McKenna's Pharmacology for Nursing, 2e

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P A R T 9  Drugs acting on the renal system

Adverse effects Adverse effects associated with these drugs include nausea, vomiting, diarrhoea, anorexia, bladder irrita- tion and dysuria. Infrequent symptoms include pruritus, urticaria, headache, dizziness, nervousness and confu- sion. These effects may result from GI irritation caused by the agent, which may be somewhat alleviated if the drug is taken with food, or from a systemic reaction to the urinary tract irritation. Clinically important drug–drug interactions Because these drugs are from several different chemical classes, the drug–drug interactions that can occur are very specific to the drug being used. Consult a drug guide for specific interactions.

Prototype summary: Norfloxacin Indications: Treatment of adults with UTIs caused by susceptible strains of bacteria; uncomplicated urethral and cervical gonorrhoea; prostatitis caused by Escherichia coli . Actions: Interferes with DNA replication in susceptible Gram-negative bacteria, leading to cell death. Pharmacokinetics: Route Onset Peak Duration Oral Varies 2–3 hours 12 hours T 1/2 : 3 to 4.5 hours; metabolised in the liver and excreted in urine. Adverse effects: Headache, dizziness, nausea, vomiting, dry mouth, fever, rash, photosensitivity. To decrease the number of bacteria introduced into the bladder, education should cover the following hygiene measures: Always wipe from front to back and never from back to front to avoid the introduction of intestinal bacteria into the urethra; avoid baths, particularly bubble baths, which facilitate the entry of bacteria into the urethra on the bubbles; and wear dry, cotton underwear to discourage bacterial growth. Education also should stress the importance of avoiding alkaline ash foods (e.g. citrus fruits, certain vegetables) and antacids and encouraging foods that acidify the urine. Cranberry juice is often recommended as a choice for fruit juice because it helps to prevent the bacteria from adhering to the bladder wall, which in turn aids infection prevention. Fluid intake, especially water, should be encouraged as much as possible to keep the bladder flushed. Finally, the person should be encouraged to complete the full course of medication prescribed and not to stop taking the drug when symptoms disappear. CARE GUIDE FOR J.K.: URINARY TRACT ANTI-INFECTIVE HEXAMINE HIPPURATE Assessment: History and examination Assess J.K.’s health history, particularly any allergies to antibacterial medications, and liver or renal dysfunction. (If J.K. were of childbearing age, you would assess pregnancy and breastfeeding status.) Focus the physical examination on the following areas: Neurological: orientation, reflexes, strength Skin: colour, texture, oedema

CRITICAL THINKING SCENARIO Teaching about cystitis treatment

THE SITUATION J.K. is a 6-year-old girl with a history of repeated urinary tract infections (UTIs). She was screened for potential sexual abuse, which may present as repeated urinary tract infections, and no evidence of abuse was found. She is seen today with complaints of dysuria, frequency, urgency and a low-grade fever. A urine sample is sent for culture and sensitivity testing. The doctor prescribes hexamine hippurate ( Hiprex ), 500 mg q.i.d., and refers J.K. and her mother to the nurse for teaching. CRITICAL THINKING What is the best approach for J.K.? What key teaching points (at least five) should be emphasised to assist the pharmacological therapy in treating this infection? Think about the following points: what the drug is doing, how it works and how it works best. DISCUSSION Cystitis is very difficult to treat in young girls and can become a chronic problem. Person and parent education is very important for blocking the growth of bacteria and curing the infection. Teaching points should emphasise activities that will decrease the number of bacteria introduced into the bladder, acidify the urine to make the bladder an inhospitable environment for bacterial growth, and flush the bladder to prevent stagnant urine from encouraging bacterial growth.