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.

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

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

dizziness. confusion. sore throat. Take missed doses as soon as remembered unless almost time for next dose. CBC with differential. severe decrease in platelets (with or without purpura). 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 . especially if diarrhea contains blood. Change in warfarin dosage may be indicated. or pus. Advise patient that sharing of this medication may be dangerous  Instruct patient to notify health care professional if fever and diarrhea develop. vomiting. platelet count. Also report failure of treatment (i. even if feeling well. especially if liver or kidney function is compromised or if certain other drugs are given. headache.  Monitor I&O volume and pattern. Most frequently observed: Thrombocytopenia (with concurrent thiazide diuretics). severe skin reactions. BUN and creatinine clearance with prolonged therapy. Health Teachings  Instruct patient to take medication around the clock and to finish drug completely as directed. mucus.  Lab tests: Baseline and followup urinalysis.  Older adult patients are at risk for severe adverse reactions.  Monitor coagulation tests and prothrombin times in patient also receiving warfarin. fever. mouth sores. bone marrow suppression. Report significant changes to forestall renal calculi formation.. continued UTI symptoms). 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.e. anorexia. and bone marrow depression.  Be alert for overdose symptoms (no extensive experience has been reported): Nausea. mental depression.Susceptibility (low in general population) is seen most frequently in asthmatics or atopic nonasthmatic persons.

tremor. 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. toxic megacolon. .  Instruct patient drowsiness may be enhanced by drugs w/ CNS-depressant properties. urgency and frequency in patients who have either idiopathic detrusor overactivity (overactive bladder) or neurogenic detrusor overactivity (detrusor hyperreflexia) from spinal cord injuries e. may be increased to 3x/day although some patients may already respond to 15-mg tablet/day. Indication: Urinary Incontinence. transverse lesion paraplegia. dizziness. Children. Patients suffering from: bowel obstruction. fatigue. severe ulcerative colitis. May be increased to 4x/day if required and tolerated (max daily dose). May impair ability to drive or operate machine. urinary retention.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.  Instruct patient that drug may cause drowsiness and blurred vision. intestinal atony. flushing. before or after meals.g. hypotension with drowsiness. Taken at regular intervals w/water. palpitation. Neurogenic detrusor overactivity: Recommended dose is 15-mg tablet 3x/day. nausea/vomiting. Adverse Reactions: Dry mouth. abnormal eye accommodation and vision. Inhibition of the efferent neurotransmission of the nervus pelvicus due to an anticholinergic action.  Care w/ acute myocardial infarction  Medicine should not be withdrawn abruptly. bladder outflow obstruction which causes urinary retention. Contraindication: Hypersensitivity. Dosage: Adult: 15-mg tablet 2x/day. rashes. pregnancy and lactation. restlessness and confusion. myasthenia gravis.  Caution to children and elderly. constipation.

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

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

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