The

1

• The
• Urinary System
• Chapter 15
• Dr. Jay Shahed

2
Diuretics

• Action
• Increases urine excretion
• Categories
• Thiazides
• Loop diuretics
• Potassium-sparing diuretics
• Osmotic agent

3
Thiazides

• Action
• Increases the excretion of water, Na, K and Cl
• Drugs
• Chlorothiazide ( Diuril)
• Hydrochlorothyazide ( HCTZ) ( Esidrix)
• Metolazone ( Diulo, Zaroxolyn).
• Indications
• Edema, HTN and electrolyte imbalance

4

• Side effect
• Hypokalemia, Hypocalcemia, GI disturbance,
  Hyperglycemia, Postural Hypotension, Skin rash
• Contraindications
• DM, Gout, Renal and Hepatic Disease
• Interactions
• NSAIDs, Hypotensive agents, Alcohol,
  Amphetamines, Quinidine

5
LOOP DIURETICS

• Action
• Act on the Loop of Henle to inhibit Na and Cl
  reabsorbtion.
• Increases the excretion of Na, Cl and Water.
• Drugs
• Furosemide ( Lasix )
• Bumetanide ( Bumex )
• Ethacrynic acid ( Edecrin )
• Torsemide ( Demadex ).

6

• Indications
• Edema associated with Renal and Hepatic
  impairment, CHF, Pulmonary edema, Ascitis and
  HTN.
• Side effects
• Fluid and Electrolytes Imbalance.
• Hypokalemia, Hypotension, Tinnitus, Rash, GI
  disturbance, Hyperglycemia, Muscle cramps,
  Headaches
• Contraindications
• Renal and Hepatic Disease, Sulfur allergy, DM and
  Gout.

7

• Interactions
• Lithium
• Corticosteroids
• Anticonvulsants
• Hypotensive agents
• Probenecid
• Alcohol
• Digitalis
• Aminoglycosides
• Indomethacin
• Salicylates.

8
Potassium Sparing Diuretics

• Indications
• Seldom used alone, often used in conjunction of
  other types of Diuretics ( Dyazide Maxzide).
• Used in conditions in which Potassium depletion
  is dangerous
• Counteracts Thiazide Diuretics to reduce the
  Hyperglycemia and Hyperkalemia.

9

• Drugs
• Spironolactone ( Aldactone)
• Triamtrerene ( Dyrenium )
• Side Effects
• Dehydration
• Hyperkalemia ( May lead to Arrhythmia
• GI distress
• Hypotension

10

• Interactions
• Potassium Supplements
• Penicillin
• Can cause Hyperkalemia
• Caution
• Patients should avoid potassium rich foods and
  rise slowly from a reclined position.
• Renal Insufficiency, Cirrhosis, Pregnancy and
  Lactation.

11
Osmotic Agents

• Action
• Reduces Intracranial and Intraoccular pressure
• Prevents and treat Renal Failure.
• Drugs
• Mannitol ( Osmitrol)
• Urea ( Ureaphil )

12

• Side Effects
• Fluid and Electrolyte Imbalance
• Hyper/Hypotension
• CNS disturbance
• Tachycardia
• Extreme Caution
• Kidney failure
• Heart Diseases
• Interactions
• Lithium

13
Medications for Gout

• Uricosuric Agents
• Probenecid ( Benemid)
• Sulfinpyrazone ( Anturane )
• Antigout Medication
• Allopurinol
• Anti-inflammatory drugs
• Colchicine
• Indicated for Acute Gout.

14
Uricosuric Agents

• Action
• Decreases Uric Acid levels
• Mechanism
• Blocking the reabsorbtion of UA by the kidney and
  promoting the excretion of UA.
• Indication
• Severe Gouty Arthritis.
• Potentiate the action of Penicillin

15

• Side effects
• Kidney Stones
• Headaches
• GI disturbances
• Contraindications
• Hx. Of Kidney stones
• Peptic ulcers
• Interactions
• PCN and Cephalosporin
• Oral Hypoglycemia
• Salicylates
• Directions
• Patients are advised to drink plenty of water and
  avoid Aspirin.

16
ANTI-GOUT

• Drugs
• Allopurinol( Zyloprim ).
• Action
• Decreases UA in the blood and urine.
• Indication
• Chronic Gout
• Not effective in acute conditions.

