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12. urinary system drugs
 

12. urinary system drugs

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    12. urinary system drugs 12. urinary system drugs Presentation Transcript

    • Chapter 12 Urinary System Drugs Copyright © 2011 Delmar, Cengage Learning
    • Basic Anatomy and Physiology
      • The structures of the urinary system include paired kidneys, paired ureters, a single urinary bladder, and a single urethra
      • Within each kidney are millions of individual structures, called nephrons, that do the actual work of the kidney
        • A nephron consists of a glomerulus, Bowman’s capsule, proximal convoluted tubule, loop of Henle, distal convoluted tubule, and a collecting duct
      Copyright © 2011 Delmar, Cengage Learning
    • Basic Anatomy and Physiology Copyright © 2011 Delmar, Cengage Learning
    • Urinary System Disorders
      • Include urinary tract infections, inflammation and irritation of the urinary tract, renal failure, urinary incontinence, and uroliths (urinary stones)
      • Bacterial infections of the urinary system may lead to:
        • inflammation, pollakiuria (increased frequency of urination)
        • dysuria (painful urination) which may result in inappropriate urination for household pets
      • These disorders affect the urinary tract resulting in clinical signs such as inappropriate urination, inability to urinate, frequent urination, increased urination, or pain
      Copyright © 2011 Delmar, Cengage Learning
    • Drugs Affecting the Urinary System
      • Diuretics
        • Increase the volume of urine excreted by the kidneys and promote release of water from tissues
        • Lower the fluid volume in tissues; are used to decrease edema and lower blood pressure
        • May also be used to reduce udder edema in cattle and promote voiding to enhance removal of toxins from the body
        • Types of diuretics include thiazides, loop diuretics, potassium-sparing diuretics, carbonic anhydrase inhibitors, and osmotics
      Copyright © 2011 Delmar, Cengage Learning
    • Drugs Affecting the Urinary System
      • Diuretics (cont.)
        • Thiazides
          • Act directly on the renal tubules to block sodium reabsorption and promote chloride ion excretion
          • Side effects include hypokalemia and cardiac dysfunction
          • Examples include hydrochlorothiazide, chlorothiazide, hydroflumethiazide, and bendroflumethiazide
      Copyright © 2011 Delmar, Cengage Learning
    • Drugs Affecting the Urinary System
      • Diuretics (cont.)
        • Loop diuretics
          • Influence the reabsorption action at the loop of Henle, resulting in tremendous diuresis
          • Side effects include electrolyte imbalances, especially hypokalemia
          • An example is furosemide
      Copyright © 2011 Delmar, Cengage Learning
    • Drugs Affecting the Urinary System
      • Diuretics (cont.)
        • Potassium-sparing diuretics
          • Act on the distal convoluted tubules to promote sodium and water excretion and potassium retention (interfere with the sodium-potassium pump that is controlled by aldosterone)
          • Main side effect is hyperkalemia
          • Examples include spironolactone, triamterene, and amiloride
      Copyright © 2011 Delmar, Cengage Learning
    • Drugs Affecting the Urinary System
      • Diuretics (cont.)
        • Carbonic anhydrase inhibitors
          • Block the action of the enzyme carbonic anhydrase, which is used by the body to maintain acid-base balance
          • Used to decrease intraocular pressure with open-angle glaucoma
          • Main side effect is metabolic acidosis
          • Examples include acetazolamide and dichlorphenamide
      Copyright © 2011 Delmar, Cengage Learning
    • Drugs Affecting the Urinary System
      • Diuretics (cont.)
        • Osmotic diuretics
          • Increase the osmolality (concentration) of the urine filtrate in the renal tubules, resulting in the excretion of chloride, potassium, and water
          • Used to prevent kidney failure and to decrease intracranial and intraocular pressure
          • Side effects include fluid and electrolyte imbalance and vomiting
          • Examples include mannitol and glycerin
      Copyright © 2011 Delmar, Cengage Learning
    • Drugs Affecting the Urinary System
      • Antihypertensive drugs
        • Drugs that decrease hypertension (lower blood pressure)
        • Types of antihypertensive drugs include:
          • Diuretics: promote sodium and water loss, which decreases fluid volume and blood pressure (covered previously in this chapter and Chapter 8)
          • Angiotensin-converting enzyme inhibitors (ACE inhibitors): block the conversion of angiotensin I to angiotensin II, which results in decreased aldosterone secretion. Examples include enalapril, captopril, lisinopril, and benazepril
