Urinary Tract Infections (Pharmacology Ch 46) Flashcards
Medications used to treat UTIs
1) sulfonamides
2) trimethoprim
3) urinary antiseptics
other medications include:
-penicillins
-aminoglycosides
-cephalosporins
-fluoroquinolones
Sulfonamides and Trimethoprim
- inhibit bacterial growth by preventing the synthesis of folic acid. Folic acid is essential for production of DNA, RNA, and proteins
- select prototype medications =
1) sulfamethoxazole-trimethoprim (SMZ-TMP, Bactrim, Septra, Co-Trim)
2) sulfadiazine
3) trimethoprim
Sulfonamides and Trimethoprim: therapeutic uses
1) SMZ-TMP is used to treat UTIs
- causative agents include Escherichia coli, klebsiella, proteus, enterobacter, and Neisseria gonorrhoeae.
- other infections include otitis media, bronchitis, shigellosis, and Pneumocystis jiroveci pneumonia
Sulfonamides and Trimethoprim:
adverse effects/medication interactions and nursing interventions/client education
1) hypersensitivity, including Stevens-Johnson syndrome–Do not administer SMZ-TMP to client who has allergies to: sulfonamides (sulfa), thiazide diuretics (hydrochlorothiazide [Microzidel]), sulfonylurea-type oral hypoglycemics (tolbutamide [Orinase]), and loop diuretics (furosemide [Lasix]); stop SMZ-TMP at first indication of hypersensitivity, such as a rash
2) blood dyscrasias (hemolytic anemia, agranulocytosis, leukopenia, thrombocytopenia, aplastic anemia)–draw client’s baseline and periodic CBC levels to detect hematologic disorders; observe for bleeding episodes, sore throat, or pallor; if above symptoms occur, instruct client to notify provider.
3) crystalluria (crystalline aggregates in the kidneys, ureters, and bladder causing irritation and obstruction that leads to acute kidney injury)–maintain adequate oral fluid intake; instruct client to drink 2-3 L/day; monitor urine output of at least 1,200 mL each day.
4) Kernicterus (jaundice, increased bilirubin levels, which is neurotoxic to infants)–avoid administering SMZ-TMP to women who are pregnant near term or breastfeeding, and infants younger than 2 months); avoid administering SMZ-TMP during 1st trimester to prevent birth defects of fetus
5) photosensitivity–advise client to avoid prolonged exposure to sunlight, use sunscreen, and wear appropriate protective clothing
6) sulfonamides can increase effects of warfarin (Coumadin), phenytoin (Dilantin), sulfonylurea oral hypoglycemics, and tolbutamide (Orinase)–reduced dosages of these meds may be required during SMZ-TMP therapy; monitor lab levels (prothrombin time and INR, phenytoin levels, and blood glucose levels)
Sulfonamides and Trimethoprim:
contraindications/precautions
1) SMZ-TMP is contraindicated in clients who have folate deficiency (increases risk of megaloblastic anemia)
2) use cautiously in clients w/ renal dysfunction. Reduced dosage of SMZ-TMP is recommended.
3) administer w/ caution in adults older than age 65 yrs who take ACE inhibitor or angiotensin II receptor blockers (ARB) because of risk of hyperkalemia
Urinary tract antiseptics
- nitrofurantoin is a broad-spectrum urinary antiseptic w/ bacteriostatic and bactericidal action. Bacterial injury occurs by damaging DNA.
