DOCSLIB.ORG

Crystalline Obstruction of the Male Feline Urethra John J

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Crystalline Obstruction of the Male Feline Urethra John J Volume 29 | Issue 3 Article 2 1967 Crystalline Obstruction of the male Feline Urethra John J. Andrews Iowa State University Follow this and additional works at: https://lib.dr.iastate.edu/iowastate_veterinarian Part of the Small or Companion Animal Medicine Commons, and the Veterinary Physiology Commons Recommended Citation Andrews, John J. (1967) "Crystalline Obstruction of the male Feline Urethra," Iowa State University Veterinarian: Vol. 29 : Iss. 3 , Article 2. Available at: https://lib.dr.iastate.edu/iowastate_veterinarian/vol29/iss3/2 This Article is brought to you for free and open access by the Journals at Iowa State University Digital Repository. It has been accepted for inclusion in Iowa State University Veterinarian by an authorized editor of Iowa State University Digital Repository. For more information, please contact [email protected]. Crystalline Obstruction of the Male Feline Urethra by John J. Andrews Obstructive urolithiasis, or more cor­ cent experiments have not supported this rectly phosphocrystalluria (since calculi claim. Likewise, hypovitaminosis A has rarely occur in the feline kidney or ureter), not been supported as a cause by research occurs quite often in the male domestic experiments. cat. The female cat seems to escape this The material which forms the urethral problem because her urethra is wider and obstruction in nearly all the cases of fe­ more expansible. The male cat, however, line urolithiasis is "struvite" crystal con­ has a relatively narrow penile urethra and glomerations. Struvite (NH4MgPO,,-6H20 fine urinary crystals may obstruct and -ammonium magnesium phosphate hex­ pack this urethral canal. If this condition ahydrate) is found in three forms in the is left untreated death is the usual result. feline urinary tract: 1) sabulous or mu­ Even if treatment is initiated, permanent cus-like plugs of fine struvite crystals urinary tract damage may have already mixed with some cellular debris; 2) "sand" occurred or the condition may reoccur and or granular material of larger struvite plague both the pet owner and the pet for crystals many in small clumps; and the rest of the cat's life. 3) "calculi," larger aglomerations of stru­ vite crystals up to several millimeters in ETIOLOGY diameter. These can usually be easily The cause of obstructive urolithiasis crushed into smaller ·granules. seems to be any factor that affects the There are two physical-chemical proper­ urine concentration of phosphate ions, the ties of these crystals that are very impor­ pH of the urine, the diameter of the ure­ tant. One, these struvite crystals have a thra or the integrity of the epithelial lining very regular rhomboid shape with perfect of the urethra. Some proposed specific sharp edges. Therefore, the usual feline causes thus include: 1) inadequate fluid calculi is not a smooth rounded stone as intake; 2) infection of the urinary tract, you might find in the dog, but rather it is especially by Proteus or Pseudomonas spp. an irregular conglomeration of regular since these organisms split urea to yield crystals which displays sharp jagged edges ammonia which increases the urine pH; around its circumference. And two, in 3) urinary stasis such as occurs in the nearly ninety percent of the normal fe­ house-broken cat; 4) castration of the im­ line urine samples that had a pH reaction mature male; and 5) trauma of the ure­ above 6.8, struvite crystals were found.8 thral lining. The normal pH of feline urine varies from Too much dietary ash has long been con­ 6.0 to 7.4; not only in different cats, but sidered to be a cause of urolithiasis but re- also in the same cat at different times. The median urine pH was 6.4. Thus we can • Mr. Andrews is a senior in .the pollege of Veter· Inary Medicine. Iowa State UniversIty. see that the probability of a male cat hav- Issue, No.3, 1967 111 ing struvite crystals in his urine sometime increases the renal tubular secretion is se­ during his life is quite high. verely reduced. Congestion and engorge­ ment of the vessels in the bladder wall be­ CLINICAL SIGNS comes marked as the urinary bladder The usual clinical picture of urethral distends beyond its normal distended size. obstruction is a severely depressed cat that This congestion gives the wall a thickened has been straining for a period of hours to impression upon palpation. The vessels in days. A frequent comment by the owner the renal parenchyma also become con­ is that the cat appears constipated because gested. Copious amounts of blood and tis­ he has been sitting in his ''kitty pan" sue debris appear in the urine arising from straining, but no feces have been passed. this engorgement and hemorrhage in the There may also be some vomiting in the