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Drugs For Urinary Tract Disorders

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Unit 5 (X)- Chapter 34 pg. 471

updated 7 years ago by jncanf

Grade levels:
College: First year, College: Second year, College: Third year, College: Fourth year, Graduate school, Professional

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1

URINARY TRACT DISORDERS ARE CAUSED BY?

URINARY TRACT INFECTIONS (UTIs): MICROBIAL INFECTIONS OF ANY PART OF THE URINARY TRACT)

2

UTIs:

CAN RESULT FROM AN UPPER UTI, SUCH AS PYELONEPHRITIS, OR A LOWER UTI SUCH AS CYSTITIS, URETHRITIS, OR PROSTATITIS.

3

A GROUP THAT PREVENTS BACTERIAL GROWTH IN THE KIDNEYS AND BLADDER, BUT IS NOT EFFECTIVE FOR SYSTEMIC INFECTIONS

URINARY ANTISEPTICS/ANTIINFECTIVES: THEY HAVE BACTERIOSTATIC (INHIBIT BACTERIAL GROWTH) EFFECTS WHEN GIVEN IN LOW DOSAGES. ALSO HAVE BACTERICIDAL (KILL BACTERIA) EFFECT WHEN GIVEN IN HIGH DOSAGES.

4

RELIEVE PAIN AND BURNING IN THE URINARY TRACT

URINARY ANALGESICS

5

AGENTS THAT INCREASE MUSCLE TONE OF URINARY MUSCLES

URINARY STIMULANTS

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ACUTE CYSTITIS

LOWER UTI. USUALLY IN FEMALES BECAUSE OF THEIR SHORTER URETHRA. MORE COMMON IN WOMEN OF CHILDBEARING AGE, OLDER WOMEN, AND YOUNG GIRLS. CAUSED BY Escherichia coli. OTHER BACTERIAL CAUSES INCLUDE: GRAM-POSITIVE Staphylococcus saprophyticus, GRAM-NEGATIVE Klebsiella, Proteus, and Pseudomonas. SYMPTOMS OF CYSTITIS: PAIN AND BURNING OF URINATION AND URINARY FREQUENCY AND URGENCY. URINE CULTURE TAKEN BEFORE ANY START OF ANY ANTIINFECTIVE/ANTIBIOTIC DRUG THERAPY. IN MALE CLIENTS, LOWER UTI IS MOST LIKELY PROSTATITIS WITH SYMPTOMS SIMILAR TO CYSTITIS.

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ACUTE PYELONEPHRITIS

UPPER UTI. COMMONLY SEEN IN WOMEN OF CHILDBEARING YEARS, OLDER WOMEN AND YOUNG GIRLS. E. coli IS THE COMMON CAUSE. SYMPTOMS: CHILLS, HIGH FEVER, FLANK PAIN, PAIN DURING URINATION, URINARY FREQUENCY AND URGENCY, AND PYURIA. BACTERIAL COUNT IN URINE IS GREATER THAN 100,000 BACTERIA/mL. IN SERVER CASES CLIENT MAY BE HOSPITALIZED AND RECEIVE (IV) ANTIBIOTICS (e.g. AN AMINOGLYCOSIDS, TICARCILLIN/CLAVULANIC ACID, OR PIPERACILLIN/TAZOBACTAM)

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URINARY ANTISEPTICS/ANTIINFECTIVES AND ANTIBIOTICS:

URINARY ANTISEPTICS/ANTIINFECTIVES ARE LIMITED TO THE TREATMENT OF UTIs. DRUG ACTION OCCURS IN THE RENAL TUBULE AND BLADDER, WHERE IT IS EFFECTIVE IN REDUCING BACTERIAL GROWTH. A URINALYSIS, AND CULTURE AND SENSITIVITY TEST, IS USUALLY PREFORMED BEFORE INITITATION OF DRUG THERAPY. THE GROUP OF URINARY ANTISEPTICS/ANTIINFECTIVES ARE NITROFURANTOIN, METHENAMINE, TRIMETHOPRIM, AND THE FLUOROQUINOLONES.

