Evaluation of Impact of Desmopressin and Alpha1 Blocker Tamsulosin Combined Therapy

4. B.J. receives subcutaneous 1-deamino-8-d-arginine vasopressin (ddAVP) to manage his high urine output. What is the rationale for this therapy? How can effectiveness be assessed?

Surgery may be performed to correct an ectopic ureter, such as an artificial urethral valve may be implanted by a surgeon. According to the American Animal Hospital Association, Treatment options for USMI include medications, such as adrenergic agents and estrogen products, minimally-invasive urethral bulking procedures, surgical procedures, or combination therapy. For hormone-responsive incontinence, two different medication options can be given. Replacement hormone medication, such as Diethylstilbestrol (DES) for females and testosterone injections for males are used to control this incontinence problem. Also, certain medications may be given to increase the tone and strengthen the urethral sphincter. Phenylpropanolamine (PPA) is a common drug prescribed for aging dogs experiencing this issue. Although this is a treatable condition, it is not always possible to prevent urinary incontinence and it is generally only preventable to the extent that its causes are

The article “Considering the prominent complaint as a guide in medical therapy for overactive bladder syndrome in women over 45 years” that Sarah wrote about was interesting. One questions that comes to mind would what was the existing symptoms that the women had from mild, moderate or severe incontinence before the treatment and how did the medication help with those different severity levels of incontinence? Also what is the effect that different ethnic backgrounds experience different symptoms from the medications? To figure out the first question we would need to separate the women into 3 different groups and within those groups we would separate them into the two different medication groups to find out it the medications help depending

Therefore patient and family teaching should focus on these instructions. The main problem that bothers both the patient and family is the urinary symptoms. Men with BPH should be instructed to reduce the fluid intake especially caffeinated beverages and alcohol intake two hours before bedtime, long meeting or event, or when travelling (Moyad, & Lowe, 2011). This can reduce nocturia, urgency and frequency to a certain extend. Also, caffeinated beverages and alcohol can affect the bladder muscle tone and stimulate kidney to produce more urine. They should be reminded drink enough fluids to prevent dehydration. In addition, double voiding technique can help to empty

(2012) highlighted a key difference in long term use of monthly GhRH antagonist degarelix (240/80 mg) over LHRH agonist goserelin (3.6mg) in a study that included (n=175) patients completing the trial over 12 weeks. Goserelin treated patients were given bicalutamide (50 mg) in combination on a daily basis for the first 28 days to control hormone flares and related side effects. This study was a randomized parallel-arm, open label, multicenter trial that found the short term efficacy to be the same in both when controlling the total prostate volume (TPV) and relief of lower urinary tract symptoms (LUTS), but more favorable over long term treatment in degarelix patients for LUTS relief. These findings potentially extrapolated the different overall effects on the GnRH receptors in the bladder and prostate with efficacy favoring degarelix in long term

It is more common in older adults, and is commonly referred to an overactive bladder. Patients with an overactive bladder may void more than eight times over a 24 hour period, including two or more times throughout a night; therefore, the general treatment is to reduce the hyperactivity of the bladder (Simon, 2013). This can be done with behavioral methods, lifestyle modification and anticholinergic medication. Anticholinergics act by relaxing the bladder muscles and preventing bladder spasms that signal the urge to urinate. Surgical option for urge incontinence is limited.

Nocturia is when an individual has to frequently urinate in the middle of the night (Hall, Perry, Potter, & Stockert, 2017, p. 995). The client has reported waking up between two to three times in the night to use the restroom. These frequent trips to the bathroom disrupts the clients sleep cycle and makes it difficult to fall back asleep at night. According the patient’s MAR, he has Benign prostatic hyperplasia (BPH), an overactive bladder and chronic kidney disease. He is being treated with the medications finasteride, tamsulosin and oxybutynin. Finasteride and tamsulosin are used to treat BPH. The medication tamsulosin is also indicated for nocturia and acts by decreasing the contraction of smooth muscle in the prostatic capsule (Deglin, Sanoski, & Vallerand, p.1164). The patient takes oxybutynin in the morning and night to treat his overactive bladder. Oxybutynin can also help treat nocturia and works by inhibiting the action of acetylcholine at the postganglionic receptors (Deglin, Sanoski, & Vallerand, 2017, p.944). One of the interventions to help improve the clients sleeping pattern is to speak to his physician about possibly increasing the dose of these medications or changing medications to something that is more effective. The goal is to decrease the number of trips to the bathroom the client has to

