Chapter 27 Chapter 27 Urinary System Disorders Urinary System Disorders 1
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Chapter 27Chapter 27
Urinary System DisordersUrinary System Disorders
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Learning ObjectivesLearning ObjectivesDiscussing specific electrolytes needed to Discussing specific electrolytes needed to
achieve homeostasis and to balance achieve homeostasis and to balance extracellular and intracellular fluids.extracellular and intracellular fluids.
Describing how and what antiinfectives Describing how and what antiinfectives are used for urinary tract infections.are used for urinary tract infections.
Explaining the role of urinary tract Explaining the role of urinary tract analgesics and antispasmodics in the analgesics and antispasmodics in the treatment of urinary tract conditions.treatment of urinary tract conditions.
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Learning Objectives (cont’Learning Objectives (cont’d.)d.)Discussing enuresis and the medications Discussing enuresis and the medications
used for its treatment.used for its treatment.Discussing medications used for treating Discussing medications used for treating
an overactive bladder (OAB).an overactive bladder (OAB).Providing patient education for Providing patient education for
compliance with medications used to compliance with medications used to treat diseases and conditions of the treat diseases and conditions of the urinary system.urinary system.
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Easy Working Knowledge of Drugs Easy Working Knowledge of Drugs for Urinary Tract Disordersfor Urinary Tract Disorders
diureticsdiureticsantimicrobials/sulfonamidesantimicrobials/sulfonamidesurinary tract antisepticsurinary tract antisepticsurinary tract antispasmodicsurinary tract antispasmodicsmedications for enuresismedications for enuresis
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Common Symptoms of Urinary Common Symptoms of Urinary Tract DisordersTract Disorders
anorexia, nausea, vomitinganorexia, nausea, vomitingmalaise, fatigue, lethargymalaise, fatigue, lethargynocturia, hematuria, pyuria, proteinurianocturia, hematuria, pyuria, proteinuriadysuria, urgency, frequencydysuria, urgency, frequencypain in lumbar region or flankpain in lumbar region or flankfeverfeveredema and ascitesedema and asciteshypertension and shortness of breathhypertension and shortness of breath
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Urinary Tract Disorder Urinary Tract Disorder Medications:Medications:
Common Side EffectsCommon Side Effectsdrying of secretionsdrying of secretionsdrowsiness, dizzinessdrowsiness, dizzinessrashrashgastrointestinal symptomsgastrointestinal symptomsheadachesheadachesbradycardia/tachycardiabradycardia/tachycardiadiscolored urinediscolored urine
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Urinary SystemUrinary System
Figure 27-1 Components of the urinary system. (From Frazier MS, Drzymkowski JW: Essentials of human diseases and conditions, ed 4, St Louis, 2008, Saunders.)
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Medications That May Alter Urine Medications That May Alter Urine ColorColor
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DiureticsDiureticsDiuretics are used to treat the edema Diuretics are used to treat the edema
that occurs with cirrhosis, nephrotic that occurs with cirrhosis, nephrotic disease, and renal failure.disease, and renal failure.
The place of action depends on the The place of action depends on the segment of the nephron that is affected.segment of the nephron that is affected.
For further information see Chapter 27 – For further information see Chapter 27 – Circulatory DisordersCirculatory Disorders
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Nephron and Sites of DiureticsNephron and Sites of Diuretics
Figure 27-2 Anatomy of a nephron.
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Patient Education with the Use of Patient Education with the Use of DiureticsDiuretics
Take in the morning so medication will not Take in the morning so medication will not interfere with sleep.interfere with sleep.
Eat foods rich in potassiumEat foods rich in potassiumif taking thiazide diuretics. if taking thiazide diuretics.
Watch for signs of orthostatic hypotension, Watch for signs of orthostatic hypotension, electrolyte imbalance.electrolyte imbalance.
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Signs of Electrolyte ImbalanceSigns of Electrolyte Imbalance
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Urinary Tract Infections (UTIs)Urinary Tract Infections (UTIs)Symptoms include frequency, urgency, Symptoms include frequency, urgency,
dysuria, incontinence, hematuria, and dysuria, incontinence, hematuria, and voiding only small amounts of urine at a voiding only small amounts of urine at a time.time.
About 90% of all UTIs are caused by About 90% of all UTIs are caused by Escherichia coli.Escherichia coli.
The bladder can be irritated by acidic The bladder can be irritated by acidic foods.foods.