9

NITROFURANTOIN:

DRUG CLASS AND DOSAGE:

DRUG CLASS: URINARY ANTIINFECTIVE
TRADE NAME- FURADANTIN, MACRODANTIN
PREGNANCY CATEGORY: B

DOSAGE:
A: PO 50 TO 100 MG q.i.d WITH MEALS AND AT BEDTIME. TAKE WITH FOOD; MAX: 7 MG/KG/D
C: >1 mo; PO 1.25 TO 1.75 MG/KG/D IN 4 DIVIDED DOSES; MAX: 7 MG/KG/D

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NITROFURANTOIN:

CONTRAINDICATIONS AND DRUG-LAB FOOD INTERACTIONS:

CONTRAINDICATIONS:HYPERSENSITIVITY, MODERATE TO SEVERE RENAL IMPAIRMENT, OLIGURIA, ANURIA.
CLcr <40 mL/MIN, INFANTS <1 MO, TERM PREGNANCY, LACTATION WITH INFANT SUSPECTED OF HAVING G-6-PD DEFICIENCY.
CAUTION: VITAMIN B DEFICIENCY; ELECTROLYTE IMBALANCE, DIABETES MELLITUS.
DRUG-LAB FOOD INTERACTIONS:
DRUG- DECREASE EFFECT WITH PROBENECID; DECREASED ABSORPTION WITH ANTACIDS.

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NITROFURANTOIN:

PHARMACOKINETICS AND PHARMACODYNAMICS:

PHARMACOKINETICS: ABSORPTION: WELL ABSORBED FROM GI TRACT, ENHANCED WITH FOOD
DISTRIBUTION: PB: 20% TO 60%, CROSSES PLACENTA, EXCRETED IN BREAST MILK
METABOLISM: t1/2 20 MIN
EXCRETION: IN URINE, SMALL AMOUNTS IN BILE

PHARMACODYNAMICS: PO: ONSET UK
PEAK: 30 MIN
DURATION: UK
IF SUDDEN ONSET OF DYSPNEA, CHEST PAIN, COUGH, FEVER AND CHILLS DEVELOP CLIENT MUST CONTACT HEALTH CARE PROVIDER, SYMPTOMS RESOLVE AFTER DISCONTINUED USE.

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NITROFURANTOIN:

THERAPEUTIC EFFECTS/USES, SIDE EFFECTS, AND ADVERSE REACTIONS

THERAPEUTIC EFFECTS/USES: TO TREAT ACUTE AND CHRONIC UTIs.
MODE OF ACTION: INHIBITS BACTERIAL ANZYMES AND METABOLISM

SIDE EFFECTS: ANOREXIA, NAUSEA, VOMITING, RUST/BROWN DISCOLORATION OF URINE, DIARRHEA, RASH, PRURITUS, DIZZINESS, HEADACHE, DROWSINESS, ABDOMINAL PAIN, DYSPNEA, CHEST PAIN, FEVER, COUGH

ADVERSE REACTIONS: SUPERINFECTION, PERIPHERAL NEUROPATHY, HEMOLYTIC ANEMIA, AGRANULOCYTOSIS
LIFE-THREATENING: ANAPHYLAXIS, HEPATOTOXICITY, STEVENS-JOHNSON SYNDROME

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NITROFURANTOIN:

MORE INFORMATION

IS A BACTERIOSTATIC AND BACTERICIDAL. EFFECTIVE AGAINST MANY GRAM-NEGATIVE, AND GRAM-POSITIVE ORGANISMS, ESPECIALLY E. coli. USED TO TREAT ACUTE AND CHRONIC UTIs. CAN BE TAKEN WITH FOOD TO DECREASE GI DISTRESS. DECREASED ABSORPTION OF DRUG IS TAKEN WITH ANTACIDS. IS MODERATELY PROTEIN-BOUND WITH NORMAL RENAL FUNCTION. RAPIDLY ELIMINATED BECAUSE OF ITS SHORT LIFE, BUT ACCUMULATES IN THE SERUM WITH URINARY DYSFUNCTION.

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METHENAMINE (Hiprex):

HAS BACTERICIDAL EFFECT WHEN THE URINE IS LESS THEN 5.5. AVAILABLE AS HIPPURATE SALT.
EFFECTIVE AGAINST GRAM-NEGATIVE AND GRAM-POSITIVE ORGANISMS, ESPECIALLY E. coli AND P. aeruginosa
USED FOR CHRONIC UTIs.
NOT TO BE TAKEN WITH SULFONAMIDS, CRYSTALLURIA WILL RESULT. ABSORBED IN GI TRACT, 90% EXCRETED IN URINE UNCHANGED. IT FORMS AMMONIA AND FORMALDEHYDE IN ACID URINE; THEREFORE URINE HAS TO BE ACIDIFIED TO EXERT A BACTERICIDAL ACTION.
CRANBERRY JUICE (SEVERAL 8-OUNCE GLASSES A DAY), ASCORBIC ACID, AND AMMONIUM CHLORIDE CAN BE TAKEN TO DECREASE THE URINE pH.

