pharmacology of urinary system psik 2015.pptx
DESCRIPTION
slide pharmacology of urinaryTRANSCRIPT
![Page 1: pharmacology of urinary system psik 2015.pptx](https://reader030.vdocument.in/reader030/viewer/2022012922/563db9d6550346aa9aa0682b/html5/thumbnails/1.jpg)
Pharmacology of Urinary System
![Page 2: pharmacology of urinary system psik 2015.pptx](https://reader030.vdocument.in/reader030/viewer/2022012922/563db9d6550346aa9aa0682b/html5/thumbnails/2.jpg)
Sistem Urogenital
Terdiri dari:1. Sistem Uropoetika2. Sistem genitalis
Organ-organ sistem Uropoitika:3. Ren/ginjal/Kidney4. Ureter5. Vesika urinaria/Kandung kemih/ bladder4. Urethra
![Page 3: pharmacology of urinary system psik 2015.pptx](https://reader030.vdocument.in/reader030/viewer/2022012922/563db9d6550346aa9aa0682b/html5/thumbnails/3.jpg)
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
![Page 4: pharmacology of urinary system psik 2015.pptx](https://reader030.vdocument.in/reader030/viewer/2022012922/563db9d6550346aa9aa0682b/html5/thumbnails/4.jpg)
• 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
![Page 5: pharmacology of urinary system psik 2015.pptx](https://reader030.vdocument.in/reader030/viewer/2022012922/563db9d6550346aa9aa0682b/html5/thumbnails/5.jpg)
Urological Assessment
• Nursing History– Reason for seeking care– Current illness– Previous illness– Family History– Social History– Sexual history
![Page 6: pharmacology of urinary system psik 2015.pptx](https://reader030.vdocument.in/reader030/viewer/2022012922/563db9d6550346aa9aa0682b/html5/thumbnails/6.jpg)
Urological Assessment
Key Signs and Symptoms of Urological ProblemsEDEMA
• 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
![Page 7: pharmacology of urinary system psik 2015.pptx](https://reader030.vdocument.in/reader030/viewer/2022012922/563db9d6550346aa9aa0682b/html5/thumbnails/7.jpg)
Menghilangkan nyeri
Provide PAIN relief• Assess the level of pain• Administer medications analgesic usually narcotic ANALGESICS
![Page 8: pharmacology of urinary system psik 2015.pptx](https://reader030.vdocument.in/reader030/viewer/2022012922/563db9d6550346aa9aa0682b/html5/thumbnails/8.jpg)
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)
![Page 9: pharmacology of urinary system psik 2015.pptx](https://reader030.vdocument.in/reader030/viewer/2022012922/563db9d6550346aa9aa0682b/html5/thumbnails/9.jpg)
Urinary Tract Infection (UTI)
• Bacterial invasion of the kidneys or bladder (CYSTITIS) usually caused by Escherichia coli
Predisposing factors include1. Poor hygiene2. Irritation from bubble baths3. Urinary reflux4. Instrumentation5. Residual urine, urinary stasis6. Dehydration
![Page 10: pharmacology of urinary system psik 2015.pptx](https://reader030.vdocument.in/reader030/viewer/2022012922/563db9d6550346aa9aa0682b/html5/thumbnails/10.jpg)
PATHOPHYSIOLOGY
• The invading organism ascends the urinary tract, irritating the mucosa and causing characteristic symptoms– Ureter= ureteritis– Bladder= cystitis– Urethra=Urethritis– Pelvis= Pyelonephritis
![Page 11: pharmacology of urinary system psik 2015.pptx](https://reader030.vdocument.in/reader030/viewer/2022012922/563db9d6550346aa9aa0682b/html5/thumbnails/11.jpg)
Assessment findings
• Low-grade fever• Abdominal pain• Enuresisn/ngompol• Pain/burning on urination• Urinary frequency• Hematuria
![Page 12: pharmacology of urinary system psik 2015.pptx](https://reader030.vdocument.in/reader030/viewer/2022012922/563db9d6550346aa9aa0682b/html5/thumbnails/12.jpg)
Assessment findings: Upper UTI• Fever and CHIILS• Flank pain• Costovertebral angle tendernessLaboratory Examination1. Urinalysis2. Urine Culture
![Page 13: pharmacology of urinary system psik 2015.pptx](https://reader030.vdocument.in/reader030/viewer/2022012922/563db9d6550346aa9aa0682b/html5/thumbnails/13.jpg)