renal parenchyma, the degeneration of the severely affected cat. The eyes are usually renal papillae and later from degeneration dull and the mucous membranes may be and hemorrhage in the lower urinary pale to "muddy." Palpation of the abdo­ tract.3 Blood in the urine is therefore a men will easily reveal a tense thick walled poor prognostic sign. bladder. Unless the cat is very depressed The blood-urea-nitrogen level is in­ pain may be elicted upon palpation of the creased by the decreased tubular function. abdomen. In many cases the penis is pro­ Also a certain amount of the retained truded and the penile tip may be a pur­ urine seeps into surrounding tissues and plish color. is picked up by the capillaries and lym­ phatics, thus causing the B.U.N. to rise DIAGNOSIS even more. This should be taken into ac­ The history of straining and the palpa­ count when the B.U.N. is being used as a tion of the distended bladder are usually prognostic tool. sufficient for a diagnosis. This condition Gross pathological changes include demands immediate treatment and there­ swollen bluish kidneys, a thickened se­ fore there is little time to differentiate ob­ verely congested bladder wall that may ex­ structive urolithiasis from other condi­ hibit numerous hemorrhagic areas and tions. presence of "sand" or "calculi" in the blad­ . Other conditions that might later be der and urethra. considered in differentiation are a stenosis Glycosuria has also been reported due of the urethra or a neoplasm impinging to tubular damage. upon the urethra. A radiograph of the pel­ vic area might be helpful in differentiating TREATl'l.BNT these conditions, however, crystal obstruc­ The treatment of fehne urethral block­ tion is so common this is probably not war­ age can be divided into three areas: ranted. 1) immediate relief, 2) aftercare, and A blood-urea-nitrogen test could be uti­ 3) surgical treatment. lized as a prognostic test to determine the amount of kidney damage caused by the IMMEDIATE TREATMENT increased pressures in the urinary tract. Since the diameter of the penile urethra I would like to emphasize that immedi­ from the prostate caudally is only one-half ate relief of the urinary stasis is more im­ the diameter of the preprostatic urethra, portant than attempting to confirm the nearly all calculi lodge in the penile por­ specific diagnosis. Proceed as if it were tion with many lodging within one-half crystalline obstruction and you will be cor­ inch of the orifice. A parenteral smooth rect in a great majority of the cases. muscle relaxant can be given as soon as a diagnosis has been made. Its usefulness PATHOLOGY is questioned because of the slight amount After crystals have lodged in and ob­ of smooth muscle surrounding the penile structed the urethra, the intravesicular portion of the feline urethra. lIS Probably pressure begins to rise. As this pressure the only urethral relaxation obtained is in 112 Iowa State University Veterinarian the preprostatic portion where smooth prove to be too traumatic. muscle is more abundant. This may be of Careful flushing should attempt to benefit if back-flushing of the urethra is break down and/or force the obstruction used. back into the bladder. If this proceedure Next a gentle digital manipulation of doesn't succeed a 32g. stainless steel wire the penis should be attempted; lightly roll­ loop can be used. This can be made by ing the penis between the forefinger and twisting the wire upon itself and leaving a thumb, trying to dislodge or break-up the small loop at one end. This loop is then obstruction. Care must be taken so that inserted into the urethra and a further at­ further damage to the urethral mucosa is tempt to disintegrate the obstruction is not caused. Even though many of these tried. struvite calculi are quite easily crushed If all else fails, puncture of the bladder many veterinarians choose not to attempt through the abdominal wall should be this manipulation because of the possibil­ done. This is a "last resort" solution for ity of causing further trauma. If the ob­ two reasons: 1) it does not solve the pri­ struction does not dislodge immediately mary problem, the obstruction (although upon digital manipulation (or if you the obstruction may now be easier to back­ choose not to use it) back-flushing of the flush because of the release of the intra­ urethra should be attempted. vesicular pressure) and 2) there is a dan­ Many of these affected cats are so de­ ger of contaminating the peritoneum with pressed that manipulation and even back­ pathogenic bacteria leaking through the flushing can be done without an anes­ needle hole in the urinary bladder wall. A thetic. In fact because the kidneys are one-inch 22g. (or smaller diameter) needle practically non-functional, long acting is the safest size to use. As much urine as barbituate anesthetics or any other anes­ possible should be withdrawn.