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METHENAMINE (Hiprex) SIDE EFFECTS:

GI SIDE EFFECTS, INCLUDING NAUSEA, VOMITING, AND DIARRHEA. THERE HAVE BEEN ALLERGIC REACTIONS TO THE DYE IN Hiprex. BLADDER IRRITATION AND CRYSTALLURIA (WHEN TAKEN IN LARGE DOSES) MAY OCCUR.

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TRIMETHOPRIM AND TRIMETHOPRIM-SULFAMETHOXAZOLE:

TRIMETHOPRIM (PROLOPRIM) CAN BE USED ALONE FOR TREATMENT OF UTIs. USUALLY USED IN COMBINATION WITH SULFONAMIDE, SULFAMETHOXAZOLE (COMBINED PREPARATION IS GENERICALLY CALLED TMP/SMZ) TO PREVENT OCCURANCE OF TRIMETHOPRIM-RESISTANT ORGANISMS. DRUG COMBINATION PRODUCES SLOW-ACTING BACTERICIDAL EFFECTS AGAINST MOST GRAM-POSTIVE/NEGATIVE ORGANISMS. TRIMETHOPRIM USED FOR TREATMENT AND PREVENTION OF ACUTE AND CHRONIC UTIs. THE AMOUNT OF TRIMETHOPRIM IN THE PROSTATIC FLUID IS ABOUT 2 AND 3 TIMES GREATER THAN THE AMOUNT IN THE VASCULAR FLUID. t1/2 IS 8 TO 11 HOURS, LONGER IN CLIENTS WITH RENAL DISFUNCTION.

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TRIMETHOPRIM SIDE EFFECTS:

GI SYMPTOMS: NAUSEA AND VOMITTING.
SKIN PROBLEMS: RASH AND PRURITIS.

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FLUOROQUINOLONES:

URINARY ANTIBACTERIALS EFFECTIVE AGAINST LOWER UTIs.
NALIDIXIC ACID (NEG-GRAM) - 1964
NORFLOXACIN (NOROXIN) AND CIPROFLOXACIN HYDROCHLORIDE (CIPRO) - 1980s.
OFLOXACIN: 1990
LOMEFLOXACIN: 1992
NEWER FLUOROQUINOLONES:
(NORFLOXACIN, CIPROFLOXACIN, OFLOXACIN, AND LOMEFLOXACIN) EFFECTIVE AGAINST A WIDE VARIETIES OF UTIs. DRUG SHOULD BE DRECREASED WHEN RENAL DISFUNCTION IS PRESENT.
t1/2: 2 TO 8 HOURS, PROLONGED WITH RENAL DYSFUNCTION.

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FLUOROQUINOLONES SIDE EFFECTS:

NALIDIXIC ACID: HEADACHES, DIZZINESS, SYNCOPE (FAINTING), PERIPHERALNEURITIS, VISUAL DISTURBANCES, AND RASH.
CINOXACIN AND NORFLOXACIN: NAUSEA, VOMITTING, DIARRHEA, HEADACHES, AND VISUAL DISTURBANCES.
PHOTOSENSITIVITY IS COMMON WITH FLUOROQUINOLONES.

20

DRUG-DRUG INTERACTIONS CAN OCCUR WITH THE USE OF URINARY ANTISEPTICS/ANTIINFECTIVES:

1. ANTACIDS DECREASE NITROFURANTOIN ABSORPTION.
2. SODIUM BICARBONATE INHIBITS THE ACTION OF METHENAMINE.
3. METHENAMINE TAKEN WITH SULFONAMIDES INCREACE THE RISK OF CRYSTALLURIA.
4. NALIDIXIC ACID ENHANCES THE EFFECTS OF WARFARIN (COUMADIN).
5. MOST URINARY ANTISEPTICS CAUSE FALSE POSITIVE CLINITEST RESULTS.

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URINARY ANAGESICS:

PHENAZOPYRIDINE HYDROCHLORIDE (PYRIDIUM)

AN AZO DYE, A URINARY ANAGESIC (RELIEVES URINARY PAIN AND BURNING).
USED TO RELIEVE PAIN, BURNING SENSATION, AND FREQUENCY AND URGENCY OF URINATION THAT IS SYMPTOMATIC OF LOWER UTIs.
DRUG CAN CAUSE GI DISTURBANCES, HEMOLYTIC ANEMIA, NEPHROTOXICITY, AND HEPATOTOXICITY.
URINE BECOMES HARMLESS REDDISH-ORANGE BECAUSE OF DYE.
CAN ALTER THE GLUCOSE URINE TEST (CLINITEST); SO BLOOD TEST SHOULD BE USED TO MONITOR GLUCOSE LEVELS.

