Many of Americans present with kidney stones, with 5 percent of women and 12 percent of men reporting stones at some time in their life, according to Andrew Evan, a kidney stone researcher. Kidney stones require passage from the kidney via the ureter--the tube to the urinary bladder--in order to pass out of the body. Stones larger than 10 mm or ½ inch become lodged in the ureter and require shock wave or laser lithotripsy. For smaller stones, medications assist in passage of the stone.
NSAIDs
Pain management heads the list of concerns of patients during the acute phase of passing kidney stones. Stones passing through the ureter cause ureteral spasm and pain. Primary analgesia treatment consists of using nonsteroidal anti-inflammatory drugs, or NSAIDs. Holdgate and Pollock, Australian researchers who published their findings in the June 2004 issue of the British Medical Journal, demonstrated adequate pain control with ketorolac, an injection form of NSAIDs, or diclofenac, an oral pill.
Narcotics
If NSAIDs fail to relieve the pain of kidney stones, a physician may order narcotics for pain management. According to Holdgate and Pollock, the narcotic meperidine appears frequently as the opioid drug used for treating kidney stone pain. For home use, the providers order hydrocodone tablets for analgesia.
Calcium Channel Blocker Drugs
For stones located in the lower half of the ureter, calcium channel blocker drugs prevent ureteral spasms and allow spontaneous movement of the stone through the ureter. According to Davis’s Drug Guide for Nurses, the patient typically takes the prescription calcium channel blocker nifedipine in an oral 40-mg dose per day. Samplaski, Irwin and Desai, urology researchers, reported a 9 percent increase in stone passage with the use of nifedipine.
Alpha Blocker Drugs
Alpha blocker drugs prevent ureteral muscle twitching and allow natural progression of the stone through the ureter. Davis’s Drug Guide for Nurses reports that the patient receives a dose of the alpha blocker, tamsulosin, of 0.4 mg or 0.8 mg in capsule form. Samplaski, Irwin and Desai, urology researchers who published their findings in the October 2009 issue of the Cleveland Clinic Journal, indicated a 29 percent improvement rate of stone expulsion with tamsulosin.
Antibiotics
If a urine culture reveals an infection, the physician initiates antibiotic therapy. Bichler et al. reported in the journal Antimicrobial Agents that approximately 10 to 15 percent of patients with kidney stones have urinary tract infections. The common organisms found in these infections included Escherichia coli, Staphylococcus, Proteus, Klebsiella and Pseudomonas. If the patient requires a lithotripsy procedure, Ciprofloxacin is given as a prophylaxis antibiotic to prevent infection. Doses of Ciprofloxacin vary from 100 to 1000 mg, depending on the patient's kidney function.
References
- “British Medical Journal”; Systematic review of the relative efficacy of NSAIDS; A. Holgate & T. Pollock; June 2004
- “Antimicrobial Agents”; Urinary infection stones; K. H. Bichler et al.; June 2002.
- “Davis’s Drug Guide for Nurses”; Judith H. Deglin et al.; 2011.
- “Pediatric Nephrology”; Pathology and etiology of stone formation; Andrew P. Evans; May 2010.
- “Cleveland Clinic Journal”; Less-invasive ways to remove stones; M. Samplaski, B. Irwin & M. Desai; October 2009.
