Meds for Urinary Tract Infections
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| trimethoprim-sulfamethoxazole & nitrofurantoin | Tx: uncomplicated cystitis, incr. effects warfarin, phenytoin, sulfonylurea oral huypoglycemics (give lower dosages). monitor: PT, INR, bd glucose, phenytoin lvls. take on empt stomach w/8oz water, complete entire course. use additional contraception.
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| fluoroquinolones | Tx: resitant to trimethoprim-sulfamethoxazole & nitrofurantoin
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| fosfomycin | requires one dose, is a good alternative for clients who have difficulty w/adherence
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| 1) sulfonamides & trimethoprim prototype meds: (trimethroprim-sulfamethoxazole, sulfadiazine, trimethoprim) | Tx: UTIs d/t Ecoli, otitis media, chancroid, pertussis, shingellosis... A/Es: hypersensitivity/ Stevens-Johnson synd, bld dyscrasias, crustalluria, kernicterus, hyperkalemia. Effective: dec. UTIs symptoms, neg. urine culture, lower WBC counts.
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| kernicterus | jaundice, increased bilirubin levels, neurotoxic for newborns. do not give trimethoprim-sulfamethoxazole to women who are in 1st trimester of pregnancy, breastfeeding or to infants <2 months d/t risk of kernicterus.
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| Prototype: Nitrofuratoin (broad-spectrum urinary antiseptic) other Meds: Methenamine | Tx UTIs, prophylaxis for recurrent lower UTIs. S/As: GI distress, hypersensitivity, bl dyscrasias, peripheral neuropathy, HA, drowsiness, dizziness. precautions: impaired kidney function increased risk of toxicity b/c inability to excrete nitrofurantoin.
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| 2) Nitrofuratoin RN adm. | turns urine rust-yellow to brown, can stain teeth. take w/food, take entire course, do not take when pregnant can cause birth defects
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| 3) Fluroquinolones (broad spectrum) prototype: ciprofloxacin other meds: ofloxacin, moxifloxac in, levofloxacin, norfloxacin | A/Es: GI distress, Achilles tendon rupture, suprainfection (thrust, vag. yeast inf), phototoxicity, CNS Cautions: do not give to clients <18 years, careful w/older clients. increases risk C. difficile infection b/c it destroys normal intestinal flora
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| fluroquinolones interactions | adm. cationic compounds 6hr before or 2hr after ciprofloxacin. monitor theophylline levels & adjust dosage of fluroguinolones, monitor PTT, INR & adjust dosages
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| fluroquinolones RN adm. | give lower dosages to clients w/impaired kidney function. IV ciprofloxacin in a dilute solutions slowly over 60min in large vein.
anthrax infection: adm. ciprofloxacin every 12hr for 60 days.
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| 4) phenazopyridine | an azo dye that functions as a local anesthetic on the mucosa of the urinary tract
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| phenazopyridine RN adm. | contraind: Acute kidney injury, CKD,
it changes urine to an orange-red color, urine can stain clothes
take w/ or after meals to minimize GI discomfort
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