DRUGS AFFECTING THE - Urinary frequency, urgency, burning on urination

(cystitis)
URINARY TRACT AND THE BLADDER - Chills, fever, flank pain
Glossary of Key Terms - Tenderness (acute pyelonephritis)
Acidification • Clinicians use specific urinary tract anti-infectives
- The process of increasing the acid level (antibiotics) that reach antibacterial levels only in the
- Used to treat bladder infections, making the bladder kidney and bladder and are thought to sterilize the
an undesirable place for bacteria urinary tract
Antispasmodics
- Agents that block muscle spasm associated with
irritation or neurological stimulation
Benign prostatic hyperplasia (BPH)
- Enlargement of the prostate gland, associated with
age and inflammation
- Also called benign prostatic hypertrophy
Cystitis
- Inflammation of the bladder, caused by infection or
irritation
Dysuria
- Painful urination
Interstitial cystitis URINARY TRACT ANTI-INFECTIVES
- Chronic inflammation of the interstitial connective
Antibiotics effective against Antibiotics that works
tissue of the bladder
Gram negative bacteria that to acidify urine, killing
- May extend into deeper tissue
cause most UTIs the bacteria that might
Nocturia
be in the bladder
- Getting up to void at night, reflecting increased renal
perfusion with fluid shifts in the supine position -Cinoxacin - Methanamine
when a person has gravity-dependent edema related -Norfloxacin - Methylene blue
to heart failure -Fosfomycin
- Other medical conditions, including UTI, increased -Nalidixic acid
the need to get up and void -Nitrofurantoin
Pyelonephritis -Ciprofloxacin (not exclusive
- Inflammation of the pelvis of the kidney, frequently for UTI)
caused by backward flow problems or by bacteria -Cotrimoxazole (not exclusive
ascending the ureter for UTI)
Urgency
- The feeling that one needs to void immediately • Act specifically within the urinary tract to destroy
- Associated with infection and inflammation in the bacteria, either through a direct antibiotic effect or
urinary tract through acidification of the urine
Urinary frequency • Drugs with an antibiotic effect interfere with
- The need to void often reproduction of the Gram-negative bacteria and
- Usually seen in response to irritation of the bladder, cause bacterial death
age, and inflammation • Those that cause acidification of the urine produce
an environment that is not conducive to bacterial
Conditions affecting the urinary tract and bladder are survival, leading to bacterial cell death
common problems and includes: • Used to:
- Urinary tract infections (UTIs) - Treat chronic UTIs
- Bladder spasms - Adjunctive therapy in acute cystitis and
- Bladder pain pyelonephritis
- Benign prostatic hyperplasia (BPH) - Prophylaxis with urinary tract anatomical
*Acute UTIs occur second in frequency only to respiratory abnormalities and residual urine disorders
infections
*Population vulnerable to repeated urinary tract, bladder, • Cinoxacin, taken orally, rapidly absorbed, undergoes
and kidney infections hepatic metabolism, and is excreted in urine
- Females (shorter urethra) • Norfloxacin, newer and broad-spectrum drug, more
- Children effective than Cinoxacin.
- Patients with indwelling catheter or intermittent • Fosfomycin, taken orally, has the convenience of
bladder catheterizations (cystitis) only a one-time dose. Unpleasant GI effects limits its
- Blockage anywhere in the urinary tract  backflow usefulness in some patients
problems spread into the kidney (pyelonephritis) • Nalidixic acid, older drug that is not effective against
as many strains due to its short half-life. Commonly
• Signs and symptoms of a UTI used in children
 • Nitrofurantoin, very short half-life. Used for
suppression therapy in chronic UTIs.
• Methenamine has established dose guidelines for
children and comes in suspension form
• Methylene blue is well absorbed orally, widely
distributed, metabolized in the tissues, and excreted
in urine, bile, and feces
• All medications needs dose adjustment in renal
impairment except nitrofurantoin
• Cinoxacin, norfloxacin, nalidixic acid, nitrofurantoin,
and methenamine crosses the placenta and enter
breast milk
• Fosfomycin might be a drug of choice for cystitis
during pregnancy or lactation
Contraindications and Cautions
• Known allergy – hypersensitivity reaction
• Caution in presence of renal dysfunction, pregnancy,
and lactation
Adverse Effects
• Nausea, vomiting, diarrhea, anorexia, bladder
irritation, and dysuria
• Infrequent symptoms: pruritus, urticaria, headache,
dizziness, nervousness, confusion – result from GI
irritation
Drug-Drug Interactions
• Drug-drug interactions that can occur are very
specific to the drug being used
• Consult a nursing drug guide for specific interactions