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 patients 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 familys 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.

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

Generic Name: Sulfamethoxazole and Trimethoprim Brand Name: Bactrim, Co-Trimoxazole, Septra Classification: antiinfective; urinary tract agent; sulfonamide Action: Fixed combination of sulfamethoxazole (SMZ), an intermediate acting antiinfective sulfonamide, and trimethoprim (TMP), a synthetic antiinfective. Both components of the combination are synthetic folate antagonist antiinfectives. Mechanism of action is principally enzyme inhibition, which prevents bacterial synthesis of essential nucleic acids and proteins. Indication: Pneumocystis carinii pneumonitis, Shigellosis enteritis, and severe complicated UTIs due to most strains of the Enterobacteriaceae. Also children with acute otitis media due to susceptible strains of Haemophilus influenzae, and acute episodes of chronic bronchitis in adults. Dosage: Systemic Infections Adult: PO 160 mg TMP/800 mg SMZ (1 double strength [DS] tablet) q12h IV 810 mg/kg/d TMP divided q612h infused over 6090 min Child: PO >2 mo & <40 kg, 4 mg/kg/d TMP q12h; >40 kg, 160 mg TMP/800 mg SMZ (1 DS tablet) q12h IV >2 mo, 810 mg/kg/d TMP divided q612h infused over 6090 min Pneumocystis carinii Pneumonia Adult: IV 20 mg/kg/d TMP divided q6h infused over 6090 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.i.d. 3 consecutive d/wk (max: 320 mg TMP/d) Renal Impairment Clcr 1030 mL/min: reduce dose by 50%; <10 mL/min: reduce dose by 75% Contraindication: Hypersensitivity to TMP, SMZ, sulfonamides, or bisulfites; group A beta-hemolytic streptococcal pharyngitis; megaloblastic anemia due to folate deficiency; creatinine clearance <15 mL/min; pregnancy (category C), lactation. Not recommended for infants <2 mo. Adverse Reactions: Skin: Mild to moderate rashes (including fixed drug eruptions), toxic epidermal necrolysis. GI: Nausea, vomiting, diarrhea, anorexia, hepatitis, pseudomembranous enterocolitis, stomatitis, glossitis, abdominal pain. Urogenital: Kidney failure, oliguria, anuria, crystalluria. Hematologic: Agranulocytosis (rare), aplastic anemia (rare), megaloblastic anemia, hypoprothrombinemia, thrombocytopenia (rare). Body as a Whole: Weakness, arthralgia, myalgia, photosensitivity, allergic myocarditis. Nursing Considerations Be aware that IV Septra contains sodium metabisulfite, which produces allergictype reactions in susceptible patients: Hives, itching, wheezing, anaphylaxis.

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

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

Generic Name: Furosemide Brand Name: Fumide , Furomide , Lasix, Luramide Classification: Electrolytic and Water Balance Agent; Loop Diuretic Action: Rapid-acting potent sulfonamide "loop" diuretic and antihypertensive with pharmacologic effects and uses almost identical to those of ethacrynic acid. Exact mode of action not clearly defined; decreases renal vascular resistance and may increase renal blood flow Indication: Treatment of edema associated with CHF, cirrhosis of liver, and kidney disease, including nephrotic syndrome. May be used for management of hypertension, alone or in combination with other antihypertensive agents, and for treatment of hypercalcemia. Has been used concomitantly with mannitol for treatment of severe cerebral edema, particularly in meningitis. Dosage: Edema Adult: PO 2080 mg in 1 or more divided doses up to 600 mg/d if needed IV/IM 2040 mg in 1 or more divided doses up to 600 mg/d Child: PO 2 mg/kg, may be increased by 12 mg/kg q68h (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 14 mg/kg q1224h IV/IM 12 mg/kg q1224h Hypertension Adult: PO 1040 mg b.i.d. (max: 480 mg/d) Contraindication: History of hypersensitivity to furosemide or sulfonamides; increasing oliguria, anuria, fluid and electrolyte depletion states; hepatic coma; pregnancy (category C), lactation. Adverse Reactions: CV: Postural hypotension, dizziness with excessive diuresis, acute hypotensive episodes, circulatory collapse. Metabolic: Hypovolemia, dehydration, hyponatremia hypokalemia, hypochloremia metabolic alkalosis, hypomagnesemia, hypocalcemia (tetany), hyperglycemia, glycosuria, elevated BUN, hyperuricemia. GI: Nausea, vomiting, oral and gastric burning, anorexia, diarrhea, constipation, abdominal cramping, acute pancreatitis, jaundice. Urogenital: Allergic interstitial nephritis, irreversible renal failure, urinary frequency. Hematologic: Anemia, leukopenia, thrombocytopenic purpura; aplastic anemia, agranulocytosis (rare). Special Senses: Tinnitus, vertigo, feeling of fullness in ears, hearing loss (rarely permanent), blurred vision.

Skin: Pruritus, urticaria, exfoliative dermatitis, purpura, photosensitivity, porphyria cutanea tarde, necrotizing angiitis (vasculitis). Body as a Whole: Increased perspiration; paresthesias; activation of SLE, muscle spasms, weakness; thrombophlebitis, pain at IM injection site. Nursing Considerations: Observe patients receiving parenteral drug carefully; closely monitor BP and vital signs. Sudden death from cardiac arrest has been reported. Monitor BP during periods of diuresis and through period of dosage adjustment. Observe older adults closely during period of brisk diuresis. Sudden alteration in fluid and electrolyte balance may precipitate significant adverse reactions. Report symptoms to physician. Lab tests: Obtain frequent blood count, serum and urine electrolytes, CO2, BUN, blood sugar, and uric acid values during first few months of therapy and periodically thereafter. Monitor for S&S of hypokalemia.

Health Teachings Instruct patient to take furosemide as directed. Take missed doses as soon as possible; do not double doses Caution patient to change positions slowly to minimize orthostatic hypotension. Caution patient that the use of alcohol, exercise during hot weather, 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, cramps, nausea, dizziness, numbness, or tingling of extremities occurs Advise diabetic patients to monitor blood glucose closely; may cause increased blood glucose levels Caution older patients or their caregivers about increased risk for falls. Suggest strategies for fall prevention

Sources: http://www.unboundmedicine.com/nursingcentral/ub/view/Davis-DrugGuide/51569/0/oxybutynin http://www.mims.com/Philippines/drug/info PPDs Nursing Drug Guide 2nd Edition