Rantell, the author of the article entitled, “Assessment and Diagnosis of Overactive Bladder in Women,” said that women used to believe that urinary frequency during the daytime is a normal part of living and of aging (2013). He discussed that there are diseases that mimic OAB symptoms, therefore, it is important to perform further assessment and examination to refrain from the risk of under-diagnosing, misdiagnosing, and even from performing invasive treatments for OAB which may not be needed (Rantell, 2013). In the study done in Europe, the overall prevalence of OAB, which includes men and women was 16.6%; thus, will even increase by 24% in the coming 20 years (Rantell, 2013). He suggested that a thorough physical assessment and complete family and medical history must be practiced by healthcare providers in order to overcome OAB and to improve diagnosis and treatment (Rantell, 2013).

The GP checked the patient’s BP when sitting and standing and noted a small drop. He does have prostate urinary type symptoms and his GP would have prescribed an alpha-blocker however with syncope symptoms, the patient was referred to a Cardiology consultant.

All of the studies took place from 2004 to 2013. The meta-analysis found similar results compared to those of Vicentini and colleagues. Three of the studies found no significant difference in the expulsion rate between the two drugs. Yet overall, tamsulosin had a significantly higher rate of passing of the kidney stones. The meta-analysis also addressed time differences in passing the stones. One study had no significant difference in expulsion time. The others found that tamsulosin was faster by variable amount of days. This time difference varied from as little as 2 days to up to 14 days. Location of the stone was also mentioned by the meta-analysis. The analysis found that expulsion rates were 48% for proximal ureteral stones, 60% for mid ureteral stones and 75% for lower ureteric stones. They also found that adverse events were slightly fewer in those that received tamsulosin. However, the difference was not statistically different. It is important to note that there were two reported serious adverse events in the nifedipine group. The severe adverse events were hypotension and palpitations and both disappeared upon discontinuation of nifedipine. The rate of the serious adverse events was also quite low (2 in 1,778 patients). While 20 mg was used by Vicentini and colleagues, 30 mg was the

The effects of the interventions on urinary excretion of sodium, chloride and potassium are summarized in Figure 5. EG significantly decreased urinary excretion of potassium, sodium and chloride. Cystone and HAPE counteracted the effect of EG and elevated the excretion of potassium, sodium and chloride as compared to the EG group. Furthermore, EG

Differentiating between normal versus abnormal aging can sometimes be difficult. Nurses must be able differentiate these changes so that the patient can be properly be treated. When an older adult comes in with new onset urinary incontinence it must not be overlooked as normal. If a person experiences weakened contractions during urination it can lead to a risk of a urinary tract infection due to post void residual(Touhy & Jett, 2012). Urinary incontinence is not a normal part of the aging process and it can interfere with an individual’s quality of life and it can also be costly (Bradway & Cacchione, 2010). An assessment must be completed and pertinent questions should be asked to further address the issue. Some questions that can be

Serotoninergic mechanisms seem to also be involved in micturition as shown by the use of Duloxetine a combined noradrenaline and serotonin reuptake inhibitor (NSRI) in the treatment of stress and urge incontinence. Therefore other NSRIs may act increase neural activity in similar ways to the bladder in those who do not suffer incontinence causing urinary retention.

Known as desmopressin, the drug can be taken regularly to treat pituitary and gestational DI [8]. As in nephrogenic and dipsogenic DI, the patient’s still produce vasopressin however has become resistant to it, so desmopressin cannot be used for treatment. In conclusion, urine production is controlled and regulated by two hormones; arginine vasopressin and aldosterone. Both of these act to keep the level of urine production balanced with fluid intake, however, problems can arise with these hormones which disrupt the balance leading to dehydration, polydipsia and nocturia. There are however, options in order to treat the sufferers of all types of diabetes

B.H. is in the 50th percentile for both weight and height, keeping on trend with his personal growth curve. He appears to be both well-nourished and well-rested and has no evidence of illness or injury. The mother of the patient reports B.H. is able to dress and undress himself and maintains both bowel and bladder control, although he occasionally wets the bed at night.