Pharmacology of Urinary System

Sistem Urogenital

Terdiri dari:
1. Sistem Uropoetika
2. Sistem genitalis

Organ-organ sistem Uropoitika:

1. Ren/ginjal/Kidney
2. Ureter
3. Vesika urinaria/Kandung kemih/
bladder
4. Urethra
 Fungsi ginjal dan saluran kemih
Ekskresi
Pembuangan sisa metabolisme tubuh dan obat
Ekskresi dan reabsorbsi selektif bahan-bahan hasil metabolisme tubuh
Regulasi
Pengaturan volume cairan tubuh dan komposisi ion
Peran utama homeostasis(pemeliharaan lingkungan internal tubuh)
Pengaturan keseimbangan asam basa
Endokrin
Sintesis renin, eritopoitin dan prostaglandin
Metabolisme
Metabolisme vitamin D dan protein-protein dengan berat molekul
kecil
Tempat utama katabolisme hormon insulin, paratiroid dan kalsitonin
 Recall the anatomy and physiology of the Renal
System
Renal Assessment
Renal Laboratory Procedure
Common Conditions:
UTI
Kidney Stones
ARF and CRF
BPH
Prostatic cancer
 Urological Assessment
Nursing History
Reason for seeking care
Current illness
Previous illness
Family History
Social History
Sexual history
 Urological Assessment
Key Signs and Symptoms of Urological Problems
EDEMA
associated with fluid retention
Renal dysfunctions usually produce ANASARCA
PAIN
Suprapubic pain= bladder
Colicky pain on the flank= kidney
HEMATURIA
Painless hematuria may indicate URINARY CANCER!
Early-stream hematuria= urethral lesion
Late-stream hematuria= bladder lesion

DYSURIA Pain with urination= lower UTI

POLYURIA
More than 2 Liters urine per day
OLIGURIA
Less than 400 mL per day
ANURIA
Less than 50 mL per day
 Menghilangkan nyeri

Provide PAIN relief

Assess the level of pain
Administer medications analgesic
usually narcotic ANALGESICS
 Infeksi saluran kemih
Keradangan bakterial saluran kemih dari
pielum ginjal sampai urethra
Dengan /tanpa gejala
Lekosituria (=inflamasi)
Harus ditemukan kuman di dalam air kemih
(bakteriuri= infeksi)
 Urinary Tract Infection (UTI)

Bacterial invasion of the kidneys or bladder

(CYSTITIS) usually caused by Escherichia coli
Predisposing factors include
1. Poor hygiene
2. Irritation from bubble baths
3. Urinary reflux
4. Instrumentation
5. Residual urine, urinary stasis
6. Dehydration
 PATHOPHYSIOLOGY

The invading organism ascends the urinary

tract, irritating the mucosa and causing
characteristic symptoms
Ureter= ureteritis
Bladder= cystitis
Urethra=Urethritis
Pelvis= Pyelonephritis
 Assessment findings

Low-grade fever
Abdominal pain
Enuresis
Pain/burning on urination
Urinary frequency
Hematuria
Assessment findings: Upper UTI
Fever and CHIILS
Flank pain
Costovertebral angle tenderness
Laboratory Examination
1. Urinalysis
2. Urine Culture
 Jaras infeksi ginjal
Hematogenous infection
Common agents:
E.Coli ( 80-90% ISK pada masyarakat)
Staphylococcus
Ascending infection
E.coli
Proteus
Enterobacter
 Diagnosis
Anamnesis
Keluhan dan gejala ISK:
Disuria, polakisuria, nokturia, urgensi, nyeri suprapubik
(ISK bawah)
Demam, mual, muntah, nyeri kostovertebral (ISK atas)
Pemeriksaan fisik
Laboratorium
Lekosituria
bakteriuria
 Pengobatan
Eradikasi kuman dari seluruh saluran kemih
Terapi efektif:
Karakteristik penderita(jenis ISK)
Kuman penyebab diketahui
Antimikroba yang digunakan sesuai hasil test kepekaan.
Terapi empiris:
Kesulitan menegakkan diagnosis
Kesulitan membedakan jenis ISK
Kultur/tes kepekaan belum ada
 Prinsip pengobatan

Sedikit/tidak mempengaruhi flora normal(saluran

cerna/vagina)
Harga murah
Kadar obat dalam urin tinggi
Batu, kateter, obstruksi dihilangkan dahulu, kecuali
keluhan berat
Berdasarkan biakan urin dan tes kepekaan
Hasil terapi dipastikan dengan kultur ulang
Kasus yang tidak mungkin teredikasi diterapi dg terapi
supresif
Minum banyak
Pengosongan buli-buli
 TERAPI UTI
Short course Tx
(3 days)
TMT SMX 160/800 mg
Cyprofloxacin 2 x 250 500 mg/days
Cypro. Extended release 500 mg/day
Cystitis Another Fluorquinolone

The longer course Tx

(7 days)

Antibiotic Therapy
Outpatient: good general condition &
not pregnant
Treat with oral fluoroquinolon, TMT-
SMX or 3rd generation cephalosporin
for 7-14 days (sometimes at least one
dose of iv antibiotic, followed by oral Tx
Acute
Pyelonephritis
Inpatient: initially treat with a 3rd
generation cephalosporin or a
fluoroquinilon for 10-14 days while the
results of urine & blood cultures &
antimicrobial susceptibility