17

• Side effects
• Rash and Allergic reaction
• Contraindications
• Renal diseases
• Liver diseases
• Interactions
• Antineoplastic drugs
• Alcohol
• Diuretics

18
Antispasmodics (
Anticholinergics)

• Actions
• Anti-Cholinergic action
• These are used reduce the strength and frequency
  of contractions of the bladder.
• Mechanism
• Increases the capacity of the bladder.

19

• Indication
• Relief symptoms like
• Incontinence
• Urgency
• Frequency
• Nocturia
• Drugs
• Flavoxate ( Urispas)
• Methantheline ( Banthine)
• Oxybutynin ( Ditropan)

20

• Side effects
• Drying of secretions
• Urinary retention
• Constipation
• Blurred vision
• Rash
• Cautions
• Geriatrics, Prostatic Hypertrophy, Pregnancy and
  Lactation.
• Patients are to be advised to avoid driving at
  night and operate heavy machinery.

21
Cholinergics

• Indications
• Parasympathetic nerves
• Urinary retention
• Bladder contraction in situations of non
  obstructive.
• Drugs
• Bethanocol ( Urecholine ).

22

• Side effect
• Cholinergic ( Increase secretions ).
• GI, Sweating, Salivation)
• Headaches
• Contraindications
• GI and Urinary tract obstruction
• Peptic Ulcer
• Asthma
• Interactions
• Neostigmine and Quinidine.

23
BPH ( Benign Prostatic Hypertrophy)

• Indications
• Reduces the size of the prostate
• Urinary obstruction
• Drugs
• Finasteride ( Proscar ).
• Side Effects
• Impotence, decreased libido and ejaculation.

24

• Caution
• Screen for cancer.
• Tablets should not be handled by pregnant
  females.
• Causes fetal damage.

25

• Gastrointestinal
• Tract
• Chapter 16

26
Antacids

• Action
• Causes the neutralization of gastric acid (HCI).
• Indication
• Gastric and duodenal ulcers
• Relief indigestion
• Heat burns
• Sour stomach
• Esophageal reflux

27

• Active ingredients
• Aluminum, Sodium, Calcium carbonate and
  Magnesium.
• Drugs
• Aluminum (Amphojel)
• Calcium carbonate (Tums)
• Aluminum magnesium
• (Maalox, Mylanta, Riopan)

28

• Side effects
• Constipation, Diarrhea, Kidneys stones,
  Osteoporosis, Belching and flatulence,
  electrolyte imbalance, acid rebound.
• Contraindications
• CHF, renal and hepatic disorders, dehydration,
  Cirrhosis.
• Interactions
• Antibiotics, Digoxin, Indocin, Salicylates,
  Dicumarol, diazepam, Amphetamines.

29
Histamine receptorantagonist

• Caution
• Patients are instructed to avoid nicotine.
• Drugs
• Famotidine (Pepcid)
• Ranatidine (Zantac)
• Cimetidine (Tagement)
• Nizatidine (Axid)

30

• Indications
• Gastroesophageal reflux (GERD)
• Ulcers
• GI hypersecretion
• Upper Gi bleeding
• Espophagitis
• Side effects
• Headaches, Mild Gynecomastia, mental confusion.

31

• Contraindications
• Hepatic and renal impairment, children, pregnancy
  and lactation.
• Interactions
• Propranolol, Phenytoin, Theophyline, Lidocaine
  and Diazepam.

32
Prostoglandins inhibitors

• Action
• Reduces the activity of Prostoglandins in the
  intestinal tract.
• Drugs
• Misoprostol (Cytotec)
• Side effects
• GI disturbance
• Headaches
• Menstrual irregularities

33

• Indication
• Gastric and duodenal Ulcers.
• Contraindications
• Children under 12, pregnant women

34
Other Antacid drugs

• Drugs
• Sucralfate (Carafate).
• Mechanism
• Pepsin inhibitor
• Reacts with HCI to form a foam that lines the
  stomach mucosa and protect it from irritation.

35

• Side effect
• Constipation
• Directions
• Given on empty stomach

36

• Drug
• Omeprazole (Prilosec).
• Mechanism
• Short term gastric antisecretory agent.
• Side effect
• GI disturbances
• headaches, dizziness

37
Inflammatory Bowel Disease

• Drug
• Mesalamine (Rowasa).
• Action
• Reduction of Prostaglandin concentrations in the
  colon.
• Indication
• Ulcerative colitis

38

• Side effect
• Abdominal discomfort
• Headache, dizziness
• Caution
• Renal impairment
• Allergics to sulfa

39
Anti diarrhea

• Drug
• kaolin and pectin (Kaopectate)
• Action
• Decrease fluidity of stools
• Combined with Paragoric (Opium ) to promote
  effect.

