Pharmacology, part 40: Renal Medications - Urinary Tract Stimulants, Antispasmodics, Analgesics
by Cathy Parkes September 15, 2021 Updated: December 29, 2021 6 min read
In this article, we begin to cover renal system medications, specifically, urinary tract stimulants, antispasmodics, and analgesics.
The Nursing Pharmacology video series follows along with our Pharmacology Second Edition Flashcards, which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.
When you see this Cool Chicken, that indicates one of Cathy's silly mnemonics to help you remember. The Cool Chicken hints in these articles are just a taste of what's available across our Level Up RN Flashcards for nursing students!
Urinary Tract Stimulant - bethanechol (Urecholine)
Bethanechol is indicated for non-obstructive urinary retention — an inability to empty the bladder despite there being no physical obstruction to the urine flow.
Beth has a “shy” bladder, and needs bethanechol to urinate. The -chol ending tells you it’s a cholinergic.
Bethanechol mode of action
Bethanechol stimulates the cholinergic receptors, which causes contraction and emptying of the urinary bladder. It also stimulates gastric motility, which can cause nausea and vomiting or diarrhea.
Bethanechol side effects
The side effects of bethanechol include cholinergic symptoms. Anticholinergic symptoms are drying, which may lead to constipation, urinary retention, and dry mouth. Cholinergic symptoms are the opposite, and may lead to flushing, sweating, urinary urgency, nausea and vomiting, as well as hypotension (low blood pressure).
There is a rhyme to help remember cholinergic symptoms: salivation, lacrimation, urination, and defecation.
Bethanechol administration/patient teaching
In terms of nursing care and patient teaching, administer bethanechol one hour before meals or two hours after meals to prevent nausea and vomiting.
Urinary Tract Antispasmodic - oxybutynin (Ditropan)
Oxybutynin is indicated for overactive bladder symptoms such as urinary frequency, urinary urgency, and nocturia (peeing a lot at night).
Oxybutynin is “buttin’ in” to stop the bladder from “tremblin.”
Oxybutynin mode of action
Oxybutynin works by inhibiting acetylcholine (ACh) in the bladder, which reduces urinary urgency and frequency. Acetylcholine is a neurotransmitter.
Oxybutynin side effects
The key side effects of oxybutynin are anticholinergic effects. These are drying effects and may lead to dry mouth, urinary retention, constipation, and blurred vision.
Oxybutynin administration/patient teaching
Increase fiber and fluid intake to offset the anticholinergic side effects. As with cholinergic symptoms, there is a complementary rhyme that goes with anticholinergic symptoms (these are the opposites of the cholinergic rhyme): Can’t pee, can’t see, can’t spit, can’t s**t.
It is also important to teach the patient to avoid extreme heat due to the increased risk of overheating.
Urinary Tract Analgesic - phenazopyridine (Pyridium)
Phenazopyridine is used to treat the symptoms of a urinary tract infection or UTI.
Pyro = “burning fire”. Phenazopyridine can decrease the “burning” feeling of a UTI. And it will cause urine to turn orange/red (like a fire).
Phenazopyridine mode of action
Phenazopyridine acts as a local anesthetic on the urinary tract to decrease the burning pain and frequency and urgency associated with a urinary tract infection.
Note that phenazopyridine is not an antibiotic, so it will not cure a UTI. Administer it to help manage the symptoms and decrease pain.
Phenazopyridine side effects
The key side effect of phenazopyridine is orange-red discoloration of the urine. This discoloration can stain clothes or bedding.
It can also cause staining of the patient’s soft contact lenses.
Phenazopyridine administration/patient teaching
It is important to warn the patient about potential urinary discoloration so they understand this is expected. A patient may be alarmed if they are not expecting this type of discoloration.
Hi, I'm Cathy with Level Up RN. In this video, I'm going to begin our coverage of renal system medications. Specifically, I will be talking about urinary tract stimulants, antispasmodics, and analgesics. At the end of this video, I'm going to provide you guys a little quiz to test your knowledge of some of the key facts I'll be covering in this video. So definitely stay tuned for that. If you have our Level Up RN pharmacology second edition flashcards, definitely pull those out so you can follow along with me.