ANTISEPTIK Metenamin, Asam nalidiksat, Nitrofurantoin,

Fosfomisin Trometamin
Farmakologi obat infeksi sal. Kencing
Sulfonamid, kotrimoksazol dan antiseptik sal.kemih

Sulfonamid resistensi bakt gram (-)

Indikasi : sistitis akut & kronis
Kotrimoksazol infeksi ringan sal kemih bag bawah, walaupun
resisten terhadap sulfa.
Trimetoprim efektif untuk infeksi sal.kemih
Kotrimoksazol = sulfonamid : trimetoprim (800 mg : 160 mg)
 PABA

Dihidropteroat
sintetase Sulfonamid berkompetisi dg
PABA

Asam dihidrofolat

Dihidrifolat
reduktase Trimetoprim

Asam tetrahidrofolat

Purin

DNA

Mekanisme kerja kotrimoksazol

Efek samping :

-Gangguan sistem hematopoetik

-Gangguan sal kemih : kristaluriuria
-Reaksi alergi
-Lain-lain : mual, muntah yg bersifat sentral
QUINOLON DAN FLUOROKUINOLON
ASAM NALIDIKSAT PROTOTIP GOL KUINOLON LAMA

1980 QUINOLON BARU

QUINOLON ASAM NALIDIKSAT

FLUOROKUINOLON SIPROFLOKSASIN, OFLOKSASIN, LEVOFLOKSASIN

Indikasi :
Asam nalidiksat dan asam pipemidat : sisititis akut tanpa komplikasi
pada wanita

Fluorokuinolon :
Infeksi saluran kemih, infeksi sal cerna, infeksi sal nafas, infeksi
tulang dan sendi, infeksi kulit dan jar lunak dan penyakit yang
ditularkan melalui hub seksual
EFEK SAMPING KUINOLON

SALURAN CERNA MUAL, MUNTAH, RASA TIDAK ENAK

SSP SAKIT KEPALA DAN PUSING
HEPATOTOSIK JARANG
KARDIOTOKSISITAS : SPARFLOKSASIN, GREPAFLOKSASIN
DISGLIKEMIA KONTRAINDIKASI PD DIABETES MELITUS
FOTOTOKSISITAS
Nursing interventions
Administer antibiotics as ordered
Provide warm baths and allow client to void
in water to alleviate painful voiding.
Force fluids. Nurses may give 3 liters of fluid
per day
Encourage measures to acidify urine
(cranberry juice, acid-ash diet).
 Provide client teaching and discharge
planning concerning
a. Avoidance of tub baths
b. Avoidance of bubble baths that might
irritate urethra
c. Importance for girls to wipe perineum from
front to back
d. Increase in foods/fluids that acidify urine.
 Diuretics
1. Thiazides
hydrochlorothiazide
chlorthalidone (Hygroton)

2. Loop diuretics
furosemide (Lasix); bumetadine (Burmex);
ethacrynic acid (Edecrin)

3. K+ Sparing
amiloride (Midamor); spironolactone (Aldactone);
triamterene (Dyrenium)

4. Osmotic
mannitol (Osmitrol); urea (Ureaphil)

5. Other
triamterene
acetazolamide (Diamox)
 Diuretics (cont)
1. Site of Action
Renal Nephron

2. Mechanism of Action
Urinary Na+ excretion
Urinary water excretion

Extracellular Fluid
and/or Plasma Volume

3. Effect on Cardiovascular System

Acute decrease in CO

Chronic decrease in TPR, normal CO

Mechanism(s) unknown
 Diuretics (cont)
4. Adverse Reactions
dizziness,
electrolyte imbalance/depletion,
hypokalemia,
hyperlipidemia,
hyperglycemia (Thiazides)
gout

5. Contraindications
hypersensitivity,
compromised kidney function
cardiac glycosides (K+ effects)
hypovolemia,
hyponatremia
 Diuretics (cont)
6. Therapeutic Considerations
Thiazides (most common diuretics for HTN)
Generally start with lower potency diuretics
Generally used to treat mild to moderate HTN
Use with lower dietary Na+ intake,
and K+ supplement or high K+ food
K+ Sparing (combination with other agent)

Loop diuretics (severe HTN, or with CHF)

Osmotic (HTN emergencies)

Maximum antihypertensive effect reached

before maximum diuresis- 2nd agent indicated
 URINARY ANTI SPASMODIC
Relax the smooth muscle
in the wall of the ureter
bladder
Promote normal bladder function
 atropine (Sal-Tropine)
bethanechol (Urecholine)
flavoxate (Urispas)antimuskarinik
L-hyoscyamine (Anaspaz, Cystospaz)
neostigmine (Prostigmin)
oxybutynin (Ditropan) antikolinergik
 Combination Antibiotic, Analgesic,
and Antispasmodic Drugs
Contain various combinations of the
following drugs:
Urinary antibiotic drug
methenamine
Urinary analgesic
phenazopyride
phenyl salicylate
 Sedative drug
butabarbitol
Urinary antispasmodic drug
atropine
hyoscyamine
Urinary antiseptic drug
methylene blue
 spasminal
Na metamizol 500 mg
Ekstrak belladonna 10 mg
Papaverin HCl 25 mg