Upper Genitourinary Trauma Medication

Updated: Jan 24, 2017
  • Author: Imad S Dandan, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
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Medication

Medication Summary

Medications for patients with upper GU injuries relate to the management of patients as critically injured rather than management specific to the GU injury.

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Antibiotics

Class Summary

Used in prophylaxis of infections of the injured GU tract. Empiric antimicrobial therapy must be comprehensive, covering all likely pathogens in the clinical setting.

Ampicillin and sulbactam (Unasyn)

Drug combination of beta-lactamase inhibitor with ampicillin. Covers skin, enteric flora, and anaerobes. Not ideal for nosocomial pathogens.

Cefotetan (Cefotan)

Second-generation cephalosporin indicated for infections caused by susceptible gram-positive cocci and gram-negative rods.

Dosage and route of administration depend on condition of patient, severity of infection, and susceptibility of causative organism.

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Analgesics

Class Summary

Pain control is essential to quality patient care. Analgesics ensure patient comfort, promote pulmonary toilet, and have sedating properties, which are beneficial for patients who have sustained trauma.

A review of opioid equivalents and conversions may be found in the following reference article:

 http://emedicine.medscape.com/article/2138678-overview

Fentanyl (Sublimaze, Abstral, Actiq, Duragesic, Fentora, Ionsys, Lazanda, Onsolis, Subsys)

A synthetic opioid that is 75-200 times more potent and much shorter half-life than morphine sulfate. Has less hypotensive effects and is safer in patients with hyperactive airway disease than morphine because of minimal-to-no associated histamine release. By itself, it causes little cardiovascular compromise, although addition of benzodiazepines or other sedatives may result in decreased cardiac output and blood pressure.

Highly lipophilic and protein-bound. Prolonged exposure leads to accumulation in fat and delays weaning process.

Consider continuous infusion because of the short half-life of fentanyl.

Parenteral form is DOC for conscious sedation analgesia. Ideal for analgesic action of short duration during anesthesia and immediate postoperative period.

Excellent choice for pain management and sedation with short duration (30-60 min) and easy to titrate. Easily and quickly reversed by naloxone.

After initial parenteral dose, subsequent parenteral doses should not be titrated more frequently than q3h or q6h thereafter.

Transdermal form is used only for chronic pain conditions in opioid tolerant patients. When using transdermal dosage form, majority of patients are controlled with 72-h dosing intervals; however, some patients require dosing intervals of 48 h.

Easily and quickly reversed by naloxone.

Morphine sulfate (Astramorph, Duramorph, MS Contin, Avinza, Infumorph, Kadian, MorphaBond, Arymo ER)

DOC for analgesia because of reliable and predictable effects, safety profile, and ease of reversibility with naloxone.

Various IV doses are used; commonly titrated until desired effect obtained.

Postoperatively, oral morphine sulfate extended-release formulations may be prescribed for severe pain, with immediate release preparations used for breakthrough pain. Arymo ER is a morphine sulfate abuse-deterrent derivative.

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