- select prototype medication = nitrofurantoin (Furadantin, Novo-Furan) and nitrofurantoin macrocrystals (Macrodantin, Macrobid)
- other medications = methenamine (Hiprex, Urex)
Urinary tract antiseptics: therapeutic uses
1) acute UTIs
2) prophylaxis for recurrent lower UTIs
Urinary tract antiseptics:
adverse effects/medication interactions and nursing interventions/client education
1) GI discomfort (anorexia, nausea, vomiting, diarrhea)–administer nitrofurantoin w/ milk or meals; reduce dosage, and use macrocrystalline tablet to reduce GI discomfort
2) hypersensitivity reactions w/ severe pulmonary manifestations (dyspnea, cough, chest pain, fever, chills, and alveolar infiltrations)–advise client to stop med and call provider if this occurs; pulmonary manifestations should subside within several days after nitrofurantoin is discontinued; advise client not to receive nitrofurantoin agents again
3) blood dyscrasias (agranulocytosis, leukopenia, thrombocytopenia, megaloblastic anemia, and hepatotoxicity)–do baseline CBC, and perform periodic blood tests to include liver function tests; monitor client for easy bruising and epistaxis (nose bleeding); notify provider if symptoms occur
4) peripheral neuropathy (numbness, tingling of the hands and feet, muscle weakness)–instruct client to notify provider if these symptoms occur; avoid chronic use of nitrofurantoin, not recommended for clients w/ kidney failure
5) headache, drowsiness, dizziness–instruct client to notify provider if these symptoms occur
Urinary tract antiseptics: contraindications/precautions
1) nitrofurantoin is contraindicated in clients who have renal dysfunction and creatinine clearance < 40 mL/min. Impaired renal function will increase risk of medication toxicity because of inability to excrete nitrofurantoin.
Urinary tract antiseptics: nursing considerations
1) inform client urine will have a brownish discoloration
2) encourage clients to administer w/ food if GI symptoms occur
3) instruct clients to complete prescribed course, even though symptoms may resolve before full course is complete
4) Recommend that clients avoid crushing tablets because of possibility of tooth staining
5) instruct clients to avoid nitrofurantoin while pregnant
Fluoroquinolones
- bactericidal as a result of inhibition of the enzyme necessary for DNA replication
- select prototype medication = ciprofloxacin (Cipro)
- other medications = ofloxacin (Floxin, moxifloxacin (Avelox), levofloxacin (Levaquin), and norfloxacin (Noroxin)
Fluoroquinolones: therapeutic uses
1) broad-spectrum antimicrobials used for wide variety of micro-organisms such as aerobic gram-negative bacteria, gram-positive bacteria, klebsiella, and E. coli
2) alternative to parenteral antibiotics for clients who have severe infections
3) urinary, respiratory, and GI tract infections; infections of bones, joints, skin, and soft tissues
4) medication of choice for prevention of anthrax in clients who have inhaled anthrax spore
Fluoroquinolones:
adverse effects/medication interactions and nursing considerations/client education
1) GI discomfort (N, V, D)–administer medications accordingly
2) Achilles tendon rupture–instruct client to observe for clinical manifestations of pain, swelling, redness @ achilles tendon site, and notify provider if they occur; ciprofloxacin should be discontinued. Client should not exercise until inflammation subsides
3) suprainfection (thrush, vaginal yeast infection)–instruct client to observe for clinical manifestations of yeast infection (cottage cheese/curd-like lesions on mouth and genital area) and notify provider if occur
4) phototoxicity (severe sunburn) when exposed to direct and indirect sunlight, and sunlamps even when sunscreen is applied–instruct client to avoid sun exposure and wear protective clothing and sunscreen at all times; discontinue immediately (ciprofloxacin and other fluoroquinolones) if phototoxicity occurs
Fluoroquinolones: contraindications/precautions
1) ciprofloxacin should not be administered to children younger than 18 yrs (due to risk of Achilles tendon rupture), unless child is being treated for E. coli infections of urinary tract or inhalational anthrax. (ciprofloxacin is the only fluoroquinolone approved for children)
2) ciprofloxacin increases risk of developing Clostridium difficile infection by decreasing normal intestinal bacteria
3) ciprofloxacin and several other fluoroquinolone meds can effect the CNS (dizziness, headache, restlessness, confusion). Use w/ caution in older adults and those who have CV disorders.
Fluoroquinolones: interactions
1) cationic compounds (aluminum-magnesium antacids, iron salts, sucralfate, milk and dairy products) decrease absorption of ciprofloxacin–administer cationic compounds 6 hr before or 2 hr after ciprofloxacin
2) plasma levels of theophylline (Theolair) can increase w/ concurrent use of ciprofloxacin–monitor levels, and adjust dosage accordingly
3) plasma levels of warfarin (Coumadin) can increase w/ concurrent use of ciprofloxacin–monitor prothrombin time and INR, and adjust dosage of warfarin accordingly
