Generic Name: Bethanechol Brand Name: Uriflow, Urecholine Classification: urinary tract stimulant; cholinergics Action: Directly stimulates

muscarinic acetycholine receptors. It mimics the effects of the parasympathetic nervous system. Stimulates gastric motility, micturation and increases lower esophageal sphincter pressure. Indication: Treatment of acute post-op and postpartum nonobstructive urinary retention and for neurogenic atony of the urinary bladder w/ retention. Dosage: Adult 10-50 mg 3x a day or 4x a day. Minimum effective dose may be determined by giving 5 or 10 mg initially and repeating the same amount at hourly intervals until satisfactory responses occurs or until a maximum of 50 mg has been given. Contraindication: Hypersensitivity, hyperthyroidism, peptic ulcer, bronchial asthma, bradycardia or hypotension, vasomotor instability, coronary artery disease, epilepsy and parkinsonism. Patients w/ recent urinary bladder surgery, gastrointestinal (GI) resection and anastomosis, GI or bladder neck obstruction, spastic GI disturbances, acute inflammatory lesion of the GI tract, peritonitis, marked vagotonia. Adverse Reactions: Malaise, abdominal discomfort, colicky pain, nausea, belching, diarrhea, borborygmi and salivation, urinary urgency, headache, hypotension w/ reflex tachycardia, vasomotor response. Nursing Considerations  Obtain history of patient’s bladder condition before therapy and reassess regularly throughout therapy.  Monitor for possible drug induced adverse reactions.  Asses for toxicity: bradycardia, hypotension, bronchospasm, headache, dizziness, seizures, sweating, cramping and respiratory depression. If toxicity occurs, discontinue drug and administer atropine.  Monitor input-output ratio and check for urinary retention or incontinence. If bladder emptying does not occur, notify physician because catheterization may be needed.  Assess patient and family’s knowledge on drug therapy. Health Teachings  Instruct patient to take drug exactly as prescribed and at least 1 hr before or 2 hrs after meals. Tell patient not to double doses or to take missed dose w/in 1 hour of scheduled dose.  Advice patient to change position slowly to prevent orthostatic hypotension.  Instruct patient to report drug induced adverse reactions like cramping, diarrhea w/ blood and flushing.

Advise patient to avoid driving and other activities requiring alertness until response to medication is known  Advise patient to avoid concurrent use of alcohol and other CNS depressants while taking this medication  Instruct patient that frequent rinsing of mouth. Health care professional should be notified if mouth dryness persists >2 wk  Inform patient that oxybutynin decreases the body's ability to perspire. Ditropan Classification: Urinary tract antispasmodics.Generic Name: Oxybutynin Brand Name: Driptane. insomnia.nocturnal enuresis in conjunction w/ nondrug therapy where this alone or in conjunction w/ other drug treatment has failed. blurred vision. nausea. Avoid strenuous activity in a warm environment because overheating may occur. severe ulcerative colitis or toxic megacolon. Dosage: Adult 5 mg bid-tid. abdominal discomfort. photosensitivity. whether due to neurogenic bladder disorders (detrusor hyperreflexia) in conditions e. Nocturnal enuresis 5 mg bid-tid.g.  Move patient to a cooler area if signs of heat stroke develop and cover torso w/ wet towels. dry eyes. Adverse Reactions: Dry mouth. diminishes frequency of uninhibited contractions of detrusor muscle and delays initial desire to void.  Monitor hypersensitivity of patient to drugs. Indication: Urinary incontinence. facial flushing & difficulty in micturition. good oral hygiene. dizziness. .  Assess patient for urinary retention before administering drug and periodically before treatment. Elderly 5 mg bid. Childn <5 yr. multiple sclerosis & spina bifida or to idiopathic detrusor instability (motor urge incontinence). intestinal atony. headache. diarrhoea. dry skin. and sugarless gum or candy may decrease dry mouth. Anticholinergics Action: Increases bladder capacity. dyspepsia. Health Teachings  May cause drowsiness or blurred vision. weakness. palpitation. Childn >5 yr w/ neurogenic bladder instability 5 mg bid. UTI. glaucoma. constipation. Contraindication: Bowel obstruction. drowsiness.  Give extra fluids when heat stroke occurs. Nursing Considerations  Obtain patient history. urgency & frequency of the unstable bladder. hypertension. a significant degree of bladder outflow obstruction. rash. use aircon or fan. myasthenia gravis. confusion. Childn >5 yr: Neurogenic bladder disorders.

