Renal Pharm Part 4 Flashcards
Physiology of micturition (innervation)
SNS
SNS → _________ n. (___ on ____ receptors)
* _________ of the detrusor muscle
* ________ of the inner urethral sphincter (___)
► This means ________ of micturition. SNS keeps us ________ urine and __________ for a later time
SNS → hypogastric n. (NE on β3 receptors)
* Relaxation of the detrusor muscle
* Contraction of the inner urethral
sphincter (α1)
► This means Inhibition of micturition. SNS keeps us accumulating urine and postpones for a later time
Physiology of micturition (innervation)
PNS
PSNS → pelvic n. (Ach on M3 receptors)
* Contraction of the detrusor muscle
* Relaxation of the inner urethral
sphincter
► Activation of micturition
Physiology of micturition (innervation)
Somatic NS
Somatic NS → Pudendal n. (Ach on N receptors)
* Contraction of the external urethral
sphincter
► Continence!
- our dogs mostly use this for continence.
Progressive filling of the bladder causes the bladder wall to ________.
If tension in the wall rises above a threshold, sensory signals will reach the spinal cord and from there, the micturition center (_____) and to the ______. From there, signals reach the ______ _____ (awareness of bladder ______, _______, in some cases ____)
Micturition
► pelvic nerve causes detrusor muscle ________ and relaxation of the _____
► internal and external sphincter open and the urine exits the body …
stretch, pons, thalamus, cerebral cortex, distention, discomfort, pain
contraction, urethra
When reach threshold, micturition contractions stop and we reach a point where we can not hold it anymore
How are micturition disorders classified?
Hypocontractile bladder
- A hypocontractile bladder is ______, meaning it does not _________.
- This is normally caused by _______ or __________ ________ lesions
- Leads to Acute or chronic ___________ of the bladder
- General muscle _________
- ___________
Parasympathomimetic drugs:
1. _____________, 5-25 mg/kg PO q 8 h (dogs); 1.25-5 mg PO q 8 h (cats)
Adverse reactions: __________, ___________, increased GI ________ (_________)
Contraindicated in ________ and ___ obstruction, and __________ GI disease
Hypocontractile bladder
- A hypocontractile bladder is atonic, meaning it does not contract.
- This is normally caused by sacral or suprasacral neurologic lesions
- Leads to Acute or chronic overdistention of the bladder
- General muscle weakness
- Dysautonomia
Parasympathomimetic drugs:
1. Bethanechol, 5-25 mg/kg PO q 8 h (dogs); 1.25-5 mg PO q 8 h (cats)
Adverse reactions: hypersalivation, defecation, increased GI motility
(cramping)
Contraindicated in urinary and GI obstruction, and ulcerative GI disease
Hypercontractile bladder is a _________ disorder that involves ________ processes, masses, neurologic disorders, idiopathic. ________ in the bladder’s filling capacity (________ response)
→ ___________ bladder contractions occur at even ____ pressure/volumes (appear very ______ and increase ______ of the bladder)
→ __________
Anticholinergic drugs:
1. _________, 1.25-5 mg/kg PO 2-3x d (dog); 0.5-1.25 mg/kg PO (cat)
2. __________ and local _______ action in the bladder
Adverse effects: ?
Contraindicated in glaucoma, cardiac disease, GI obstruction
Hypercontractile bladder is a congenital disorder that involves inflammatory processes, masses, neurologic disorders, idiopathic Failure in the bladder’s filling capacity (adaptive response)
→ involuntary bladder contractions occur at even low pressure/volumes (appear very early and increase contraction of the bladder)
→ incontinence
Anticholinergic drugs:
1. Oxybutynin, 1.25-5 mg/kg PO 2-3x d (dog); 0.5-1.25 mg/kg PO (cat)
2. Antispasmodic and local anesthetic action in the bladder
Adverse effects: sedation, urine retention, vomiting, diarrhea
Contraindicated in glaucoma, cardiac disease, GI obstruction
A Hypercontractile bladder can be treated with a ________ __________, such as
Imipramine (_________ and ________ properties) → facilitates urine ______
Dosages: 5-15 mg.kg PO 2x daily (dogs); 2.5-5 mg/kg PO 2x daily (cats)
Adverse effects: ?
