PHARM WEEK 7 - URINARY DRUGS

a patient complains “it burns when I pee”. what is the problem, treatment, and class of the treatment

PROBLEM: UTI

TREATMENT: fosfomycin

CLASS: antiinfectives

what is fosfomycin used for

• uncomplicated lower UTI

• works in the urinary tract to kill the bacteria

** single dose treatment

other antiinfectives you’ll see

• nitrofurantoin

• TMP-SMX

• fluoroquinolones

• cefiximine

• methenamine

a patient complains “i pee all the time”. what is the problem, treatment, and class of the treatment

PROBLEM: overactive bladder

TREATMENT: oxybutynin

CLASS: anticholinergic urinary antispasmodic

how does oxybutynin help with overactive bladder

• relaxes bladder muscles (detrusor)

• reduces urgency, frequency, and incontinence

** with anticholinergic: it blocks parasympathetic activity → bladder relaxes → decrease in urgency and spams

patient complains “my UTI medicine is not working”. what is the problem, treatment, and class of the treatment

PROBLEM: the patient believes her pain medication is treating her infection

TREATMENT: phenazopyridine (AZO)

CLASS: urinary analgesic

what is phenazopyridine used for and not used for

this medication is treating the pain NOT the infection

• it relieves the burning, pain, and discomfort in the urinary tract (the patient still needs the antibiotic to treat/ cure the infection)

what urine color should you educate your patient taking phenazopyridine is normal

orange/ red dye is expected because of the dye of the medication

important reminders for phenazopyridine

• this medication is for short term use (no more than 2 days)

• take with food to reduce stomach upset

• continue/ complete your antibiotic as prescribed to treat the infection

a patient complains “my bladder hurts but i dont have a UTI”. what is the problem, treatment, and class of the treatment

PROBLEM: interstitial cystitis (chronic bladder irritation/ pain)

TREATMENT: pentosan polysulfate

CLASS: bladder protectant

signs of interstitial cystitis

• bladder pain/ pressure

• urinary frequency

• pain with filling their bladder

• no infection on testing

how does pentosan polysulfate help with interstitial cystitis

• adheres to the bladder lining and creates a protective barrier (coating)

• helps reduce irritation and pain

a patient complains “i stand there to use the bathroom and nothing comes out”. what is the problem, treatment, and class of the treatment

PROBLEM: BPH (benign prostatic hyperplasia)

TREATMENT: tamsulosin AND/OR finasteride

CLASS: tamsulosin → alpha blocker . finasteride → 5- alpha- reductase inhibitor

difference in treatment pathway between tamsulon and finasteride

• tamsulosin RELAXES smooth muscle → urine flows easier

  • relaxes the prostate and neck of bladder = opens the path → easier flow (works quickly: days to weeks)

• finasteride SHRINKS the prostate → improves urine flow over time

  • shrinks the prostate over time = less pressure → better flow (takes time to work: months)

symptoms of BPH

• hesitancy: takes a long time to start urinating

• weak stream: dribbles or weak urine flow

• nocturia: waking up multiple times at night

• difficulty urinating

are tamsulosin and finasteride used together

depends on the severity

• if mild then tamsulosin alone may be enough (based on prostate size and symptom severity)

adrenal crisis

the adrenal glands cant meet the bodys demand for cortisol

causes leading to adrenal crisis

• abruptly stopping hydrocortisone

• illness/ vomiting/ diarrhea

• forgetting your med doses

Addison’s disease

the adrenal glands dont produce enough of cortisol or aldesterone

where are adrenal glands located and what do they produce

sit on top of the kidney and they produce cortisol (stress hormone) and aldosterone (regulates sodium/ potassium)