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guavaguavapeachespeachesplumsplumsstrawberriesstrawberriesteateatomatoestomatoesvinegarvinegarvitamin B complexvitamin B complex
Foods That Irritate the BladderFoods That Irritate the Bladderalcoholic beveragesalcoholic beveragesapples and apple juiceapples and apple juicecantaloupecantaloupecarbonated beveragescarbonated beverageschocolatechocolatecitrus fruitscitrus fruitscoffeecoffeespicy foodsspicy foods
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Medications for Urinary Tract Medications for Urinary Tract InfectionsInfections
Septra, BactrimSeptra, BactrimPyridium, AZOPyridium, AZOUrispasUrispasDitropanDitropanDetrolDetrolTofranilTofranilDDAVPDDAVP
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UTI Medications - SulfonamidesUTI Medications - SulfonamidesSulfonamides are drugs of choice for UTIs.Sulfonamides are drugs of choice for UTIs.TMP-SMZ is the preferred medication for TMP-SMZ is the preferred medication for
UTIs.UTIs.Side effects of TMP-SMZ are Side effects of TMP-SMZ are
hypersensitivity, kernicterus, and renal hypersensitivity, kernicterus, and renal injury.injury.
Sulfonamides should be discontinued at the Sulfonamides should be discontinued at the first sign of a hypersensitivity reaction.first sign of a hypersensitivity reaction.
Sulfonamides may increase the effects of Sulfonamides may increase the effects of warfarin and oral hypoglycemics.warfarin and oral hypoglycemics.
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Causes of and Prophylaxis of UTIsCauses of and Prophylaxis of UTIsE. coli is the most common cause of E. coli is the most common cause of
uncomplicated UTIs.uncomplicated UTIs.Most UTIs can be treated on an Most UTIs can be treated on an
outpatient basis with oral medications.outpatient basis with oral medications.Prophylaxis for a UTI may be achieved Prophylaxis for a UTI may be achieved
with low doses of trimethoprim, TMP-with low doses of trimethoprim, TMP-SMZ, or urinary antiseptics.SMZ, or urinary antiseptics.
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Patient Education with UTI Patient Education with UTI MedicationsMedications
Take sulfonamides (drug of choice) on Take sulfonamides (drug of choice) on empty stomach with full glass of water.empty stomach with full glass of water.
Complete entire course of treatment.Complete entire course of treatment.Avoid prolonged exposure to sunlight.Avoid prolonged exposure to sunlight.Drink 8 to 10, 8-ounce glasses of water Drink 8 to 10, 8-ounce glasses of water
each day.each day.
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Antiseptics, Analgesics, Antiseptics, Analgesics, AntispasmodicsAntispasmodics
Antiseptics are the second-line drug choice Antiseptics are the second-line drug choice for UTIs.for UTIs.
Pyridium can be used as an analgesic or local Pyridium can be used as an analgesic or local anesthetic on the urinary tract mucosa.anesthetic on the urinary tract mucosa.
Pyridium is used only for the symptomatic Pyridium is used only for the symptomatic relief of burning, pain, discomfort, or relief of burning, pain, discomfort, or urgency.urgency.
Urinary antispasmodics reduce the strength Urinary antispasmodics reduce the strength and frequency of urinary bladder contraction.and frequency of urinary bladder contraction.
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Patient Education with Antiseptics, Patient Education with Antiseptics, Analgesics, AntispasmodicsAnalgesics, Antispasmodics
Pyridium may change urine to orange-red Pyridium may change urine to orange-red color, which may stain clothing.color, which may stain clothing.
Large doses of vitamin C will promote acidic Large doses of vitamin C will promote acidic urine, making urinary antiseptics more effective.urine, making urinary antiseptics more effective.
Fever may be sign of drug reaction.Fever may be sign of drug reaction.Urinary antispasmodics may cause drowsiness.Urinary antispasmodics may cause drowsiness.Urinary antispasmodics reduce Urinary antispasmodics reduce
strength/frequency of urinary bladder strength/frequency of urinary bladder contractions.contractions.
Detrol—treats overactive bladder (relaxes Detrol—treats overactive bladder (relaxes bladder muscles)bladder muscles)
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Miscellaneous Urinary Tract Miscellaneous Urinary Tract MedicationsMedications
Enuresis (bed-wetting) common in Enuresis (bed-wetting) common in childrenchildren Tofranil improves enuresis symptoms in some Tofranil improves enuresis symptoms in some
children.children.DDAVP (desmopressin)—hormone DDAVP (desmopressin)—hormone
increasing water reabsorption; nasal increasing water reabsorption; nasal sprayspray
Withholding fluids at bedtime is not Withholding fluids at bedtime is not effective in treating enuresis.effective in treating enuresis.
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