pharmacodynamics

ration of TMP to SMZ is 1:5, bactericidal effects against gram +/- bacteria, peak action is at 4 hours

methenamine MOA

bactericidal effect when urine pH is less than 5.5 (urine can be acidified with cran juice, ascorbic acid, or ammonium chloride)

methenamine uses

effective against E. coli, used for UTI prophylaxis

methenamine contraindications

should NOT be taken with sulfonomides d/t crystaluria

methenamine absorption site

GI tract

methenamine side effects

nausea, dysura, rash, elevated hepatic enzymes, hemauria, crystellura

nitrofurantoin

approved in 1954, antacids decrease absorption, short half life, use with food to avoid GI upset

nitrofurantoin MOA

bacteriostatic or bactericidal, low does are preventative,

nitrofurantoin uses

E. coli, UTIs and cystitis

nitrofurantoin excretion

urine, levels can build if there are urinary issues

nitrofurantoin side effects

dyspnea, angina, cough, febrile, chills (call provider), symptoms should stop after drug is stopped

fluroquinolones drugs

ciproflaxacin, ofloxacin, levofloxacin

fluoroquinolones uses

used for lower UTI bacteria, reserved for those with no other treatment options

fluoroquinolones adverse reactions

tendon rupture, peripheral neuropathy, CNS effects, myasthenia gravis exacerbation

fluoroquinolones half life

2-8 hours (longer if pt has renal dysfunction

fluoroquinolones contraindications

do not take within two hours of mineral supplements, magnesium antacids, sucralfate, or didanosine, NO dairy

what do antacids do to nitrofurantin absorption

decrease absorption

what does sodium bicarb do to methenamine

inhibits action

taking methenamine with sulfonamides increases the risk of

cyrstalluria

urinary antiseptics cause false positive

clinitest (glucose urine tests)

phenazopyradine (azo dye)

urinary analgesic

phenazopyridine use

relieves urinary pain, burning, frequency, urgency (cystitis symptoms)

phenazopyridine can cause

methemoglobinemia, hemolytic anemia, renal and hepatic dysfunction

phenazopyridine odd side effects

urine turns reddish-orange, can interfere with urine glucose test, can cause garlic taste and odor, skin, eye, and urine discoloration

urinary stimulant drug of choice

bethenechol chloride

urinary stimulants

bladder function can be lost d/t neurgenic bladder (lesion of NS), spinal cord injury; may be used to cause micturition

bethenechol chloride MOA

urinary stimulant (parasympathomimetic), increases bladder tome bu increasing the tone of detrusor urinal muscle

bethenechol chloride contraindication

patients with peptic ulcer

antispasmodics

relive UTI, direct action on smooth muscles of urinary tract

antispaspodic med

oxybutynin

oxybutynin contraindication

if pt has urinary or GI obstruction, glaucoma

antimuscarinics/ anticholinergics

block parasympathetic nerve impulses, decrease urinary urgency and incontinence

antimuscarinics/ anticholinergics side effects

blurred vision, headache, dizziness, dry mouth, constipation, tachy

antimuscarinics/ anticholinergics patient reporting

urinary retention, severe dizziness, blurred vision, palpitations, confusion

antimuscarinics/ anticholinergics drug

solifenacin

solifenacin uses

overactive bladder and incontinent

nursing concept for urinary antiinfectives

infection, infective microorg has invaded part of body

nursing assessment for urinary antiinfectives

assess S/S, pain, burning, frequency and urgency, assess renal and hepatic function

nursing actions for urinary

monitor urinary output and SG, report decreased urine output, obtain urine culture, assess for S/S

patient teaching for urinary

teach pt not to crush or open capsules, rinse after taking nitro (can stain teeth), antacids can interfere, need to report pregnancy, alert that nitro can cause brown color of urine, pt taking methenamine should drink cranberry juice