Jaras infeksi ginjal
• Hematogenous infection– Common agents:
• E.Coli ( 80-90% ISK pada masyarakat)• Staphylococcus
• Ascending infection– E.coli– Proteus– Enterobacter
![Page 14: pharmacology of urinary system psik 2015.pptx](https://reader030.vdocument.in/reader030/viewer/2022012922/563db9d6550346aa9aa0682b/html5/thumbnails/14.jpg)
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
![Page 15: pharmacology of urinary system psik 2015.pptx](https://reader030.vdocument.in/reader030/viewer/2022012922/563db9d6550346aa9aa0682b/html5/thumbnails/15.jpg)
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
![Page 16: pharmacology of urinary system psik 2015.pptx](https://reader030.vdocument.in/reader030/viewer/2022012922/563db9d6550346aa9aa0682b/html5/thumbnails/16.jpg)
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
![Page 17: pharmacology of urinary system psik 2015.pptx](https://reader030.vdocument.in/reader030/viewer/2022012922/563db9d6550346aa9aa0682b/html5/thumbnails/17.jpg)
Antibiotic Therapy
Cystitis
Acute Pyelonephritis
Short course Tx(3 days)
The longer course Tx (7 days)
Outpatient: good general condition & not pregnantTreat 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
Inpatient: initially treat with a 3rd generation cephalosporin or a fluoroquinilon for 10-14 days while the results of urine & blood cultures & antimicrobial susceptibility
TMT SMX 160/800 mgCyprofloxacin 2 x 250 – 500 mg/daysCypro. Extended release 500 mg/dayAnother Fluorquinolone
TERAPI UTI
ANTISEPTIK Metenamin, Asam nalidiksat, Nitrofurantoin, Fosfomisin Trometamin
![Page 18: pharmacology of urinary system psik 2015.pptx](https://reader030.vdocument.in/reader030/viewer/2022012922/563db9d6550346aa9aa0682b/html5/thumbnails/18.jpg)
![Page 19: pharmacology of urinary system psik 2015.pptx](https://reader030.vdocument.in/reader030/viewer/2022012922/563db9d6550346aa9aa0682b/html5/thumbnails/19.jpg)
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)
![Page 20: pharmacology of urinary system psik 2015.pptx](https://reader030.vdocument.in/reader030/viewer/2022012922/563db9d6550346aa9aa0682b/html5/thumbnails/20.jpg)
PABA
Asam dihidrofolat
Asam tetrahidrofolat
Purin
DNA
Dihidropteroatsintetase Sulfonamid berkompetisi dg
PABA
TrimetoprimDihidrifolat reduktase
Mekanisme kerja kotrimoksazol
![Page 21: pharmacology of urinary system psik 2015.pptx](https://reader030.vdocument.in/reader030/viewer/2022012922/563db9d6550346aa9aa0682b/html5/thumbnails/21.jpg)
Efek samping :
-Gangguan sistem hematopoetik-Gangguan sal kemih : kristaluriuria-Reaksi alergi-Lain-lain : mual, muntah yg bersifat sentral
![Page 22: pharmacology of urinary system psik 2015.pptx](https://reader030.vdocument.in/reader030/viewer/2022012922/563db9d6550346aa9aa0682b/html5/thumbnails/22.jpg)
QUINOLON DAN FLUOROKUINOLON
ASAM NALIDIKSAT PROTOTIP GOL KUINOLON LAMA
1980 QUINOLON BARU
QUINOLON ASAM NALIDIKSATFLUOROKUINOLON 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
![Page 23: pharmacology of urinary system psik 2015.pptx](https://reader030.vdocument.in/reader030/viewer/2022012922/563db9d6550346aa9aa0682b/html5/thumbnails/23.jpg)
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
![Page 24: pharmacology of urinary system psik 2015.pptx](https://reader030.vdocument.in/reader030/viewer/2022012922/563db9d6550346aa9aa0682b/html5/thumbnails/24.jpg)
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).
• intervensi keperawatan• Berikan antibiotik seperti yang diperintahkan• Menyediakan mandi air hangat dan memungkinkan klien untuk
membatalkan dalam air untuk mengurangi berkemih menyakitkan.• Cairan Force. Perawat dapat memberikan 3 liter cairan per hari• Mendorong langkah-langkah untuk mengasamkan urin (jus cranberry,
diet asam-abu).