Let's start with coverage of our urinary tract stimulant, which is bethanechol.
Bethanechol is used for nonobstructive urinary retention, and its mode of action is to stimulate the cholinergic receptors, which causes contraction and emptying of that urinary bladder. It also stimulates gastric motility as well, which can cause nausea and vomiting, diarrhea, that type of thing.
So side effects of bethanechol include cholinergic symptoms. So if you recall, anticholinergic symptoms are very drying. So we have constipation, urinary retention, and dry mouth. With cholinergic symptoms, we have the wet symptoms. So we have things like flushing, sweating, urinary urgency, nausea and vomiting, as well as hypotension. So a little rhyme to help you remember, cholinergic symptoms is salivation, lacrimation, urination, and defecation.
So in terms of nursing care and patient teaching, you want to administer this medication one hour before meals or two hours after meals to prevent nausea and vomiting with administration.
In terms of how I remember this medication in our cool chicken hint here on the card, if you look at bethanechol, you have that Beth at the front end of that. So I imagine that Beth has a shy bladder, and she needs bethanechol in order to urinate, and then the chol at the end, so C-H-O-L, helps me to remember that we have cholinergic side effects when we give this medication.
Next, we have our urinary tract antispasmodic, which is oxybutynin.
Oxybutynin is used for overactive bladder symptoms such as urinary frequency, urinary urgency, and nocturia, which is peeing a lot at night.
It works by inhibiting acetylcholine in the bladder, which reduces urinary urgency and frequency.
The key side effect with this medication is anticholinergic effects. So these are our drying effects. So we'll have things such as dry mouth, urinary retention, constipation, and blurred vision.
So some of you may be familiar with my anticholinergic rhyme, which is can't pee, can't see, can't spit, and can't poop. So those are our anticholinergic side effects, which we will have with oxybutynin. Our cool chicken hint here on the card to help you remember what this is for oxybutynin is button in to stop the bladder from trembling. So a key member of my team came up with that rhyme, and I love it. Hope you enjoyed as well.
Next, we have a urinary tract analgesic, which is phenazopyridine.
This medication is used to treat the symptoms of a urinary tract infection or UTI. So it acts as a local anesthetic on the urinary tract to decrease the burning pain and frequency and urgency associated with a urinary tract infection.
It is not an antibiotic, so it will not cure a UTI, just used to help manage the symptoms and decrease pain.
Key side effect with this medication is that it causes orange-red discoloration of the urine, and this discoloration can cause staining of clothes or bedding. It can also cause staining of the patient's soft contact lenses. So you definitely give the patient a heads up about this discoloration and let them know it's expected, as it can be kind of alarming if the patient isn't expecting this type of discoloration.
So our cool chicken hint for remembering what this medication is for if you look at the name phenazopyridine, you have that pyri in the middle, so P-Y-R-I, and when I think of pyro, I think about fire, and this helps me remember that this medication can decrease the burning feeling of a UTI. It also helps me to remember that this medication can cause orange-red discoloration, orange and red just like a fire. So hopefully that's helpful for you as well.
All right, you guys ready for your quiz? I have three questions for you. First question, when should you administer bethanechol to your patient? The answer is one hour before or two hours after meals to prevent nausea and vomiting. So remember, bethanechol is a cholinergic medication. So it can cause nausea and vomiting. So if you give it to your patient with their meals, they may just throw up that meal. Question number two, oxybutynin can cause cholinergic side effects. True or false? The answer is false. So oxybutynin causes anticholinergic side effects. So bethanechol causes cholinergic side effects, so those wet symptoms, and oxybutynin causes anticholinergic side effects, so those drying effects. Question number three, what side effect of phenazopyridine should you warn your patient about? The answer is orange-red discoloration of the urine and possibly the soft contact lenses as well. So definitely want to give your patient a heads up about those things.
Okay. I hope you did well on that quiz. If not, you can go back and watch the video, review our flashcards. Learning this pharmacology information, it really takes repetition. That's why flashcards worked so well for me in nursing school, and I truly believe they're really the most effective way at learning the information. So take care and good luck with studying.
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