      Copyright © 2011 Delmar, Cengage Learning
    • Drugs Affecting the Urinary System
      • Antihypertensive drugs (cont.)
        • Types of antihypertensive drugs include:
          • Calcium-channel blockers: block the influx of calcium ions into the myocardial cells, resulting in an inhibition of cardiac and smooth muscle contractility; examples include diltiazem, verapamil, and nifedipine
          • Direct-acting arteriole vasodilators: relax smooth muscles of blood vessels causing vasodilation; examples include hydralazine and minoxidil
      Copyright © 2011 Delmar, Cengage Learning
    • Drugs Affecting the Urinary System
      • Antihypertensive drugs (cont.)
        • Types of antihypertensive drugs include:
          • Beta-adrenergic antagonists (also known as beta-blockers): has side effect of decreasing blood pressure; an example of a nonselective beta-blocker is propranolol
          • Alpha-adrenergic antagonists: block alpha-1 adrenergic receptors, resulting in vasodilation; examples include phenoxybenzamine, prazosin, and nicergoline
      Copyright © 2011 Delmar, Cengage Learning
    • Drugs Affecting the Urinary System
      • Urolith treatment
        • Uroliths are abnormal mineral masses in the urinary system
        • Types of uroliths include: struvite, calcium oxalate, calcium phosphate, urate, cystine, and mixed
        • Each type of urolith may be treated differently and may include dietary management as well as drug treatment
        • Drug categories used to treat uroliths include urinary acidifiers, urinary alkalinizers, and xanthine oxidase inhibitors
      Copyright © 2011 Delmar, Cengage Learning
    • Drugs Affecting the Urinary System
      • Urolith treatment (cont.)
        • Urinary acidifiers are used clinically to produce acid urine, which dissolves and helps prevent formation of struvite uroliths; their use has declined with the use of urinary acidifying diets; examples include methionine and ammonium chloride
        • Urinary alkalinizers are used clinically to treat calcium oxalate, cystine, and ammonium urate uroliths; an example is potassium citrate
        • Xanthine oxidase inhibitors decrease the production of uric acid, which helps decrease the formation of ammonium urate uroliths; an example is allopurinol
      Copyright © 2011 Delmar, Cengage Learning
    • Drugs Affecting the Urinary System
      • Urinary incontinence drugs
        • Urinary incontinence is the loss of voluntary control of micturition
        • Urinary incontinence may be due to:
          • Neurologic disorders resulting from trauma to the spinal cord, tumors of the nervous system, or degeneration of the nervous system tracts
          • Nonneurologic disorders, which include hormone-responsive, stress, urge, ectopic ureter formation, or urinary bladder overdistention
      Copyright © 2011 Delmar, Cengage Learning
    • Drugs Affecting the Urinary System
      • Drugs used to treat neurologically caused urinary incontinence:
        • Cholinergic agonists treat animals with damage to the nerves that control relaxation of the urinary bladder
          • Promote voiding of urine from the urinary bladder
          • An example is bethanechol
        • Anticholinergics treat urinary incontinence by promoting urine retention in the urinary bladder
          • Block binding of ACh to its receptor site, causing muscle relaxation
          • Examples include propantheline, dicyclomine, and butylhyoscine
      Copyright © 2011 Delmar, Cengage Learning
    • Drugs Affecting the Urinary System
      • Drugs used to treat neurologically caused urinary incontinence (cont.):
        • Alpha-adrenergic antagonists decrease the tone of internal urethral sphincters and are used to treat urinary incontinence due to decreased urinary tone as a result of overdistention of the urinary bladder
          • Examples include phenoxybenzamine, prazosin, and nicergoline
      Copyright © 2011 Delmar, Cengage Learning
    • Drugs Affecting the Urinary System
      • Drugs used to treat nonneurologically caused urinary incontinence:
        • Estrogen treats hormone-responsive urinary incontinence seen mainly in F/S dogs; an example is diethylstilbestrol (DES)
        • Testosterone treats hormone-responsive urinary incontinence seen mainly in M/C dogs; examples include testosterone cypionate and testosterone propionate
      Copyright © 2011 Delmar, Cengage Learning
    • Drugs Affecting the Urinary System
      • Drugs used to treat nonneurologically caused urinary incontinence (cont.):
        • Alpha- and beta-adrenergic agonists stimulate these receptors, which increases urethral tone; examples include phenylpropanolamine and ephedrine
        • Skeletal muscle relaxants treat urge incontinence or urethral obstructions due to increased external urethral sphincter tone; examples include dantrolene, aminopropazine, and diazepam
      Copyright © 2011 Delmar, Cengage Learning