Medications Affecting the Urinary System
, Diuretics A Action: Increase the amount of fluid excretion via the renal system
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
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
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)
,. Action: Increases detrusor muscle tone to allow st~ong shtart_ to voiding for clients with postoperative unnary es1tancy
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.
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
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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 fitrate 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 ,
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(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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