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URINARY STIMULANTS:

WHEN BLADDER FUNCTION IS DECREASED OR LOST AS A RESULT OF (1) NEUROGENIC BLADDER (2) DYSFUNCTION CAUSED BY A LESION OF THE NERVOUS SYSTEM (3) SEVERE HEAD INJURY, A PARASYMPATHETIC MAY BE USED TO STIMULATE MICTURITION (URINATION).
DRUG OF CHOICE: BETHANECHOL CHLORIDE (URECHOLINE) A URINARY STIMULANT, KNOWN AS DIRECT-ACTING PARASYMPATHEMIMETIC (CHOLINOMIMETIC). ACTION IS TO INCREASE BLADDER TONE BY INCREASING TONE OF THE DETRUSOR URINAL MUSCLE, THAT PRODUCES CONTRACTION STRONG ENOUGH TO STIMULATE URINATION.

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URINARY ANTISPASMODICS:

URINARY TRACT SPASMS RESULTING FROM INFECTION OR INJURY CAN BE RELIEVED WITH ANTISPASMODICS THAT HAVE A DIRECT ACTION ON THE SMOOTH MUSCLES OF THE URINARY TRACT. THIS GROUP OF DRUGS (dimethyl sulfoxide [ALSO KNOWN AS DMSO], OXYBUTYNIM [DITROPAN], AND flavoxate [URISPAS]) IS CONTRAINDICATED FOR USE OF URINARY OR GI OBSTRUCTION IS PRESENT OT IF CLIENT HAS GLAUCOMA.

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URINARY ANTIMUSCARINICS:

ANTIMUSCARINICS (AGENTS THAT BLOCK PARASYMPATHETIC NERVE IMPULSES)

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URINARY ANTISPASMODIC/ANTIMUSCARINIC SIDE EFFECTS:

DRY MOUTH, INCREASED HEART RATE, DIZZINESS, INTESTINAL DISTENTION AND CONSTIPATION. A CLIENT TAKING URINARY ANTISPASMODIC/ANTIMUSCARINICS, SHOULD BE TAUGHT TO REPORT URINARY RETENTION, SEVERE DIZZINESS, BLURRED VISION, PALPITATIONS AND CONFUSION. THEY ALSO SHOULD BE WARNED TO USE CAUTION IN HOT ENVIRONMENTS AND TO AVOID HEAT PROSTRATION.

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TOLTERODINE TARTRATE (Detrol)

AN ANTIMUSCARINIC/ANTICHOLINERGIC DRUG USED TO CONTROL AN OVERACTIVE BLADDER, WHICH CAUSES FREQUENCY IN URINATION. ALSO DECREASES URGE URINARY INCONTINENCE.

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ANTISEPTICS AND URINARY ANTIINFECTIVES:

fosfomycin tromethamine (Monurol)

ROUTE AND DOSAGE:
A: PO 3 G PACKET DISSOLVED IN 4 OZ WATER; AS A SINGLE DOSE
USES AND CONSIDERATIONS: FOR UNCOMPLICATED UTIs IN WOMEN. HAS A BACTERICIDAL EFFECT AGAINST MOST GRAM-NEGATIVE AND GRAM-POSITIVE BACTERIA. SIDE EFFECTS INCLUDE HEADACHES AND DIARRHEA. PREGNANCY CATEGORY: B; PB: 0%; t1/2 4 TO 8 H

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ANTISEPTICS AND URINARY ANTIINFECTIVES:

methenamine hippurate (Hiprex, Urex)

ROUTE AND DOSAGE:
HIPPURATE: A: PO 1 G b.i.d
C: 6 TO 12 Y: PO 0.5 TO 1 G q12h
USES AND CONSIDERATIONS: FOR CHRONIC UTIs. URINE pH SHOULD BE ACIDIC (<5.5). IT SHOULD NOT BE USED WITH SULFOMAMIDES. MAY CAUSE CRYSTALLURIA, SO PUSH FLUIDS. MAY CAUSE GI IRRITATION, SO TAKE WITH MEALS. PREGNANCY CATEGORY: C; PB: UK; t1/2 4 H

29

ANTISEPTICS AND URINARY ANTIINFECTIVES:

trimethoprim (Proloprim)

