Ch. 34, 56, 57 & 58 Quiz Flashcards
Name and upper UTI and tell how it is usually gotten.
Acute Pyelonephritis - usually develops from a lower UTI
What are some s/s of an upper UTI?
Chills, fever, flank pain, painful urination, urgency, frequency, pyuria
Name 3 lower UTIs.
Acute cystitis, urethritis, and prostatitis
What organisms usually cause a lower UTI?
E. coli, Staph, Klebsiella, Pseudomonas
What are some s/s of a lower UTI?
Pain and burning on urination, frequency, urgency, foul smelling
What is a combo drug often used to treat UTIs and what is the purpose of using it?
Trimethoprim-sulfamethoxazole (Bactrim). Used to prevent trimethoprim resistant organisms b/c single agent treatment can lead to drug resistance.
Name the 5 classes of drugs used to fight UTIs.
Urinary Anti-infectives, Sulfanomides, Fluoroquinolones, Penicillins, and 3rd-generation Cephalosporins
What anti-infective treats UTIs?
Nitrofurantoin (Furadantin, Macrodantin)
What Sulfanomides are used to treat UTIs?
Trimethoprim-sulphamethazole (Bactrim)
What Fuoroquinolones are used to treat UTIs?
Nalidaxic acid (Neg-Gam), ciprofloxacin (Cipro)
What Penicillins are used to treat UTIs?
Amoxicillin/clavulanic acid (Augmentin)
What 3rd-generation Cephalosporins are used to treat UTIs?
Cefixime (Maxipime)
How does Nitrofurantoin work?
Treats gram+ and gram- and inhibits bacterial enzymes and metabolism
What are the side effects of Nitrofurantoin?
Rust or brown colored urine, N/V, rash, pruruitis, dizziness, HA, drowsiness
What would some adverse reactions to Nitrofurantoin be?
Superinfection, peripheral neuropathy, hepatotoxicity, Stevens-Johnson syndrome, and blood dyscrasias
What are some nursing interventions when administering Nitrofurantoin?
Take with food to decrease GI distress, Shake liquid suspension well, rinse mouth after taking drug, avoid antacids (2hrs before and after), Increase fluid intake, consume cranberry juice, plums, proteins, vitamin C
What food should not be eaten when taking Nitrofurantoin and why?
Grapefruit b/c it hinders absorption
What antiseptic/antiinfective is effective against Pseudomonas and E. coli?
Methenamine hippurate (Hiprex)
When is Methenamine hippurate (Hiprex) bactericidal?
When urine is acidic.
What other class of drug should NOT be taken with Methenamine hippurate (Hiprex) and why?
Sulfonamides b/c they may cause crystalluria
What client teaching is appropriate with Methenamine hippurate (Hiprex)?
Consume acidic foods and fluids; Vitamin C produces an acid-ash diet (meat, fish, eggs, and cereals), which enhances the function of this medication
What does Methenamine hippurate (Hiprex) treat?
Treats chronic UITS
What is a urinary analgesic used to treat the symptoms of a UTI?
Phenazopyridine (Pyridium)…doesn’t actually treat the UTI, it treats the symptoms
What does Phenazopyridine (Pyridium) relieve?
N/V and diarrhea (should report if severe b/c may become dehydrated); Red-orange urine: this is an expected SE (most common)
What are some adverse reactions to Phenazopyridine (Pyridium)?
Blood dyscrasia, nephrotoxicity, hepatotoxicity
Name a urinary stimulant.
Bthanechol (Urecholine)
What does Bethanechol (Urecholine) treat and how?
Treats hypotonic bladder by increasing bladder tone of detrusor muscle
What are some contraindications of using Behtanechol (Urecholine)?
Peptic ulcer, COPD (may cause bronchodilation)
What are some SE/adverse reactions of Bethanechol (Urecholine)?
GI distress, dizziness, fainting
Name a urinary Antispasmodic.
Oxybutynin (Ditropan)
How does Oxybutynin (Ditropan) work?
Direct action on smooth muscles to relieve spasms
What are some SE/adverse reactions of Oxybutynin (Ditropan)?
Drowsiness, tachycardia, dizziness, fainting, blurred vision, dry mouth, constipation (has similar effects as anticholinergics)
When should Oxybutynin (Ditropan) be avoided?
Avoid in narrow-angle glaucoma, cardiac, renal, hepatic, prostate problems, urinary and GI obstructions
Name an Antimuscarinic and what it does?
Tolterodine tartrate (Detrol). It blocks parasympathetic nerve impulses to control overactive bladder
What are the side effects of Tolterodine tartrate (Detrol)?
Drowsiness, tachycardia, dizziness, fainting, blurred vision, dry mouth, constipation (may also cause urinary retention which needs to be reported)
What are some contraindications for Tolterodine tartrate (Detrol)?