tricyclic, antidepressant, anticholinergic, adrenergic, storage
tremors, seizures, tachycardia, excitability
The hypotonic urethra (poor outlet _________)
Common in ________-aged, _______, ______- to ______-breed dogs (German Shepherds, Dobermann, Pinschers, Old English Sheepdogs, Springer Spaniels, Boxers, Rottweilers, Weimaraners, Irish Setters)
Treatment involves ________ supplementation
(__________ receptor upregulation via _________ hormones in the _________ urinary tract) → _________ integrity, _______ fibers content, blood supply enhanced by _________.
resistance
Common in middle-aged, neutered, medium- to large-breed dogs (German
Shepherds, Dobermann, Pinschers, Old English Sheepdogs, Springer
Spaniels, Boxers, Rottweilers, Weimaraners, Irish Setters)
Treatment involves hormone supplementation
(adrenergic receptor upregulation via reproductive hormones in the lower
urinary tract) → mucosal integrity, collagen fibers content, blood supply
enhanced by estrogens
The reproductive hormones used to treat The hypotonic urethra include:
1. _______________ (___)
- ____ dog (females): 0.1-1 mg PO daily for 5 days, followed by 0.1-1 mg q 5-14 days as needed
2. ______
3. ______
Adverse effects: Signs of ______, bone _______ suppression (check ______ count!), ________, ________- changes
Response rate ___-___%
The reproductive hormones used to treat The hypotonic urethra include:
1. Diethylstilbestrol (DES)
- DES dog (females): 0.1-1 mg PO daily for 5 days, followed by 0.1-1 mg q 5-14 days as needed
2. stilbestrol
3. estriol
Adverse effects: Signs of estrus, bone marrow suppression (check blood count!), pyometra, behavioral changes
Response rate 60-70%
The reproductive hormones used to treat The hypotonic urethra include:
- ____________ _________- (dogs and cats)
- Dosages: 2.2 mg/kg SC or IM q 2-3 days (dogs); 5-10 mg IM as needed (cats)
Adverse effects: ?
Testosterone propionate
aggression, behavioral changes, prostatic disease, perianal issues
The reproductive hormones used to treat The hypotonic urethra include:
- Gonadotropin-releasing hormone (GnRH) analogs: _________, _________-
Act by “re-establishing the ________ feedback” (recall, lack of sex hormones in ________ dogs leads to increased ___ and ____ levels …)
Dosages: 5-10 mg depot injection (dogs)
Adverse effects: _______ reported thus far.
Other drugs tested (women): duloxetine (serotonin and NEPI reuptake inhibitor). Side effects: nausea, fatigue, insomnia, constipation, diarrhea, headache
The reproductive hormones used to treat The hypotonic urethra include:
- Gonadotropin-releasing hormone (GnRH) analogs: Deslorelin, buserelin
Act by “re-establishing the negative feedback” (recall, lack of sex hormones in ovariectomized dogs leads to increased FSH and LH levels …)
Dosages: 5-10 mg depot injection (dogs)
Adverse effects: none reported thus far.
Other drugs tested (women): duloxetine (serotonin and NEPI reuptake inhibitor). Side effects: nausea, fatigue, insomnia, constipation, diarrhea, headache
The alpha-adrenergic agonists used to treat a hypotonic urethra are?
MOA: Enhance urethral _____ via endogenous _____ release and ___-receptor stimulation in the bladder _____ and ____
Dosages phenylpropanolamine: 1.5 mg/kg PO 2-3x day (dogs); 1.5-2.2 mg/kg
PO2-3x day (cats)
Adverse effects: ?
Contraindicated in _____ or ______ patients, _____ disease and ________ _______
Response rate: ___-___% in dogs; effectivity variable/questionable in ___
- Phenylpropanolamine
- Ephedrine
closure, NEPI, α, neck, urethra
tachycardia, hypertension, restlessness, anorexia
cardiac, hypertensive, renal, diabetes mellitus, 75-90, cats
The hypertonic urethra (___________ urethral obstruction) –> ______ urethral resistance
Urethral obstruction (_____ or ___) → (2?) → urine ______
o Alpha-adrenergic __________
o ________ muscle relaxants
Functional, Inappropriate, uroliths, plugs,
inflammation, spasms, retention
antagonists, Striated