ROUTE AND DOSAGE:
A: PO 100 MG b.i.d OR 200 MG/D FOR 10 TO 14 DAYS
C: PO 2 TO 3 MG/KG/D FOR 10 D
USES AND CONSIDERATIONS: FOR PREVENTION AND TREATMENT OF ACUTE AND CHRONIC UTIs IN BOTH MEN AND WOMEN. HIGH DOSAGES CAN CAUSE GI UPSET. DRUG CAN BE COMBINED WITH SULFAMETHOXAZOLE (Bactrim). PREGNANCY CATEGORY: C; PB: 45%; t1/2 8 TO 11 H

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ANTISEPTICS AND URINARY ANTIINFECTIVES:

ertapenem (Invanz)

ROUTE AND DOSAGE:
A/ADOLESCENTS: IM/IV 1 g q.d. FOR 10 TO 14 DAYS
C: >3 MONTHS: IM/IV 15 MG/KG b.i.d FOR 10 TO 14 DAYS.

USES AND CONSIDERATIONS: TO TREAT COMPLICATED UTIs, ACUTE PELVIC INFECTIONS, AND DIABETIC FOOT INFECTIONS. EFFECTIVE AGAINST GRAM-POSITIVE AND GRAM-NEGATIVE BACTERIA. COMMONLY CAUSES DIARRHEA, NAUSEA, AND HEADACHE. PREGNANCY CATEGORY: B; PB: 95%; t1/2 4 H.

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ANTISEPTICS AND URINARY ANTIINFECTIVES

SULFONAMIDES: trimethoprim-sulfamethoxazole (TMP-SMZ, Bactrim, Septra)

DRUG CLASS AND DOSAGE:

DRUG CLASS:
ANTIBACTERIAL: SULFONAMIDE
TRADE NAME: Bactrim, Septra
PREGNANCY CATEGORY: C/D

DOSAGE:
A: PO 160/800 MG Q12-24H (160 MG [TMP]/800 MG [SMZ]
A/C: IV 8 TO 10 MG/KG/D IN 2 TO 4 DIVIDED DOSES; INFUSE OVER 1 TO 1.5 H
C: PO <40 KG: 8/40 MG/KG/D IN 2 DIVIDED DOSES

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ANTISEPTICS AND URINARY ANTIINFECTIVES

SULFONAMIDES: trimethoprim-sulfamethoxazole (TMP-SMZ, Bactrim, Septra)

CONTRAINDICATIONS AND DRUG-LAB FOOD INTERACTIONS:

CONTRAINDICATIONS: SEVERE RENAL OR HEPATIC DISEASE, HYPERSENSITIVITY TO SULFONAMIDES

DRUG-LAB FOOD INTERACTIONS:
DRUG: INCREASE ANTICOAGULANT EFFECT WITH WARFARIN; INCREASE HYPOGLYCEMIC EFFECT WITH AN ORAL HYPOGLYCEMIC DRUG
LAB: MAY INCREASE BUN, SERUM CREATINE, AST, ALT, ALP

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ANTISEPTICS AND URINARY ANTIINFECTIVES

SULFONAMIDES: trimethoprim-sulfamethoxazole (TMP-SMZ, Bactrim, Septra)

PHARMACOKINETICS AND PHARMACODYNAMICS:

PHARMACOKINETICS:
ABSORPTION: PO WELL ABSORBED
DISTRIBUTION: PB 50% TO 65%; CROSSES PLACENTA
METABOLISM: t1/2 8 TO 12 H
EXCRETION: IN URINE AS METABOLITES

PHARMACODYNAMICS: PO: ONSET 0.5 TO 1 H
PEAK: 2 TO 4 H
DURATION: UK
IV: ONSET: IMMEDIATE
PEAK: 0.5 TO 1 H
DURATION: UK

34

ANTISEPTICS AND URINARY ANTIINFECTIVES

SULFONAMIDES: trimethoprim-sulfamethoxazole (TMP-SMZ, Bactrim, Septra)

THERAPEUTIC EFFECTS/USES, SIDE EFFECTS, ADVERSE REACTIONS:

THERAPEUTIC EFFECTS/USES: TO TREAT URINARY TRACT INFECTIONS, OTITS MEDIA, BRONCHITIS, PNEUMONIA, PNEUMOCYSTIS CARINII INFECTION, RHEUMATIC FEVER, BURNS.
MODE OF ACTION: INHIBITION OF PROTEIN SYNTHESIS OF NUCLEIC ACIDS; BACTERICIDAL EFFECT

SIDE EFFECTS: ANOREXIA, NAUSEA, VOMITING, DIARRHEA, RASH, STOMATITIS, FATIGUE, DEPRESSION, HEADACHE, VERTIGO, PHOTOSENSITIVITY

