Medications Affecting the urinary system

SECTION 8

Medications Affecting
the Urinary System

, Diuretics
A Action: Increase the amount of fluid excretion via the renal system

DIURETIC MEDICATIONS

Loop

Furosemide
Bumetanide

a. Therapeutic Use

Thiazide Potassium Sparing
Hydrochlorothiazide Spironolactone
Chlorothiazide Triamterene

1. Pulmonary edema caused by heart failure
2. Edema unresponsive to other diuretics
3. Hypertension unresponsive to other diuretics

c. Precautions/Interactions
1. Use cautiously in clients who have diabetes mellitus.
2. Contraindicated in pregnancy.
3. NSAIDs reduce diuretic effect.

o. Side/Adverse Effects
1. Loop and thiazide diuretics

a. Hypovolemia
b. Ototoxicity (loop diuretics)
c. Hypokalemia
d. Hyponatremia
e. Hyperglycemia
f. Digoxin toxicity
9. Lithium toxicity

2. Potassium-sparing diuretics
a. Hyperkalemia
b. Endocrine effects (impotence,

menstrual irregularities)
1ji; E. Nursing Interventions and Client Education

~p

1. Monitor I&O.
2. Monitor vital signs.
3. Monitor for F&E imbalances.

4. Administer early morning to prevent nocturia .
s. Instruct clients taking loop/thiazide diuretics to

increase intake of foods high in potassium.

6. Instruct clients taking potassium-sparing diuretics to
avoid foods high in potassium such as salt substitutes.

0 motic Diuretics 11 5
. d b k into the vascular and extravascutar

A. Action: P~ll flm . a~erum osmolality to promote space by mcreasmg
osmotic changes

8_ Medication
1. Mannitol

c. Therapeutic Uses .
1. Prevent renal failure related to hypovolem1a
2. Decrease intracranial pressure related to

cerebral edema
3. Decrease intraocular pressure

o. Precautions/Interactions
,. Use with caution in heart failure .

E. Side/Adverse Effects
1. Pulmonary edema
2. F&E imbalances
3. Thirst, dry mouth

CE F. Nursing Interventions and Client Education
1. Monitor daily weight, I&O, and electrolytes.
2. Monitor for signs of hypovolemia.
3. Monitor neurological status.

111 Alpha Adrenergic Blockers
for Urinary Hesitancy
A Tamsulosin

1. Action: Inhibits smooth muscle contraction in the
prostate, which improves the rate of urine flow for clients with BPH

2. Precautions/Interactions

a. Mus! r_ule ~ut bladder cancer prior to
adm1mstenng tamsulosin.

b. Combined use With cimetidine may
facilitate toxicity.

c. Use cauti?usly With medications causing
hypotens1on (such as sildenafil)

B. Bethanechol

,. Action: Increases detrusor muscle tone to allow st
~ong shtart_ to voiding for clients with postoperative unnary es1tancy

2. Precautions/Interactions

a. Contraindicated for clients Who ha .
tract obstructi ve urmary on.

b. Contraindicated for clients With h .
decreased cardia YPotens1on or

c output. May cause bradycardia.

ADRENERGIC BLOCKERS

Tarnsulosin

510Ef/lDVERSE
EFFECTS

May cause decreased libido, headache, and
dizziness

:—-
u NURSING ‘lJ INTERVENTIONS

AND CLIENT
EDUCATION

Take 30 min’ after meal at same time each day
If dose is missed for several days, restart at the
lowest dose
Can cause orthostatic hypotension 1

Bethanech’._’..’o:_I ________ ~:—–:——-
— Excessive salivation, abdominal cramps,

s10E/ADVERSE diarrhea
EFFECTS

Administer on empty stomach
‘lJ INTERVENTIONS

Anticholinergic Medications
for Overactive Bladder ,
A Action: Antispasmodic actioi:is to decrease detrusor

muscle spasms and contract10ns

8 Medications
1. oxybutynin
2 Tolterodine
3. Darifenacin
4. Solifenacin
s. Trospium
6. Fesoterodine

c. Therapeutic Use
1. Urinary incontinence
2. Urinary urgency and frequency

o. Precautions/Interactions
1. Do not use for clients who have intestinal obstruction.
2. Use with other anticholinergics can increase

anticholinergic effects.
3. Risk for cognitive irnpairment in older clients. ,, .

E. Side/Adverse Effects
1. Anticholinergic symptoms
2. Drowsiness
1 Dyspepsia c~F. Nursing Interventions ind Client Edu~ation

‘ • I

1. Instruct client to manage. anticholinergic side effects.
2. Instruct client to rep~rt constipation lasting longer

than 3 days. · ”

THE COMPREHENSIVE NCLEX-RN® REVIEW

v Sexual Dysfunction ,
A. Action:. Enhances_ the effect of nitric oxide to promote

relaxation of pemle muscles, alilowing increased blood
flow to produce an erection

B. Medications ‘
1. Sildenafil
2. Tadalafil
3. Vardenafil

c. Therapeutic U~es
1. Erectile dysfunction
2. Less commonly used in the treatment of .pulmonary

arterial hypertension ‘ , ,. , 1
‘ , ,

D. Precautions/Jnteractions ,, ‘
1. Contraindicated for clients taking f\itrate drugs, alpha ,, !’ ,

blockers for BPH, or antihypertensives. . , , , ,
2. Contraindicated for clients who have histofy of stroke,

hypo/hypertension, or heart failure,, I ‘ ‘ ‘ • ‘

E. Side/Adverse Effects
1. Hypotension·
2. Priapism (erection lasting longe~ tµan 4 hr)
3. Vision impairment
4. Hearing loss
s., Headache

. ,,

6. Flushing ,

‘ .,· ,,

(Ji] F. Nursjpg Interventions and Cli~’nt·Education ‘ :
‘ .1. Administer 1 hr before sexual activity; do not ,use more
· th,m Ol)Ce daily. <. , , , '· · •

2. Instruct client to notify provider .’of•/~11 rnedicatiohs
‘ ,\11 l , ‘ currently taken, including herbal preparation~.

3. Instruct client’to avoid intake of a1:w organic nitra~es.
4. Instruct client to stop taking medit;ation’ an¢:ri’otify

prescriber immediately fo+ ere~tion lasting longer ¢an
‘4 hr or any l,oss of vision. )’, l’,.

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