![Page 25: pharmacology of urinary system psik 2015.pptx](https://reader030.vdocument.in/reader030/viewer/2022012922/563db9d6550346aa9aa0682b/html5/thumbnails/25.jpg)
• Provide client teaching and discharge planning concerninga. Avoidance of tub baths / hindari brendamb. Avoidance of bubble baths that might irritate urethra/ hindari sabunc. Importance for girls to wipe perineum from front to back/dari depan ke belakangd. Increase in foods/fluids that acidify urine./minum mkn asam
![Page 26: pharmacology of urinary system psik 2015.pptx](https://reader030.vdocument.in/reader030/viewer/2022012922/563db9d6550346aa9aa0682b/html5/thumbnails/26.jpg)
Diuretics1. Thiazides
hydrochlorothiazide chlorthalidone (Hygroton)
2. Loop diureticsfurosemide (Lasix); bumetadine (Burmex);ethacrynic acid (Edecrin)
3. K+ Sparingamiloride (Midamor); spironolactone (Aldactone);triamterene (Dyrenium)
4. Osmotic mannitol (Osmitrol); urea (Ureaphil)
5. Othertriamterene acetazolamide (Diamox)
![Page 27: pharmacology of urinary system psik 2015.pptx](https://reader030.vdocument.in/reader030/viewer/2022012922/563db9d6550346aa9aa0682b/html5/thumbnails/27.jpg)
Diuretics (cont)
2. Mechanism of Action
Urinary Na+ excretionUrinary water excretion
Extracellular Fluid and/or Plasma Volume
3. Effect on Cardiovascular System
Acute decrease in CO
Chronic decrease in TPR, normal COMechanism(s) unknown
1. Site of Action Renal Nephron
![Page 28: pharmacology of urinary system psik 2015.pptx](https://reader030.vdocument.in/reader030/viewer/2022012922/563db9d6550346aa9aa0682b/html5/thumbnails/28.jpg)
Diuretics (cont)4. Adverse Reactions
dizziness, electrolyte imbalance/depletion,hypokalemia, hyperlipidemia,hyperglycemia (Thiazides)gout
5. Contraindicationshypersensitivity, compromised kidney functioncardiac glycosides (K+ effects)hypovolemia,hyponatremia
![Page 29: pharmacology of urinary system psik 2015.pptx](https://reader030.vdocument.in/reader030/viewer/2022012922/563db9d6550346aa9aa0682b/html5/thumbnails/29.jpg)
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 reachedbefore maximum diuresis- 2nd agent indicated
![Page 30: pharmacology of urinary system psik 2015.pptx](https://reader030.vdocument.in/reader030/viewer/2022012922/563db9d6550346aa9aa0682b/html5/thumbnails/30.jpg)
URINARY ANTI SPASMODIC
• Relax the smooth muscle– in the wall of the ureter– bladder
• Promote normal bladder function
![Page 31: pharmacology of urinary system psik 2015.pptx](https://reader030.vdocument.in/reader030/viewer/2022012922/563db9d6550346aa9aa0682b/html5/thumbnails/31.jpg)
• atropine (Sal-Tropine)• bethanechol (Urecholine)• flavoxate (Urispas)antimuskarinik• L-hyoscyamine (Anaspaz, Cystospaz)• neostigmine (Prostigmin)• oxybutynin (Ditropan) antikolinergik
![Page 32: pharmacology of urinary system psik 2015.pptx](https://reader030.vdocument.in/reader030/viewer/2022012922/563db9d6550346aa9aa0682b/html5/thumbnails/32.jpg)
Combination Antibiotic, Analgesic, and Antispasmodic Drugs
• Contain various combinations of the following drugs:
• Urinary antibiotic drug– methenamine
• Urinary analgesic– phenazopyride– phenyl salicylate
![Page 33: pharmacology of urinary system psik 2015.pptx](https://reader030.vdocument.in/reader030/viewer/2022012922/563db9d6550346aa9aa0682b/html5/thumbnails/33.jpg)
• Sedative drug– butabarbitol
• Urinary antispasmodic drug– atropine– hyoscyamine
• Urinary antiseptic drug– methylene blue
![Page 34: pharmacology of urinary system psik 2015.pptx](https://reader030.vdocument.in/reader030/viewer/2022012922/563db9d6550346aa9aa0682b/html5/thumbnails/34.jpg)
spasminal
• Na metamizol 500 mg• Ekstrak belladonna 10 mg• Papaverin HCl 25 mg
![Page 35: pharmacology of urinary system psik 2015.pptx](https://reader030.vdocument.in/reader030/viewer/2022012922/563db9d6550346aa9aa0682b/html5/thumbnails/35.jpg)
![Page 36: pharmacology of urinary system psik 2015.pptx](https://reader030.vdocument.in/reader030/viewer/2022012922/563db9d6550346aa9aa0682b/html5/thumbnails/36.jpg)
![Page 37: pharmacology of urinary system psik 2015.pptx](https://reader030.vdocument.in/reader030/viewer/2022012922/563db9d6550346aa9aa0682b/html5/thumbnails/37.jpg)
![Page 38: pharmacology of urinary system psik 2015.pptx](https://reader030.vdocument.in/reader030/viewer/2022012922/563db9d6550346aa9aa0682b/html5/thumbnails/38.jpg)
![Page 39: pharmacology of urinary system psik 2015.pptx](https://reader030.vdocument.in/reader030/viewer/2022012922/563db9d6550346aa9aa0682b/html5/thumbnails/39.jpg)
![Page 40: pharmacology of urinary system psik 2015.pptx](https://reader030.vdocument.in/reader030/viewer/2022012922/563db9d6550346aa9aa0682b/html5/thumbnails/40.jpg)