Generic Name: Sulfamethoxazole and Trimethoprim Brand Name: Bactrim. thrombocytopenia (rare). anaphylaxis. a synthetic antiinfective. Shigellosis enteritis. an intermediate acting antiinfective sulfonamide. oliguria. pseudomembranous enterocolitis. sulfonamide Action: Fixed combination of sulfamethoxazole (SMZ). Dosage: Systemic Infections Adult: PO 160 mg TMP/800 mg SMZ (1 double strength [DS] tablet) q12h IV 8–10 mg/kg/d TMP divided q6–12h infused over 60–90 min Child: PO >2 mo & <40 kg. megaloblastic anemia due to folate deficiency. sulfonamides. Co-Trimoxazole. 3 consecutive d/wk (max: 320 mg TMP/d) Renal Impairment Clcr 10–30 mL/min: reduce dose by 50%.i. toxic epidermal necrolysis. glossitis. and acute episodes of chronic bronchitis in adults.d. Also children with acute otitis media due to susceptible strains of Haemophilus influenzae. myalgia. arthralgia. Both components of the combination are synthetic folate antagonist antiinfectives. <10 mL/min: reduce dose by 75% Contraindication: Hypersensitivity to TMP. urinary tract agent. . megaloblastic anemia. and trimethoprim (TMP). which prevents bacterial synthesis of essential nucleic acids and proteins. anorexia. and severe complicated UTIs due to most strains of the Enterobacteriaceae. abdominal pain. stomatitis. hypoprothrombinemia. Mechanism of action is principally enzyme inhibition. anuria. Nursing Considerations  Be aware that IV Septra contains sodium metabisulfite. photosensitivity. lactation. allergic myocarditis. itching. or bisulfites. Septra Classification: antiinfective. Adverse Reactions: Skin: Mild to moderate rashes (including fixed drug eruptions). crystalluria. Hematologic: Agranulocytosis (rare). 160 mg TMP/800 mg SMZ (1 DS tablet) q12h IV >2 mo. wheezing. >40 kg. Body as a Whole: Weakness. diarrhea. GI: Nausea. hepatitis. vomiting. 8–10 mg/kg/d TMP divided q6–12h infused over 60–90 min Pneumocystis carinii Pneumonia Adult: IV 20 mg/kg/d TMP divided q6h infused over 60–90 min Prophylaxis for Pneumocystis carinii Pneumonia Adult: PO 160 mg TMP/800 mg SMZ q24h Child: PO 150 mg/m2 TMP/750 mg/m2 SMZ b. SMZ. Not recommended for infants <2 mo. aplastic anemia (rare). 4 mg/kg/d TMP q12h. Urogenital: Kidney failure. Indication: Pneumocystis carinii pneumonitis. which produces allergictype reactions in susceptible patients: Hives. pregnancy (category C). creatinine clearance <15 mL/min. group A beta-hemolytic streptococcal pharyngitis.

especially if diarrhea contains blood. platelet count. mucus. fever.  Be alert for overdose symptoms (no extensive experience has been reported): Nausea. Change in warfarin dosage may be indicated. BUN and creatinine clearance with prolonged therapy. or pus.  Monitor coagulation tests and prothrombin times in patient also receiving warfarin.e. Most frequently observed: Thrombocytopenia (with concurrent thiazide diuretics). mouth sores. anorexia.  Monitor I&O volume and pattern. vomiting. Advise patient that sharing of this medication may be dangerous  Instruct patient to notify health care professional if fever and diarrhea develop. even if feeling well.  Lab tests: Baseline and followup urinalysis. Advise patient not to treat diarrhea without consulting health care professional  Caution patient to use sunscreen and protective clothing to prevent photosensitivity reactions  Advise patient to notify health care professional if skin rash. severe skin reactions. sore throat. continued UTI symptoms). especially if liver or kidney function is compromised or if certain other drugs are given. dizziness.Susceptibility (low in general population) is seen most frequently in asthmatics or atopic nonasthmatic persons. or unusual bleeding or bruising occurs  Instruct patient to notify health care professional if symptoms do not improve within a few days  Emphasize importance of regular follow-up exams to monitor blood counts in patients on prolonged therapy .  Older adult patients are at risk for severe adverse reactions. severe decrease in platelets (with or without purpura). mental depression. and bone marrow depression. bone marrow suppression. confusion.. Health Teachings  Instruct patient to take medication around the clock and to finish drug completely as directed. Report significant changes to forestall renal calculi formation. Also report failure of treatment (i. Take missed doses as soon as remembered unless almost time for next dose. CBC with differential. headache.

g.  Instruct patient that drug may cause drowsiness and blurred vision. Children. May impair ability to drive or operate machine. Indication: Urinary Incontinence. constipation.  Instruct patient drowsiness may be enhanced by drugs w/ CNS-depressant properties. Patients suffering from: bowel obstruction. abnormal eye accommodation and vision. dizziness. palpitation. . may be increased to 3x/day although some patients may already respond to 15-mg tablet/day. toxic megacolon.Generic Name: Propiverine HCl Brand Name: Mictonorm Classification: Urinary Antispasmodic Action: Inhibition of calcium reflux and modulation of intracellular calcium in urinary bladder smooth muscle cells causing musculotropic spasmolysis.  Care w/ acute myocardial infarction  Medicine should not be withdrawn abruptly. Taken at regular intervals w/water. tremor. myasthenia gravis. nausea/vomiting. before or after meals. Adverse Reactions: Dry mouth. Neurogenic detrusor overactivity: Recommended dose is 15-mg tablet 3x/day. bladder outflow obstruction which causes urinary retention. Dosage: Adult: 15-mg tablet 2x/day. Inhibition of the efferent neurotransmission of the nervus pelvicus due to an anticholinergic action. Nursing Considerations      Assess patient previous sensitivity reaction Monitor allergic conditions such as hypotension and drowsiness Monitor hepatic or severe renal impairment Monitor liver enzyme values in patients receiving long term therapy Monitor patient urine sample Health Teachings  Instruct patient hypotension may occur when treated w/ isoniazid. hypotension with drowsiness. intestinal atony. pregnancy and lactation. severe ulcerative colitis. urgency and frequency in patients who have either idiopathic detrusor overactivity (overactive bladder) or neurogenic detrusor overactivity (detrusor hyperreflexia) from spinal cord injuries e. restlessness and confusion. flushing. fatigue. transverse lesion paraplegia. Contraindication: Hypersensitivity. May be increased to 4x/day if required and tolerated (max daily dose). rashes.  Caution to children and elderly. urinary retention.