35

ANTISEPTICS AND URINARY ANTIINFECTIVES

SULFONAMIDES: trimethoprim-sulfamethoxazole (TMP-SMZ, Bactrim, Septra)

ADVERSE REACTIONS:

ADVERSE REACTIONS:
LIFE-THREATENING: LEUKOPENIA, THROMBOCYTOPENIA, INCREASED BONE MARROW DEPRESSION, HEMOLYTIC ANEMIA, APLASTIC ANEMIA, AGRANULOCYTOSIS, STEVENS-JOHNSON SYNDROME, RENAL FAILURE

36

ANTISEPTICS AND URINARY ANTIINFECTIVES:

QUINOLONES (FLUOROQUINOLONES): ciprofloxacin (Cipro) ROUTE AND DOSAGE

ROUTE AND DOSAGE: A: PO MILD TO MODERATE: 250 TO 500 MG Q12H FOR 7 TO 14 DAYS.
A: IV: 200 Q12H;
A: PO: SEVERE/COMPLICATED: 500 MG Q12H FOR 7 TO 14 DAYS: 1 G/D XR FOR 7 TO 14 DAYS.
C: PO 10 TO 20 MG/KG Q12H FOR 10 TO 21D
A: IV: 400 MG Q12H FOR 7 TO 14 D; DILUTE AND INFUSE OVER 1 H.
C: IV: 6 TO 10 MG/KG Q8H FOR 10 TO 21 D

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ANTISEPTICS AND URINARY ANTIINFECTIVES:

QUINOLONES (FLUOROQUINOLONES): ciprofloxacin (Cipro) USES AND CONSIDERATIONS

USES AND CONSIDERATIONS: HAS A BROAD-SPECTRUM ANTIBACTERIAL EFFECT. FOR UTI, SKIN AND SOFT-TISSUE INFECTIONS, BONE AND JOINT INFECTIONS, AND ANTHRAX INFECTION. ANTACID INHIBITS DRUG ABSORPTION. USE WITH CAUTION IN CLIENTS WITH SEIZURE DISORDERS. CAN BE TAKEN WITHOUT FOOD. PHOTOSENSITIVITY CAN OCCUR. AVOID EXCESSIVE EXPOSURE TO SUNLIGHT. PREGNANCY CATEGORY: C; PB: 20% TO 40%; t1/2 4 H

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ANTISEPTICS AND URINARY ANTIINFECTIVES:

QUINOLONES (FLUOROQUINOLONES): Iomeflexacin (Maxaquin)

ROUTE AND DOSAGE:
A: PO 400 MG/D x 3 TO 10 D

USES AND CONSIDERATIONS: FOR UTIs AND TRANSURETHRAL SURGERY PROPHYLAXIS. PREGNANCY CATEGORY: C; PB: 10%; t1/2 8 H

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ANTISEPTICS AND URINARY ANTIINFECTIVES:

QUINOLONES (FLUOROQUINOLONES): nalidixic acid (Neg-Gram)

ROUTE AND DOSAGE: A: PO 1 G q.i.d FOR 1 TO 2 WK; 500 MG q.i.d FOR LONG TERM USE.
C: >3 MO: PO 55 MG/KG/D IN 4 DIVIDED DOSES FOR 1 TO 2 WK; 33 MG/KG/D FOR LONG TERM USE.
USES AND CONSIDERATIONS: FOR ACUTE AND CHRONIC UTIs. RESISTANCE TO DRUG MAY OCCUR. HIGHLY PROTEIN-BOUND. NOT DISTRIBUTED IN PROSTATIC FLUID. TAKE WITH FOOD TO AVOID GI UPSET. PHOTOSENSITIVITY CAN OCCUR. CONTACT HEALTH CARE PROVIDER IF SEIZURES OR SEVERE HEADACHES OCCUR. PREGNANCY CATEGORY: B; PB: 93%; t1/2 1 TO 2.5 H.

40

ANTISEPTICS AND URINARY ANTIINFECTIVES:

QUINOLONES (FLUOROQUINOLONES): norfloxacin (Noroxin)

ROUTE AND DOSAGE:
A: PO 400 MG Q12H FOR 3 TO 21 D ON EMPTY STOMACH

USES AND CONSIDERATIONS: FOR ACUTE AND CHRONIC UTIs. MOST POTENT DRUG OF THE QUINOLONE GROUP. FOOD MAY INHIBIT DRUG ABORSPTION. PREGNANCY CATEGORY: C; PB: 10% TO 15%; t1/2 3 TO 4 H

41

ANTISEPTICS AND URINARY ANTIINFECTIVES:

