Urinary Meds

Question 1

Diuretics

Answer 1

Loop:
- Furosemide
- Bumetanide

Thiazide:
- Hydrochlorothiazide
- Chlorothiazide

Potassium Sparing:
- Spironolactone
- Triamterene

Facts:
- Used for pulmonary edema caused by heart failure, hypertension, and edema
- use cautiosly for patients with diabetes
- do not give to pregnant patients
- NSAIDs reduce diruetic effect
- can cause hypovolemia, ototoxicity (loop), hypokalemia (loop and thiazide), hyponatremia, digoxin toxicity, lithium toxicity, hyperkalemia (potassium-sparing)
- hypokalemia = inverted T waves, or U waves
- hyperkalemia = peaked T waves, wide QRS
- administer early morning
- fall risk due to electrolyte imbalance and orthostatic hypotension
- take furosemide with milk to avoid gastric irritation

Question 2

Osmotic Diuretic

Answer 2

• Mannitol

Facts:
- decreases intracranial pressure due to cerebral edema, intraocular pressure, and prevents renal failure due to hypovolemia
- use with caution in heart failure patients, if lung crackles are heard, stop infusion
- can cause pulmonary edema, dry mouth, and fluid and electrolyte imbalance
- monitor for heart failure and edema

Question 3

Adrenergic Blockers for Urinary Hesitancy (Anti-adrenergics)

Answer 3

• Tamsulosin
• Bethanechol

Facts:
- allow voiding in clients with BPH and post-op urinary hesitancy
- do not take with cimetidine (H2 antagonist for GERD)
- do not give to patients with bladder cancer or urinary obstruction, or hypotension
- may cause decreased libido, headache, dizziness, excessive salivation, cholinergic symptoms (SLUDGE)
- Tamsulosin: take 30 min after meal at same time each day
-Bethanechol: take on empty stomach

Question 4

Anticholinergics for Overactive Bladder

Answer 4

• Oxybutin
• Tolterodine
• Danifenacin
• Solifenacin
• Trospium
• Fesoterodine

Facts:
- used for patients who have urinary incontinence and frequency
- do not give to patients with intestinal obstruction
- can cause cognitive impairment in older adults and dyspepsia (indigestion)
- Oxybutin: can cause dry mouth, dry eyes, blurred vision
- do not give to patients with glaucoma
- report constipation that lasts more than 3 days

Question 5

Sexual Dysfunction

Answer 5

• Sildenafil
• Tadalafil
• Vardenafil

Facts:
- “-fil” it up
- do not give to patients who are taking nitrate drugs, alpha adrenergic blockers for BPH, or antihypertensives
- can cause hypotension, priapism (erection lasting longer than 4 hours), vision problems, headache, flushing, hearing loss
- give 1 hour before sexual activity