To be avoided if client has narrow-angle glaucoma or cardiac, renal, hepatic, prostate problems
What does the client need to be taught when taking Tolterodine tartrate (Detrol)?
Teach the client to palpate their bladder and report if there is tenderness or pain
A client with a lower UTI has been prescribed nitrofurantoin (Mcrodantin). What side effects/adverse reactions would the nurse teach the client to expect? A.) Irritability; B.) Anxiety; C.) Crystalluria; D.) Brown, discolored urine
D.) Brown, discolored urine. Nitrofurantoin may cause a rust or brown discoloration of urine. Drowsiness, not irritability and anxiety, is a side effect. Nitrofurantoin does not cause crystalluria as methenamine or sulfa preparations do
A client entering the medical clinic has been dx with an overactive bladder. Which medication would the nurse expect to be ordered? A.) Ciprofloxacin (Cipro); B.) Oxybutynin (Ditropan); C.) Bethanechol (Urecholine); D.) Tolterodine tartrate (Detrol)
D.) Tolterodine tartrate (Detrol). Tolterodine tartrate is an antimuscarinic that controls an overactive bladder. Ciprofloxacin is a fluroquinolone antibiotic, oxybutynin relieves urinary spasms, and bethanechol is a urinary stimulant
Why are most oral contraceptives commonly used?
Most commonly used for pregnancy prevention, endometriosis, dysmenorrhea
What is the method of action of estrogen products?
Prevents formation of dominant estrogen-producing follicle so estrogen levels remain constant and ovulation is inhibited
What are the 3 types of estrogen/progestin combinations?
Monophasic (fixed E:P ratio throughout cycle), Biphasic (estrogen fixed, progestin varies), and Triphasic (low doses of both with minimal side effects)
What was the first chewable oral contraceptives?
Femcon FE
What was the first continuous dose oral contraceptive?
Lybrel
What is Loestrin 24 Fe?
First 24 days of active hormones and 4 days Fe (iron)
Which oral contraceptive combines ethinylestradiol with progestin drospirenone?
Yaz (combo with diuretic) - fewer side effects than ones in the past
Name 3 progestin-only oral contracetives.
Ovrette, Ortho Micronor, and Nor-QD
What is the action of progestin-only oral contraceptives?
Alters cervical mucus (thickens it to slow sperm passage). Alters endometrium to inhibit implantation
What does a client do if they miss a dose of progestin-only contraceptive?
Take tablet as soon as realize and back up contraception for 48 hrs
What are the guidelines for missed doses of oral contraceptives?
1 tab = take tab as soon as realized, take the next pill as scheduled; 2 tabs = take 2 tabs for 2 days with next tablet as scheduled, use a backup method of contraception for the rest of the cycle; 3 tabs = discontinue the present pack and allow for withdrawal bleeding. Start a new package of tabs 7 days after the last tab was taken. Use another form of contraception until tabs have been taken for 7 consecutive days
What is spotting/bleeding between periods called?
Breakthrough bleeding
What are some side effects due to estrogen EXCESS?
N/V, dizziness, fluid retention, bloating, breast enlargement, leg cramps, decreased tearing and visual changes, HA, hypertension
What are some side effects due to estrogen DEFICIENCY?
Nervousness, dyspareunia (pain in the labia, vagina, or pelvis during or after sexual intercourse), vaginal bleeding, oligomenorrhea (scanty or infrequent menstrual flow)
What are some contraindications for contraceptive use?
Pregnancy, venous thrombosis, vascular disease, liver disease, breast cancer, smoking > 15 per day if over 35
What is dyspareunia?
Pain in the labia, vagina, or pelvis during or after sexual intercourse
What are some side effects due to EXCESS progestin?
Increased appetite, weight gain, decreased breast size. Oily skin and scalp, acne, excess hair growth, depression. Vaginitis from yeast, amenorrhea after cessation of use
What are some side effects from progestin DEFICIENCY?
Dysmenorrhea (painful menstrual cramps), bleeding late in cycle, heavy flow with clots, amenorrhea (absence of menstrual bleeding)
What drugs do oral contraceptives decrease the effectiveness of?
Oral anticoagulants and oral hypoglycemics (Monitor PT/INR & blood glucose)
What effect does an oral contraceptive have on PT/INR levels?
It decreases them
What might you have to do when taking an oral contraceptive with anticoagulants?
Increase the dose of anticoagulant meds
What does an oral contraceptive do to a client’s blood glucose?
Increases it
When do you ABSOLUTELY not take oral contraceptives?
Pregnancy (#1), breastfeeding, hypertension (If monitoring pre-hypertension, may be put on it after assessing other risk factors), heavy smoking habit, multiple risk factors
What is the #1 side effect in oral contraceptives?
DVT (Deep Vein Thrombosis)
What are some cautions against using oral contraceptives?
Undiagnosed genital bleeding, postpartum less than 21 days, hyperlipidemia