QUINOLONES (FLUOROQUINOLONES): orfloxacin (Floxin)

ROUTE AND DOSAGE:
A: PO 200 TO 400 MG Q12H FOR 3 TO 10 D
A: IV 300 MG Q12H FOR 7 D

USES AND CONSIDERATIONS: FOR UTIs, RESPIRATORY TRACT INFECTIONS, AND SKIN INFECTIONS. MAY CAUSE HEADACHES, DIZZINESS, AND INSOMNIA. PREGNANCY CATEGORY: C; PB: 32%; t1/2 4 TO 8 H

42

ANTISEPTICS AND URINARY ANTIINFECTIVES:

OTHER: aztreonam (Azactam)

ROUTE AND DOSAGE:
A: IM/IV 500 MG TO 1 G q8-12H
C: >9 MONTHS IM/IV 30 MG/KG q6 TO 8H

USES AND CONSIDERATIONS: TREATMENT OF UTIs CAUSED BY GRAM-NEGATIVE ORGANISMS. ALSO USEFUL FOR LOWER RESPIRATORY INFECTION AND SEPTICEMIA. PREGNANCY CATEGORY: B; PB: 56% TO 60%; t1/2 1.5 TO 2 H

43

ANTISEPTICS AND URINARY ANTIINFECTIVES:

OTHER: imipenem/cilastatin sodium (Primaxin)

ROUTE AND DOSAGE:
A: IV 250 MG q6-8H; MAX 4 G/D OR 50 MG/KG/D, WHICHEVER IS THE LESSER AMOUNT.

USES AND CONSIDERATIONS: TREATMENT OF SERIOUS UTIs. ALSO USEFUL FOR LOWER RESPIRATORY, BONE, JOINT INFECTIONS, SEPTICEMIA; AND ENDOCARDITIS. PREGNANCY CATEGORY: C; PB: 20%; t1/2 1 H

44

ANTISEPTICS AND URINARY ANTIINFECTIVES:

OTHER: polymyxin B SO4 (Aerosporin)

ROUTE AND DOSAGE:
A/C: IV 15,000 TO 25,000 UNITS/KG/D IN DIVIDED DOSES Q12H
A/C: IM 25,000 TO 30,000 UNITS/KG/D IN 4 TO 6 DIVIDED DOSAGES (IM NOT RECOMMENDED DUE TO SEVERE PAIN AT INJECTION SITE)

USES AND CONSIDERATIONS: EFFECTIVE FOR UTIs AND PREVENTION OF BACTERURIA FROM FOLEY CATHETER. CAN CAUSE NEPHROTOXICITY. MONITOR RENAL FUNCTION (BUN, SERUM CREATINE). PREGNANCY CATEGORY; B; PB: UK; t1/2 4 TO 6 H

45

URINARY ANALGESICS, STIMULANTS, AND ANTISPASMODICS:

URINARY ANALGESICS: phenazopyridine HCL (Pyridium)

ROUTE AND DOSAGE:
A: PO 200 MG t.i.d AFTER MEALS

USES AND CONSIDERATIONS: FOR CHRONIC CYSTITIS TO ALLEVIATE PAIN AND BURNING SENSATION DURING URINATION - REDDISH ORANGE. CAN BE TAKEN CONCURRENTLY WITH ANTIBIOTIC. TREATS JUST SYMPTOMS NOT CAUSE. SHOULDN'T BE USED FOR LONG-TERM URINARY TRACT PAIN. PREGNANCY CATEGORY: B; PB: UK; t1/2 UK

46

URINARY ANALGESICS, STIMULANTS, AND ANTISPASMODICS:

URINARY STIMULANTS: bethanechol CL (Urecholine)

ROUTE AND DOSAGE:
A: PO 10 TO 50 MG b.i.d/q.i.d 1 h, a.c. or 2 h p.c.; max: 200 mg/d

USES AND CONSIDERATIONS: 4 HYPOTONIC AND ATONIC BLADDER. SHOULDN'T BE TAKEN IF PEPTIC ULCER IS PRESENT. CAN CAUSE EPIGASTRIC DISTRESS, ABDOMINAL CRAMPS, NAUSEA, VOMITING, DIARRHEA, FLATULENCE, DIZZINESS, LIGHTHEADEDNESS, AND FAINTING (STANDING FROM LYING OR SITTING) PREGNANCY CATEGORY: C; PB: UL; t1/2 UK

47

URINARY ANALGESICS, STIMULANTS, AND ANTISPASMODICS:

URINARY ANTISPASMODICS: dimethyl sulfoxide (DMSO, Rimso-50)