dehydration. vertigo. hearing loss (rarely permanent). cirrhosis of liver. constipation. and for treatment of hypercalcemia. increasing oliguria. hypomagnesemia. Metabolic: Hypovolemia. acute hypotensive episodes. fluid and electrolyte depletion states.d. abdominal cramping. anuria. irreversible renal failure. hyponatremia hypokalemia. acute pancreatitis. Furomide . oral and gastric burning. elevated BUN. . (max: 480 mg/d) Contraindication: History of hypersensitivity to furosemide or sulfonamides. Has been used concomitantly with mannitol for treatment of severe cerebral edema. lactation. agranulocytosis (rare). including nephrotic syndrome. May be used for management of hypertension. blurred vision. diarrhea. Loop Diuretic Action: Rapid-acting potent sulfonamide "loop" diuretic and antihypertensive with pharmacologic effects and uses almost identical to those of ethacrynic acid.i. particularly in meningitis. GI: Nausea. thrombocytopenic purpura. hypocalcemia (tetany). decreases renal vascular resistance and may increase renal blood flow Indication: Treatment of edema associated with CHF. hyperglycemia. Special Senses: Tinnitus. Adverse Reactions: CV: Postural hypotension. hyperuricemia. jaundice. Lasix. pregnancy (category C). hypochloremia metabolic alkalosis. feeling of fullness in ears. may be increased by 1–2 mg/kg q6–8h (max: 6 mg/kg/dose) IV/IM 1 mg/kg. may be increased by 1 mg/kg q2h if needed (max: mg/kg/dose) Neonate: PO 1–4 mg/kg q12–24h IV/IM 1–2 mg/kg q12–24h Hypertension Adult: PO 10–40 mg b. hepatic coma. circulatory collapse. and kidney disease. Dosage: Edema Adult: PO 20–80 mg in 1 or more divided doses up to 600 mg/d if needed IV/IM 20–40 mg in 1 or more divided doses up to 600 mg/d Child: PO 2 mg/kg. Urogenital: Allergic interstitial nephritis. Luramide Classification: Electrolytic and Water Balance Agent. anorexia. alone or in combination with other antihypertensive agents. vomiting.Generic Name: Furosemide Brand Name: Fumide . Exact mode of action not clearly defined. urinary frequency. leukopenia. dizziness with excessive diuresis. Hematologic: Anemia. glycosuria. aplastic anemia.

BUN. numbness. exfoliative dermatitis. Body as a Whole: Increased perspiration. closely monitor BP and vital signs. dizziness. porphyria cutanea tarde. exercise during hot weather. Sudden alteration in fluid and electrolyte balance may precipitate significant adverse reactions. Lab tests: Obtain frequent blood count. Sudden death from cardiac arrest has been reported. Caution patient that the use of alcohol. do not double doses  Caution patient to change positions slowly to minimize orthostatic hypotension. nausea. Monitor BP during periods of diuresis and through period of dosage adjustment. and uric acid values during first few months of therapy and periodically thereafter. Monitor for S&S of hypokalemia. serum and urine electrolytes. Report symptoms to physician.unboundmedicine. or standing for long periods during therapy may enhance orthostatic hypotension  Caution patient to use sunscreen and protective clothing to prevent photosensitivity reactions  Advise patient to contact health care professional immediately if muscle weakness. or tingling of extremities occurs  Advise diabetic patients to monitor blood glucose closely. pain at IM injection site. may cause increased blood glucose levels  Caution older patients or their caregivers about increased risk for falls. activation of SLE.Skin: Pruritus. blood sugar.com/nursingcentral/ub/view/Davis-DrugGuide/51569/0/oxybutynin http://www. urticaria. photosensitivity. thrombophlebitis. weakness. purpura.mims. Take missed doses as soon as possible.com/Philippines/drug/info PPD’s Nursing Drug Guide 2nd Edition . cramps. Observe older adults closely during period of brisk diuresis. muscle spasms. Health Teachings  Instruct patient to take furosemide as directed. necrotizing angiitis (vasculitis). paresthesias.      Nursing Considerations: Observe patients receiving parenteral drug carefully. CO2. Suggest strategies for fall prevention Sources: http://www.

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