40

• Side effects
• constipation.
• Interactions
• Licomycin
• Digoxin
• Caution
• Must be administered under Physicians
  supervision.

41

• Drugs
• Diphenoxylate with Atropine (Lomotil)
• Ioperamide (Imodium).
• Action
• slowing intestinal motility.
• Side effects
• Anticholinergic effects
• Urinary retention
• GI disturbance.

42

• Contraindications
• Young children
• Pregnancy.
• Colitis
• Cirrhosis

43
Lactobacillus acidophilus(Lactinex)

• Non pathogenic acid producing bacteria.
• Found in milk
• Indication
• Antidiarrheal caused by Antibiotics and GI
  infections
• Contraindications
• In situations of fever.
• Sensitivity to milk
• Long term use.

44
Antiflatulants

• Drugs
• Semethicone (Mylicon).
• Indications
• Gastric bloating
• Postoperative gas pains
• Caution
• Patients should avoid onions, cabbage and beans.

45
Laxatives and Cathartics

• Action
• Promotes the evacuation of the intestinal tract
  and also to change the consistency of stool.

46
Bulk forming laxatives

• Categories
• Bulk forming
• Stool softeners
• Mineral oil
• Saline Laxatives
• Stimulant laxatives
• Senna
• Bisacodyl
• Phenolphthalein
• Combinations

47
Include Bran.

• Drugs
• Psyllium (Metamucil)
• Fiberall
• Cellulose
• Karaya
• Malt soup
• Bran

48

• Indications
• Geriatrics
• Contraindications
• Acute GI pain
• Bowel obstruction.

49
Stool softeners

• Examples
• Colace
• Surfak
• Doxidan
• Dialose

50

• Indications
• Pregnant women
• Side effects
• GI cramping
• Contraindications
• Acute abdominal pain.

51
Mineral Oil

• Drugs
• Agoral
• Kondremul
• Indications
• Oil retention enema
• Side effects
• Seepage
• Anal irritation
• ADEK Malabsorption.

52

• Contraindications
• Geriatrics
• Debilitated patients
• Children

53
Saline Laxatives

• Drugs
• Milk of Magnesia
• Side effects
• Electrolyte imbalance
• CNS symptoms
• Edema
• Cardiac complications.
• Renal and hepatic complications.

54

• Caution
• Never to be given on a repeated doses
• Contraindications
• Hepatic and renal disorders.

55
Stimulant Laxatives

• Drugs
• Cascara
• Bisacodyl (Dulcolax)
• Phenolphthalein (Ex-Lax)
• Action
• Produces a strong peristaltic action.
• Hese laxatives are habit forming and laxative
  dependency occurs.

56

• Indications
• Pre op
• Proctoscopic
• Sigmoidscopic
• Radiological procedures
• Side effects
• Rectal and colonic irritation.
• Contraindications
• Ulcerative colitis
• Children, pregnancy and lactation

57
Hyperosmotic Laxatives

• Drugs
• Glycerin
• Sorbitol
• Action
• Draws water from the tissues into the feces
• Caution
• Severe diarrhea

58
Antiemetics

• Drugs
• Benzquinamide (Emete - con)
• Prochlorperazine (Compazine),
• Trimrthobenzamide (Tigan)
• Promethazine (Phenergan)
• Scopalamine (Trans -Scop)
• Dimenhydrinate (Dramamine)
• Meclizine (Antivert),
• Metochlopramide (Reglan).
• Cisapride (Propulsid)

59

• Indication
• Motion sickness
• Nausea and Vomiting
• Vertigo associated with vestibular system
• Menieres disease
• Side effects
• Confusion, anxiety, restlessness
• Sedation, drowsiness, vertigo
• Depression
• GI disturbance.
• Dry mouth, Blurt vision

60

• Contraindications
• Glaucoma
• Seizure disorder
• Alcohol
• Children and elderly.
• Pregnancy
• Prostatic hypertrophy
• Cardiac arrhythmias
• Interactions
• CNS depressant
• Tranquilizers
• Hypnotics
• Alcohol Muscle relaxants