ROUTE AND DOSAGE:
BLADDER INSTILLATION: 50 mL OF 50% SOL RETAINED FOR 15 MIN; REPEAT Q2WK UNTIL RELIEF

USES AND CONSIDERATIONS: FOR CYSTITIS. ADMINISTERED INTO BLADDER TO REMAIN 15 MINUTES. ADDITIONAL EFFECTS: ANTIINFLAMMATORY, ANESTHETIC, AND BACTERIOSTATIC. CAN CAUSE A GARLICLIKE TASTE AND ODOR ON BREATH AND SKIN FOR UP TO 72 H. PREGNANCY CATEGORY: C; PB: UK; t1/2 UK

48

URINARY ANALGESICS, STIMULANTS, AND ANTISPASMODICS:

URINARY ANTISPASMODICS: flavoxate HCL (Urispas)

ROUTE AND DOSAGE:
A: PO 100 TO 200 MG t.i.d/q.i.d

USES AND CONSIDERATIONS: FOR URINARY TRACT SPASMS. AVOID IN PERSONS WITH GLAUCOMA. CAUTIOUS USE BY OLDER ADULTS. SIDE EFFECTS INCLUDE NAUSEA, VOMITING, DRY MOUTH, DROWSINESS, BLURRED VISION.
PREGNANCY CATEGORY: C; PB: 50% TO 80%; t1/2 10 TO 20 H

49

URINARY ANALGESICS, STIMULANTS, AND ANTISPASMODICS:

URINARY ANTISPASMODICS: oxybutynin CL (Ditropan)

ROUTE AND DOSAGE:
A: PO 5 MG b.i.d/t.i.d.; Max: 20 mg/d
OLDER ADULTS: PO 2.5 TO 5 MG b.i.d; MAX 15 MG/D
C: >5 Y; PO 5 MG b.i.d; MAX: 15 MG/D

USES AND CONSIDERATIONS: FOR URINARY TRACT SPASMS AND OVERACTIVE BLADDER. CONTRAINDICATED FOR CLIENTS WITH CARDIAC, RENAL, HEPATIC, AND PRESTATE PROBLEMS. SIDE EFFECTS INCLUDE DROWSINESS, BLURRED VISION, AND DRY MOUTH. PREGNANCY CATEGORY: B; PB: UK; t1/2 2 TO 5 H

50

URINARY ANALGESICS, STIMULANTS, AND ANTISPASMODICS:

tolterodine tartrate (Detrol, Detrol LA)

ROUTE AND DOSAGE:
A: PO 2 MG b.i.d
A: EXTENDED RELEASE 4 MG QD

USES AND CONSIDERATIONS: TO CONTROL OVERACTED BLADDER BY DECREASING URINARY FREQUENCY AND URGENCY. CLIENT WITH NARROW-ANGLE GLAUCOMA SHOULD NOT TAKE THIS DRUG. DRY MOUTH IS COMMON. PREGNANCY CATEGORY: C; PB: 96%; t1/2 2 TO 3.5 H

51

URINARY ANALGESICS, STIMULANTS, AND ANTISPASMODICS:

trospium chloride (Sanctura, Sanctura XR)

ROUTE AND DOSAGE:
A: PO 20 MG b.i.d
A: EXTENDED RELEASE 60 MG QD IN MORNING

USES AND CONSIDERATIONS: TO TREAT OVERACTIVE BLADDER BY ACTION OF A MUSCARINIC-RECEPTOR ANTAGONIST. PREGNANCY CATEGORY: C; PB: 50%; t1/2 20 TO 35 H

52

URINARY ANALGESICS, STIMULANTS, AND ANTISPASMODICS:

solifenacin succinate (VESIcare)

ROUTE AND DOSAGE:
A: PO 5 MG/D INITIALLY; THEN UP TO 10 MG/D IF TOLERATED

USES AND CONSIDERATIONS: TO TREAT OVERACTIVE BLADDER BY ACTION OF A MUSCARINIC-RECEPTOR ANTAGONIST. PREGNANCY CATEGORY: C; PB: 98%; t1/2 55 H

53

URINARY ANALGESICS, STIMULANTS, AND ANTISPASMODICS:

darifenacin hydrobromide (Enablex)

ROUTE AND DOSAGE:
A: PO 7.5 TO 15 MG DAILY

USES AND CONSIDERATIONS: TO TREAT OVERACTIVE BLADDER BY ACTION OF A MUSCARINIC -RECEPTOR ANTAGONIST. PREGNANCY CATEGORY: C; PB: 98%; t1/2 13 TO 19 H


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