ATI section 8: Medications Affecting the Urinary System Flashcards
Diuretics
- Action: increase the amount of fluid excretion via the renal system
- Loop: Furosemide, Bumetanide
- Thiazide: Hydrochlorothiazide, Chlorothiazide
- Potassium Sparing: Spironolactone, Triamterene
Diuretics
Therapeutic use
- Pulmonary edema caused by heart failure
- Edema unresponsive to other diuretics
Diuretics
Precautions/Interactions
- Use cautiously in clients who have DM
- Contraindicated during pregnancy
- NSAIDs reduce diuretic effect
Diuretics
Side/Adverse Effects
-Loop and thiazide diuretics: Hypovolemia Ototoxicity Hypokalemia Hyponatremia Hyperglycemia Digoxin toxicity Lithium toxicity
-Potassium-sparing diuretics
Hyperkalemia
Endocrine effects (impotence, menstrual irregularities
Osmotic Diuretics
-Mannitol
-Therapeutic Use
Prevent renal failure related to hypovolemia
Decrease intracranial pressure related to cerebral edema
Decrease intraocular pressure
-Precautions/Interactions
Use with caution in heart failure
May increase digoxin levels due to hypokalemia
-Side/Adverse Effects
Pulmonary edema
F&E imbalances
Thirst, dry mouth
-Nursing Interventions and Client Education
Monitor daily weight, I&O, and electrolytes
Monitor for signs of hypovolemia
Monitor neurological status
Osmotic Diuretics
-Mannitol
-Therapeutic Use
Prevent renal failure related to hypovolemia
Decrease intracranial pressure related to cerebral edema
Decrease intraocular pressure
-Precautions/Interactions
Use with caution in heart failure
May increase digoxin levels due to hypokalemia
-Side/Adverse Effects
Pulmonary edema
F&E imbalances
Thirst, dry mouth
-Nursing Interventions and Client Education
Monitor daily weight, I&O, and electrolytes
Monitor for signs of hypovolemia
Monitor neurological status
Diuretics
Therapeutic use
- Pulmonary edema caused by heart failure
- Edema unresponsive to other diuretics
Diuretics
Precautions/Interactions
- Use cautiously in clients who have DM
- Contraindicated during pregnancy
- NSAIDs reduce diuretic effect
Sexual Dysfunction
-Sildenafil (Viagra), Tadalfil (Cialis), Vardenafil (Levitra)
-Therapeutic Use
Erectile dysfunction
Sexual dysfunction in women (unlabeled use)
-Precautions/Interactions
Contraindicated for clients taking nitrate drugs, anticoagulants, alpha blockers for BPH, or antihypertensives
Contraindicated for clients who have a hx of stroke, uncontrolled DM, hypo/hypertension, or heart failure
-Side/Adverse Effects
headache, heartburn, diarrhea, flushing, nosebleeds, difficulty falling asleep, paresthesias, muscle aches, changes in color vision, sensitivity to light
Nursing Interventions and Client Education
- Administer 1 hr before sexual activity, do not use more than once daily
- Instruct avoid intake of any organic nitrates
- Instruct client to stop taking medication and notify prescriber immediately for any of the following: erection lasting longer than 4 hr, any loss of vision, and unusual bleeding problems
Diuretics
Nursing Interventions and Client Education
- Monitor I&O
- Monitor vital signs
- Monitor F&E imbalances
- Administer early morning to prevent nocturia
- Instruct clients taking loop/thiazide diuretics to increase intake of foods high in potassium
- Instruct clients taking potassium-sparing diuretics to avoid salt substitutes
Osmotic Diuretics
-Mannitol
-Therapeutic Use
Prevent renal failure related to hypovolemia
Decrease intracranial pressure related to cerebral edema
Decrease intraocular pressure
-Precautions/Interactions
Use with caution in heart failure
May increase digoxin levels due to hypokalemia
-Side/Adverse Effects
Pulmonary edema
F&E imbalances
Thirst, dry mouth
-Nursing Interventions and Client Education
Monitor daily weight, I&O, and electrolytes
Monitor for signs of hypovolemia
Monitor neurological status
Alpha-Adrenergic Blockers for Urinary Hesitancy
Tamsulosin
-Inhibits smooth muscle contraction in the prostate, which improves the rate of urine flow for clients with BPH
-Precautions/Interactions
Must rule out bladder cancer prior to administering
Combined use with cimetidine may facilitate toxicity
-Side/Adverse Effects
May cause decreased libido, reduce ejaculate
-Nursing Interventions and Client Education
Take 30 min after meat at same time each day
Teach client to contact prescriber if greater than 4 doses are missed
Alpha-Adrenergic Blockers for Urinary Hesitancy
Bethanechol
-Increases detrusor muscle tone to allow strong start to voiding for clients with postoperative urinary hesitancy
-Precautions/Interactions
Do not administer IV or IM
Contraindicated for clients with hypotension or decreased cardiac output
-Side/Adverse Effects
Excessive salivation, tearing
-Nursing Interventions and Client Education
Administer on empty stomach
Anticholinergic Medications for Overactive Bladder
- fenacin, dine, Oxybutynin, Trospium
-Therapeutic Use
Urinary incontinence
Urinary urgency and frequency
-Precautions/Interactions
Do not use for clients who have intestinal obstruction
Use with other anticholinergics can increase anticholinergic effects
-Side/Adverse Effects
Anticholinergic symptoms
Drowsiness
Dyspepsia
-Nursing Interventions and Client Education
Administer medication with a full glass of water
Instruct client that full effects may take 1-2 months
Instruct client to manage anticholinergic side effects
instruct client to report constipation lasting longer than 3 days
Sexual Dysfunction
- Sildenafil (Viagra), Tadalfil (Cialis), Vardenafil (Levitra)
- Therapeutic Use