cues of adrenal crisis

• severe hypotension

• tachycardia

• hypoglycemia

• hyponatremia

• hyperkalemia

• weak, confused, dizzy

** PATTERN TO RECOGNIZE: low sugar, low salt, low pressure

replacement drug for cortisol

hydrocortisone

replacement drug for aldosterone

fludrocortisone

the specific hormone of glucorticoid is

cortisol

** no glucorticoid = blood glucose plummets

the specific hormone of mineralcorticoid is

aldosterone

** no mineralocorticoid = body dumps salt and water, holding onto potassium

treatment priority for adrenal crisis

1. vascular collapse/ hypovolemic shock

2. fatal cardia dysrhythmias

vascular collapse/ hypovolemic shock

• the organs are not getting enough oxygen

• no aldosterone = body dumping sodium and water = blood volume crashes

** without IMMEDIATE IV fluids and steroids = death

** the most immediate killer

fatal cardiac dysrhythmias

• high potassium makes the heart extremely irritable

• risk for V. fib or asystole = heart stops beating effectively

** second most immediate killer

order of treatment for adrenal crisis

1. fix the BP with IV fluids and steroids

2. fix the potassium + cardiac monitoring

3. fix the glucose with dextrose

4. fix the confusion (follows automatically when the above is fixed)

cushings

high cortisol

“puffy and powerful”

• high sugar, high BP, high salt

addison’s

low cortisol

“weak and wiped out”

• low sugar, low BP, low salt

what two signals does the hypothalamus send

1. GHRH: tells the pituitary to release growth hormone

2. somatostatin: tells pituitary to stop releasing growth hormone

drug used for prostate cancer and precocious puberty (early puberty in children)

leuprolide

what do the TSH, ACTH, and GH do

• TSH → thyroid: tells thyroid to make thyroid hormone

• ACTH → adrenal glands: tells adrenals to make more cortisol

• GH → bones and muscles: tells them to grow

too little growth hormone

dwarfism

too much growth hormone

acromegaly

the class and prototype drug given to kids with growth failure (GH deficiency, Turner’s)

CLASS: growth hormone/ growth replacement

PROTOTYPE: somatropin

adverse effects of somatropin

• joint pain (growing pains)

• insulin resistance ** check sugars

BEFORE you give somatropin, what should you check and why

** what should you watch for

X-rays because if the epiphyses (growth plates) are closed and you keep giving this drug, since the bones cant grow long they’ll grow thick leading to acromegaly

** watch for a limp

meds for GH anatagonist

• bromocriptine

• octeotide

• lanreotide

side effects of GH anatagonist drugs

GI upset (nausea and cramps)

high ADH

holds water, no peeing

low ADH

dumps water, flood of pee

what is DI

diabetes insipidus, the patient is “dry inside”

• has no ADH = peeing everything out

treatment for DI

desmopressin (DDAVP)

what to watch for with DI

water intoxication (hyponatremia → if the patient presents confused or with a headache)

med to treat hypothyroidism

levothyroxine

MOA, teaching, and adverse effects of levothyroxine

MOA: replaces T4 = speeds up metabolism

TEACHING: take in the AM on an empty stomach (30-60 minutes before food), it is a lifelong therapy

ADVERSE: chest pain, palpitations/ tachycardia, heat intolerance

med to treat hyperthyroidism

methimazole

MOA, teaching, and adverse effects of methimazole

MOA: blocks thyroid production

TEACHING: report sore throat immediately, monitor CBC/ WBC labs

ADVERSE: agranulocytosis (low WBC), liver toxicity

med for hypocalcemia

calcitrol

MOA, teaching, and adverse effects of calcitrol

MOA: increases calcium absorption from gut

TEACHING: monitor calcium labs, weight- bearing exercise

ADVERSE: hypercalcemia, kidney stones

med for osteoporosis

alendronate (fosamax)

MOA, teaching, and adverse effects of alendronate (fosamax)

MOA: inhibits osteoclasts (stops bone breakdown)

TEACHING: sit upright for 30 min + full glass of water + NPO for 30 min after taking medication

ADVERSE: can cause esophagitis/ ulcers if stays in esophagus, jaw necrosis

steroid med for inflammation/ autoimmune

prednisone

MOA, teaching, and adverse effects of prednisone

MOA: systemic cortisol = shuts down inflammation + suppresses immune system

TEACHING: take with food, infection awareness, taper

ADVERSE: infection risk, hyperglycemia, GI bleeding/ ulcers, osteoporosis, adrenal suppression

expected side effect of prednisone

cushingoid appearance

• moon face

• buffalo hump

• fluid retention

• trunical obesity

solutions for hyperthyroidism

1. humidified oxygen

2. 12- lead EKG

3. acetaminophen

4. cooling blanket

5. normal saline fluid bolus

6. methimazole