Learning Outcomes
By the end of this section, you should be able to:
- 35.4.1 Identify the characteristics of urinary stimulant drugs used for urinary and bladder disorders.
- 35.4.2 Explain the indications, actions, adverse reactions, contraindications, and interactions of urinary stimulant drugs used for urinary and bladder disorders.
- 35.4.3 Describe nursing implications of urinary stimulant drugs used for urinary and bladder disorders.
- 35.4.4 Explain the client education related to urinary stimulant drugs used for urinary and bladder disorders.
Urinary stimulants stimulate the smooth muscles of the urinary bladder. These drugs work by activating the muscarinic receptors of the bladder, leading to increased bladder contractions and improved bladder emptying. They are primarily prescribed for urinary retention or to improve bladder function in individuals with certain neurologic conditions, such as a spinal cord injury.
Bethanechol Chloride
Bethanechol chloride (Duvoid) is indicated for acute postoperative and postpartum nonobstructive (functional) urinary retention and for neurogenic atony of the urinary bladder with retention (Padda & Derain, 2022).
Determine the minimum effective dose by giving 5–10 mg initially and repeating the same amount at hourly intervals until a satisfactory response occurs or until a maximum of 50 mg has been given (DailyMed, Bethanechol chloride, 2022).
The drug’s effects sometimes appear within 30 minutes, usually peak between 60 and 90 minutes, and persist for approximately 1 hour (DailyMed, Bethanechol chloride, 2022).
Adverse Effects and Contraindications
Common adverse effects include malaise, urinary urgency, headache, vasomotor response, sweating, and miosis. Contraindications include hyperthyroidism, peptic ulcer disease, asthma, pronounced bradycardia, hypotension, coronary artery disease, seizure, Parkinson’s disease, and hypersensitivity to the drug or any of its components.
Table 35.6 is a drug prototype table for urinary stimulants featuring bethanechol chloride. It lists drug class, mechanism of action, adult dosage, indications, therapeutic effects, drug and food interactions, adverse effects, and contraindications.
| Drug Class Urinary stimulant, cholinergic Mechanism of Action Stimulates activation of the parasympathetic nervous system, causing increased tone of the detrusor muscle of the bladder, producing contraction and emptying of the bladder |
Drug Dosage 10–50 mg orally 3–4 times a day. |
| Indications Treatment of acute postoperative and postpartum nonobstructive (functional) urinary retention Neurogenic atony of the urinary bladder with retention Therapeutic Effects Minimizes urinary retention |
Drug Interactions Atropine Diphenhydramine Donepezil Glutamine Hyoscyamine Neostigmine Procainamide Propantheline Scopolamine Food Interactions No significant interactions |
| Adverse Effects Malaise Headache Urinary urgency Sweating Vasomotor response Miosis Monitor closely for bacteremia due to reflex infection from incomplete bladder emptying |
Contraindications Hypersensitivity Hyperthyroidism Peptic ulcer disease Asthma Bradycardia Hypotension Coronary artery disease Seizures Parkinson’s disease |
Nursing Implications
The nurse should do the following for clients who are taking urinary stimulants:
- Before administering the drug, check the client’s medical history, current drug list (including over-the-counter medications), and allergies.
- Monitor the client closely for vasomotor responses, such as hypotension, bradycardia, and orthostatic hypotension.
- For a client taking bethanechol chloride, monitor closely for bronchospasm, wheezing, and tachycardia because these can be serious adverse effects of the drug.
- Monitor the client’s urine output closely.
- Provide client teaching regarding the drug and when to call the health care provider. See below for additional client teaching guidelines.
Client Teaching Guidelines
The client taking a urinary stimulant should:
- Take the medication as prescribed by their health care provider.
- Take bethanechol chloride on an empty stomach, at least 1 hour before or 2 hours after a meal, for better absorption.
- Notify their health care provider if symptoms do not improve within 90 minutes after taking bethanechol chloride because the treatment may need to be modified.
- Store bethanechol chloride at room temperature and away from moisture and heat.
- Avoid getting up too fast from a sitting or lying position because this drug may cause a vasomotor response that includes dizziness.
- Take two or more doses at one time because this may cause a significant vasomotor response such as severe hypotension and bradycardia.