Urinary retention

Primary drug Secondary drug URINARY RETENTION Effect Mechanism Precautions 

ALPHA-BLOCKERS Cardiovascular Drugs, Antihypertensives and heart failure drugs  

PARASYMPATHOMIMETICS - Drugs Acting on the Nervous System, Drugs used to treat neuromuscular diseases and movement disorders  

DUTASTERIDE ANTIVIRALS - PROTEASE INHIBITORS Possibly t adverse effects of dutasteride with indinavir or ritonavir (with or without lopinavir) Inhibition of CYP3A4-mediated metabolism of dutasteride Monitor closely l dosing frequency if side-effects occur 

DUTASTERIDE CALCIUM CHANNEL BLOCKERS Plasma concentrations of dutasteride may T when it is co-adminis-tered with diltiazem or verapamil Uncertain but postulated that it may be due to inhibition of CYP3A4-mediated metabolism of dutasteride Watch for side-effects of dutasteride 

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Adverse effects with atropine therapy include dry mouth, myosis, loss of visual accommodations, constipation, and urinary retention. The dmg can also produce flushing, hyperthermia, delirium, tachycardia, and exacerbate glaucoma (85). 

Antagonists of muscarinic acetylcholine receptors had widely been used since 1860 for the treatment of Parkinson s disease, prior to the discovery of l-DOPA. They block receptors that mediate the response to striatal cholinergic interneurons. The antiparkinsonian effects of drugs like benzatropine, trihexyphenidyl and biper-iden are moderate the resting tremor may sometimes respond in a favorable manner. The adverse effects, e.g., constipation, urinary retention, and mental confusion, may be troublesome, especially in the elderly. 

Adverse reactions of amantadine include gastrointestinal upset with nausea and vomiting, anorexia, asthenia (weakness, loss of strength), constipation, depression, visual disturbances, psychosis, urinary retention, and orthostatic hypotension. 

B. urinary retention, which indicates renal insufficiency... 

Genitourinary—spasms of die ureters and bladder sphincter, urinary retention or hesitancy... 

This type of pain management is used for postoperative pain, labor pain, and cancer pain. The most serious adverse reaction associated with the administration of narcotics by the epidural route is respiratory depression. The patient may also experience sedation, confusion, nausea, pruritus, or urinary retention. Fentanyl is increasingly used as an alternative to morphine sulfate because patients experience fewer adverse reactions. 

The major uses of the cholinergic drugp are in the treatment of glaucoma, myasthenia gravis, and urinary retention. 

URINARY RETENTION. If a patient receives a cholinergic drug for the treatment of urinary retention, die nurse palpates die abdomen in the pelvis area to determine if distention is present. A rounded swelling over die pelvis usually indicates retention and a distended bladder. The patient may also complain of discomfort in the lower abdomen. In addition, die nurse takes die patient s blood pressure and pulse rate... 

URINARY RETENTION. The ongoing assessment for a patient witii urinary retention includes measuring and recording die fluid intake and output. The nurse must notify die primary healdi care provider if the patient fails to void after drug administration. 

If a cholinergic drug is ordered for the prevention of urinary retention, die nurse measures and records the fluid intake and output. If die amount of each voidingis insufficient or die patient fails to void, the nurse palpates the bladder to determine its size and notifies the primary healdi care provider. 

Discuss the types of ongoing assessments made when a patient takes a cholinergic drug for urinary retention. 

The nurse observesthe elderly patient receiving a cholinergic blocking drug at frequent intervals for excitement, agitation, mental confusion, drowsiness urinary retention, or other adverse effects. If any of these should occur, it is important to withhold the next dose of the drug and contact the primary health care provider. The nurse ensures patient safety until these adverse reactions disappear. 

Nausea and vomiting may occur with the administration of an analeptic therefore, the nurse should keep a suction machine nearby should vomiting occur. Urinary retention may be seen with the administration of doxapram therefore, the nurse measures intake and output and notifies the primary health care provider if the patient is unable to void or the bladder appears distended on palpation. 

The most common serious adverse reactions to amantadine are orthostatic hypotension, depression, congestive heart failure, psychosis, urinary retention, convulsions, leukopenia, and neutropenia Less serious reactions include hallucinations, confusion, anxiety, anorexia, nausea, and constipation. Adverse reactions with selegiline include nausea, hallucinations, confusion, depression, loss of balance, and dizziness. 

These dragp are used with caution in patients with tachycardia, cardiac arrhythmias, hypertension, hypotension, those with a tendency toward urinary retention, those with decreased liver or kidney function, and those with obstructive disease of the urinary system or gastrointestinal tract. The anticholinergic drugp are given with caution to the older adult. 

Frequently seen adverse reactions to dragp with anticholinergic activity include dry mouth, blurred vision, dizziness, mild nausea, and nervousness. These may become less pronounced as therapy progresses. Other adverse reactions may include skin rash, urticaria (hives), urinary retention, dysuria, tachycardia, muscle weakness, disorientation, and confusion. If any of these reactions are severe, the drug may be discontinued for several days and restarted at a lower dosage, or a different antiparkinsonism drag may be prescribed. 

Some patients with parkinsonism communicate poorly and do not tell the primary health care provider or nurse that problems are occurring. The nurse observes the patient with parkinsonism for outward changes that may indicate one or more adverse reactions. For example a sudden change in the facial expression or changes in posture may indicate abdominal pain or discomfort, which may be caused by urinary retention, paralytic ileus, or constipation. Sudden changes in behavior may indicate hallucinations, depression, or other psychotic episodes. 

Sedation and dry mouth are the most common adverse reactions seen with the use of TCAs. Tolerance to these effects develops with continued use. Orthostatic hypotension can occur with the administration of the TCAs. Orthostatic hypotension is a drop in blood pressure of 20 to 30 points when a person changes position, such as going from a lying position to a standing position. Mental confusion, lethargy, disorientation, rash, nausea, vomiting, constipation, urinary retention, visual disturbances, photosensitivity, and nasal congestion also may be seen. Sexual dysfunction may occur with administration of clomipramine. 

Sedation, anticholinergic effects (dry mouth, dry eyes, urinary retention), nausea, nasal congestion, blurred vision, orthostatic hypotension, lethargy, confusion, constipation, diarrhea... 

TCAs. The tricyclics cause anticholinergic effects (see Chap. 25) such as dry mouth, blurred vision, postural hypotension, urinary retention, and constipation. 

Older men with prostatic enlargement are at increased risk for urinary retention when they take the tricyclic antidepressants. 

ADMINISTERING DISOPYRAMIDE. Because of the cholinergic blocking effects of disopyramide (see Chap. 25), urinary retention may occur. The nurse monitors the urinary output closely, especially during the initial period of therapy. If the patient s intake is sufficient but the output is low, the lower abdomen is... 

Edema, fluid and electrolyte imbalance, headache, blurred vision, nausea, vomiting, diarrhea, urinary retention Headache, nausea, vomiting, fluid and electrolyte imbalance, syncope... 

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