Urinary/Renal DRUGS

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nitrofurantoin/ Macrodantin, Macrobid

URINARY TRACT ANTISEPTIC (not an antibiotic)
become concentrated in urine, not in blood & need contact with living tissue.
not-well absorbed; less systemic effects
take with food or milk to lessen GI distress
Don't crush= stained teeth
antacids DECREASE absorption
Acidic urine (pH<5.5)- Take Vit C, cranberries, prunes (carbonated beverages= alkaline effect)
Increase fluid intake
for prophylaxis of recurrent UTI, take low dose at bedtime

phenazopyridine/ Pyridium

URINARY TRACT ANALGESIC
AZO dye exerts local anesthetic action on urinary tract mucosa, NOT antibacterial action.
Rx: burning with urination; pain relief, post urinary procedures
Nsg: take with meals
urine bright orange to brown; WILL stain clothing
Take 2-3 days to relieve pain; d/c if pain relieved
CHECK ASA allergy
Long use- toxicity, yellow sclera; hemolytic anemia = check BUN & creatitine

urised

URINARY TRACT ANALGESIC
urinary antiseptic, analgesic, and anticholinergic combination
helps to kill bacteria in the urine, decreases pain/ inflammation, reduce muscle spasms in urinary tract
Avoid if allergy to ASA, NSAIDS
Urine turns blue due to methylene blue ingredient

trimethoprim-sulfamethoxazole/ Bactrim, Septra

SULFONAMIDES AND TRIMETHOPRIM
introduced 1970s, sulfonamide use expanded again
Caution: with sulfa allergy, thiazide or loop diuretics
Adverse effects: rash, anemias, photosensitivity
NSG: complete prescription; empty stomach, full glass of water; increase fluid

bethanechol/ Urecholine, Duvoid, Urabeth

URINARY STIMULANT/MUSCARINIC AGONIST/ PARASYMPATHOMIMETIC/ CHOLINERGIC AGENT
Bind to muscarinic receptors within parasympathetic nervous system
relaxes urinary sphincter, contracts detrussor muscle of bladder, increase bladder tone
Rx: non-obstructive Urinary Retention; neurogenic bladder= nerves arent stimulating bladder
se: vasodilation/hypotension, abdominal cramp (cholinergic action; caution bronchoconstriction
Nsg: will cause voiding within 30-90 minutes
monitor BP, P, R and I&O
monitor for excess cholinergic effects- salivation, sweating, flusing, n/v/d
Take 1 hr ac or 2 hr pc; dose titered to reach effectiveness (altered to get the side effects needed)

oxybutynin (Ditropan, Ditropan XL

MUSCARINIC ANTAGONISTS/PARASYMPATHOLYTIC/ MUSCARINIC BLOCKERS/ ANTICHOLINERGIC/ ANTISPASMOTIC
block muscarinic receptors in urinary tract reduces pressure within bladder and increases tone of urinary sphincter; prevent involuntary bladder contraction; increase bladder capacity
Rx: urge incontinence, overactive bladder, post-op transurethral procedures, nocturia
se: anticholinergics, esp dry mouth, constipation, dry eyes, dyspepsia
NSG: void before taking med to minimize urinary retention

epotein alfa / Erythropoietin

HRMSYOPOIRYIV=Build blood
stimulate production of RBCs, but need iron, folic acid, Vit B12 to work (lack of any will cause anemia)
Low oxygen and anemia stimulate erythropoietin release normally from kidney--> bone marrow
use to increase HCT of anemia secondary to CRF; HCT increases in 2-4 weeks
Administered IV or SC; Do not shake vial
se: may increase BP
Nsg: monitor HCT and BP; check clotting in AV fistula "feel the trill
No intrinisic factor=B12, shots for life
Folic acid- H20 Soluble vitamin (eggs, green leafy veggies, liver)

ferrus sulfate/ Feosol

HEMATOPOIETIC
iron supplement to treat anemia
Administer 1 hr ac or 2 hr pc
if gastric irritation take with meal, but less absorption
antacids and calcium decrease absorption; Vit C increases absorption
Darkens Stool
Vitamin B12 (cyancobalamin) IM or SC

sildenafil/ Viagra

ERECTILE DYSFUNCTION
35-75% of DM; advancing age, drugs: HTN meds, SSRIs, Thiazides, B blockers
1998- In absence of sexual activity nothing happens
se: hypotension,priaprism (long lasting painful erection, se: flushing, headache, dyspepsia)
Nsg: avoid nitrates; high fat meals delay effects
nitric oxide causes vasodilation
viagra-release with sexual stimulation

tadalafil/ Cialis--vardenafil/ Levitra

same as viagra
take 30 min to 4 hr before sexual activity for both

finasteride/ Proscar

BPH
5-ALPHA-REDUCTASE INHIBITORS
reduces epithelial tissue of mechanical obstruction by inhibiting enzyme that converts testosterone into its active from dihydrotestosterone (DHT)
Rx: highly enlarged prostate cases; effects in 6-12 months
also, lower dose used to treat male pattern baldness (Propecia)
se: decrease ejaculate volume, decrease libido, grow breast tissue
Nsg: check PSA levels before and during rx... level should decrease
take with/without food for LIFE

dustasteride/ Avodart

BPH
5-ALPHA-REDUCTASE-INHIBITORS
similiar to finasteride, with more DHT reduction
harmful to developing male fetus; Category X
pregnant women should not handle it; absorbs through skin
men should not donate blood for 6 months to 1 year from stopping med
long half life- 5 weeks
se: Nsg: same as Proscar

tamsulosin/ Flomax

BPH
ALPHA1-ADRENERGIC ANTAGONISTS/ ALPHA BLOCKERS
Relax smooth muscles in prostate, urethra bladder neck... decreases dynamic obstruction of urethra.
Block alpha receptors in systemic blood vessels and prostate
improvement of symptoms and urinary flow develop rapidly
rx: mild prostatic enlargement; client with HTN and BPH
selective for alpha receptos in prostate take daily 30 mins before same meal
Nsg blood pressure

premarin

ESTROGEN
used for menopause (HRT) Horomone replacement therapy
osteoporosis with menopause
rx: uterus dysfunction
*rx: used to treat prostate cancer in males
Se: nausea
PO= hs TD=patch 1 wk-trunk of body Intravaginal
*Weight bearing will keep Ca+ in bones
Nsg: risk for thromboembolyi (red, pain, edema, warmth)
break through for bleeding,self breast exam every month

progestin/ Provera

with HRT
IM,Intravaginal, SQ, Trans
Megace (stimulates appetite
uterine bleeding, amenorrhea, endometriosis
Se: breast cancer
HPV vaccine 3 doses x 6 mo

BPH

overgrowth of cells cause mechanical obstruction of urethra
overgrowth of smooth muscle causes dynamic obstruction of urethra
50% of men by age 60;90% by age 85
rx: drugs, surgery(TURP), "watchful waiting"

testosterone

Need to produce androgen
will increase LDL, and decrease HDL
promotes synthesis of erythropoietin

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