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, eritropoitin 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 p.e
POLYURIA
More than 2 Liters urine per day
OLIGURIA
Less than 400 mL per day
ANURIA
Less than 50 mL per day

cystitis

Menghilangkan nyeri
Provide PAIN relief
Assess the level of pain
Administer medications analgesic :
non narcotic
- narcotic

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

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, 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

ANTISEPTI
K

Metenamin, Asam nalidiksat, Nitrofurantoin,

Fosfomisin Trometamin

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

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
Dihidroptero
at
sintetase

Sulfonamid
berkompetisi dg PABA
Asam
dihidrofolat

Dihidrifolat
reduktase

Trimetoprim
Asam tetrahidrofolat

Purin

DN
A

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 tube 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

Antispasmodic drugs
are used to counteract the smooth
musclecontraction, especially in tubular
organs of the GIT.
the effect is to prevent spasms of the
stomach, intestine, biliary or urinary bladder.

Two main types:

- antimuscarinics (dicycloverine, hyoscine,
atropine).
- smooth muscle relaxants (alverine,
mebeverine, peppermint oil).

Antispasmodic drugs
antimuscarinics inhibit the action of Ach.
they stop the transmission of parasympathetic
nerve impulses therefore lessen the spasms of
smooth muscle, such as in the GIT and in the
bladder.
reducing the muscle contractions in this way
often helps to relieve some of the symptoms
(IBS).
smooth muscle relaxants work directly on the
smooth muscle in the wall of the gut. Here
they help to relax the muscle and relieve the
pain associated with a contraction of the gut.

Antispasmodic drugs
C.I.:
- paralytic ileus (paralysis of the gut
muscles),
- myasthenia gravis (a condition causing
muscle weakness),
- pyloric stenosis (narrowing of the outlet
from the stomach)
- prostatic hypertrophia.
- pregnancy or breast-feeding mothers.
- Children ????

Antispasmodic drugs
The most common side-effects
are:
- flatulence and bloating
- heartburn
- constipation
- dry mouth

atropine (Sal-Tropine)
bethanechol (Urecholine)
flavoxate (Urispas)
L-hyoscyamine (Anaspaz, Cystospaz)
neostigmine (Prostigmin)
oxybutynin (Ditropan)

Antispasmodic drugs
atropine, propantheline,
butylscopolamine,
metoclopramid.
selective anticholinergic drugs (rec.
M1) (pirenzepine, telenzepine)

Antispasmodic drugs
Direct acting on smooth muscle
(anticholinergics and Ca channels
blockers):
- otilonium bromide
- pinaverium;
- propiverine, rociverine
- temiverina,
- mebeverine - GIT specificity
- alverine,
- drotaverine.
Indications: IBS, GD ulcer, biliary
colics.

Combination Antibiotic, Analgesic,

and Antispasmodic Drugs
Contain various combinations of
the following drugs:
Urinary antiseptic drug
methenamine

Urinary analgesic
phenazopyride
phenyl salicylate

 Sedative drug
butabarbitol

Urinary antispasmodic drug

atropine
hyoscyamine

Urinary antiseptic drug

methylene blue

SPASMIUM DRAGE@100
Kandungan
Phenyl-propyl-ethylamine 30 mgIndikasi
Nyeri spastik, dismenore, tukak peptik.Kontra Indikasi
Glaukoma sudut sempit akut, miastenia gravis, syok, psikosis berat
Efek Samping
Lesu, mengantuk, lemah ototPerhatian
Ketergantungan, amnesia & serangan grand mal. Peny otak organik,
insufisiensi kardiorespiratoris, menurunkan fungsi hati atau ginjal. Gagal
nafas atau PPOK. Hamil & menyusui. Usia lanjut. Hindari penggunaan jangka
panjangDosis
1-2 drag 3 x/hr
Interaksi
Meningkatkan efek depresan SSP pada alkohol, barbiturat, antihistamin,
fenotiazin, opiat, fenitoin,, meningkatkan efek relaksasi otot dg
benzodiazepin & relaksan otot lainnya. Antasida mengganggu absorpsi di GI