Renal and Bladder Disorders

Prescribing Notes

Incontinence

Anticholinergic (oxybutynin, propiverine, tolterodine, trospium chloride) and antispasmodic (flavoxate) drugs may be used to treat urinary frequency, urgency and incontinence. They lower intravesicular pressure, increase capacity and reduce the frequency of bladder contraction. they block the parasympathetic nerves which control bladder voiding or exert a direct spasmolytic effect on the detrusor muscle of the bladder. Typical anticholinergic effects such as dry mouth, visual distrubances, constipation and tachycardia are common, though less so with propiverine and tolterodine than oxybutynin. All the drugs are contraindicated in prostatic hypertrophy and glaucoma.

The vasopressin analogue, desmopressin corrects overnight polyuria by supplementing the natural hormone shown to be deflicient in enuretic patients. It may be given orally or as an intranasal spray. A single dose lasts for approx. 10 to 12 hours allowing control of nocturnal enuresis without affecting daytime urine production. It may also be used to suppress nocturia in patients with multiple sclerosis. It has no vasopressor or smooth muscle side effects. When there is stress incontinence due to intrinsic sphincter defliciency, bovline collagen may be injected near the bladder neck to increase outflow resistance.

Urinary Retention

Cholinergics and anticholinesterases are used in urinary retention. They promote bladder voiding by ncreasing the tone of the detrusor muscle. As these drugs also stimulate cholinergic receptors in other organs they should be used with caution in patients with parkinson's disease. The selective a1 [5C]f23-}blockers alfuzosin, doxazosin, indoramin, prazosin, tamsulosin and terazosin may be used as adjuncts in the symptomatic treatment of urinary obstruction caused by benign prostatic hypertrophy (BPH). They block sympathetic activity and relax the smooth muscle component of prostatic obstruction. The 5-alpha reductase inhibitors, dutasteride and finasteride are indicated for the treatment of BPH, and to reduce the long term complications of the condition, particularly the incidence of acute urinary retention and the need for surgery. They alleviate urinary obstruction by blocking the formation of dihydrotestosterone and therefore induce shrinkage of hyperplastic tissue in the prostate.

Urinary Tract Infection

Antifungals and antibacterials included in this section are specifically indicated for bladder instillation or irrigation. Preparations for UTLs can be found in 8A and 9B.

Anaemia of Renal Failure

The recombinant erythropoietins, epoietin alfa, epoietin beta, darbepoietin alfa, are used in anaemia associated with chronic renal failure. They stimulate red cell production by imitating the actions of endogenous erythropoietin on mesenchymal stem cells in bone marrow.

UN commission adopts safety guidelines for vitamin and food supplements (July 13)

With a view to preventing consumers from taking overdose of Labelling to stop consumers overdosing on vitamin and mineral food supplements, guidelines to minimize the emergence of potentially deadly drug-resistant microbes were among some 20 new and amended standards were announced on July 11 by a United Nations Commission that is the highest international body on food standards. The UN Food and Agriculture Organization (FAO) and the UN World Health Organization (WHO) said in a joint release that the Codex Alimentarius Commission (CAC), a subsidiary of both agencies, adopted the recommendations at the end of a weeklong meeting in Rome attended by delegates from 120 countries.

The CAC adopted global guidelines for vitamin and mineral food supplements, calling for labelling that contains information on maximum consumption levels of vitamin and mineral food supplements. These labels will assist countries to increase consumer information, which will help consumers use them in a safe and effective way. According to WHO, the guidelines ensure that consumers receive beneficial health effects from vitamins and minerals. The guidelines say people should be encouraged to select a balanced diet to get the sufficient amount of vitamins and minerals. Only in cases where food does not provide sufficient vitamins and minerals should supplements be used.

The CAC also tentatively agreed to a task force to address antimicrobial resistance, with a formal decision set for next year. WHO, FAO and the inter-governmental World Organization for Animal Health (OIE) have all drafted guidelines for prudent use of antimicrobials in treatment of human illnesses and animal production. But agreement has been difficult as it involves collaboration from different sectors: animal health and production, human health and drug manufacturing. The new task force will bring all these sectors together and develop a holistic approach to this growing problem.

Resistance to antimicrobial drugs such as antibiotics, is an emerging public heath problem caused by a number of factors, including inappropriate use of antibiotics in humans, and antibiotic treatment of sick animals used for human consumption and, in some cases, to promote faster growth. Use of antimicrobials as pesticides is also a factor.

Resistant microorganisms developed in animals used for human consumption may be transmitted to humans mainly by contaminated food. For example, resistant strains of salmonella and other food-borne microorganisms are now frequently encountered, limiting the effective treatment of human infections, which in some cases can result in death. The CAC has 172 members, all of which are members of FAO or WHO or both.

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