Load more

Recommended publications
  • Formulary (List of Covered Drugs)
    3ODQ<HDU 202 Formulary (List of Covered Drugs) PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THE FOLLOWING PLAN: $0 Cost Share AI/AN HMO Minimum Coverage HMO Silver 70 HMO Active Choice PPO Silver Opal 25 Gold HMO Silver 70 OFF Exchange HMO Amber 50 HMO Silver Opal 50 Silver HMO Silver 73 HMO Bronze 60 HDHP HMO Platinum 90 HMO Silver 87 HMO Bronze 60 HMO Ruby 10 Platinum HMO Silver 94 HMO Gold 80 HMO Ruby 20 Platinum HMO Jade 15 HMO Ruby 40 Platinum HMO This formulary was last updated on8//20. This formulary is VXEMHFWto change and all previous versions of the formulary no longer apply. For more recent information or other questions, please contact Chinese Community Health Plan Member Services at 1-888-775-7888 or, for TTY users, 1-877-681-8898, seven days a week from 8:00 a.m. to 8:00 p.m., or visit www.cchphealthplan.com/family-member -,-ϭ -,-ϭ"&* !#" + 5 5 ),-$+" %(%'.')/"+#" %&/"+ -%/"$)% "%&/"+ *& )&! %&/"+ 0 $(#" '"+ %&/"+ *& %&/"+ %&/"+ +)(2" &-%(.' %&/"+ +)(2" .1&-%(.' %&/"+ )&! .1&-%(.' !" .1&-%(.' dŚŝƐĨŽƌŵƵůĂƌLJǁĂƐůĂƐƚƵƉĚĂƚĞĚ8ͬϭͬϮϬϮϭ͘dŚŝƐĨŽƌŵƵůĂƌLJŝƐƐƵďũĞĐƚƚŽ ĐŚĂŶŐĞĂŶĚĂůůƉƌĞǀŝŽƵƐǀĞƌƐŝŽŶƐŽĨƚŚĞĨŽƌŵƵůĂƌLJŶŽůŽŶŐĞƌĂƉƉůLJ͘&ŽƌŵŽƌĞ ƌĞĐĞŶƚŝŶĨŽƌŵĂƚŝŽŶŽƌŽƚŚĞƌƋƵĞƐƚŝŽŶƐ͕ƉůĞĂƐĞĐŽŶƚĂĐƚŚŝŶĞƐĞŽŵŵƵŶŝƚLJ ,ĞĂůƚŚWůĂŶDĞŵďĞƌ^ĞƌǀŝĐĞƐĂƚϭͲϴϴϴͲϳϳϱͲϳϴϴϴŽƌ͕ĨŽƌddzƵƐĞƌƐ͕ ϭͲϴϳϳͲϲϴϭͲϴϴϵϴ͕ƐĞǀĞŶĚĂLJƐĂǁĞĞŬĨƌŽŵϴ͗ϬϬĂ͘ŵ͘ƚŽϴ͗ϬϬƉ͘ŵ͕͘ŽƌǀŝƐŝƚ ǁǁǁ͘ĐĐŚƉŚĞĂůƚŚƉůĂŶ͘ĐŽŵͬĨĂŵŝůLJͲŵĞŵďĞƌ !! %+)&,+ &%+&+&)$,#)0),# *+666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666I % + &%*6666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666I
    [Show full text]
  • Anthem Blue Cross Prescription Formulary List
    National Drug List Drug list — Three Tier Drug Plan Your prescription benefit comes with a drug list, which is also called a formulary. This list is made up of brand-name and generic prescription drugs approved by the U.S. Food & Drug Administration (FDA). We’re here to help. If you are a current Anthem member with questions about your pharmacy benefits, we're here to help. Just call us at the Member Services number on your ID card. The plan names to which this formulary applies are shown below. Solution PPO 1500/15/20 $5/$15/$50/$65/30% to $250 after deductible Solution PPO 2000/20/20 $5/$20/$30/$50/30% to $250 Solution PPO 2500/25/20 $5/$20/$40/$60/30% to $250 Solution PPO 3500/30/30 $5/$20/$40/$60/30% to $250 Rx ded $150 Solution PPO 4500/30/30 $5/$20/$40/$75/30% to $250 Solution PPO 5500/30/30 $5/$20/$40/$75/30% to $250 Rx ded $250 $5/$15/$25/$45/30% to $250 $5/$20/$50/$65/30% to $250 Rx ded $500 $5/$15/$30/$50/30% to $250 $5/$20/$50/$70/30% to $250 $5/$15/$40/$60/30% to $250 $5/$20/$50/$70/30% to $250 after deductible Here are a few things to remember: o You can view and search our current drug lists when you visit anthem.com/ca/pharmacyinformation. Please note: The formulary is subject to change and all previous versions of the formulary are no longer in effect.
    [Show full text]
  • Advice Concerning the Addition of Certain Pharmaceutical Products
    U.S. International Trade Commission COMMISSIONERS Daniel R. Pearson, Chairman Shara L. Aranoff, Vice Chairman Jennifer A. Hillman Stephen Koplan Deanna Tanner Okun Charlotte R. Lane Robert A. Rogowsky Director of Operations Karen Laney-Cummings Director of Industries Address all communications to Secretary to the Commission United States International Trade Commission Washington, DC 20436 U.S. International Trade Commission Washington, DC 20436 www.usitc.gov Advice Concerning the Addition of Certain Pharmaceutical Products and Chemical Intermediates to the Pharmaceutical Appendix to the Harmonized Tariff Schedule of the United States Investigation No. 332--476 Publication 3883 September 2006 This report was prepared principally by Office of Industries Philip Stone, Project Leader With assistance from Elizabeth R. Nesbitt Primary Reviewers David G. Michels, Office of Tariff Affairs and Trde Agreements, John Benedetto, and Nannette Christ, Office of Economics Administrative Support Brenda F. Carroll Under the direction of Dennis Rapkins, Chief Chemicals and Textiles Division ABSTRACT Under the Pharmaceutical Zero-for-Zero Initiative, which entered into force in 1995, the United States and its major trading partners eliminated tariffs on many pharmaceuticals, their derivatives, and certain chemical intermediates used to make pharmaceuticals. The U.S. list of pharmaceutical products and chemical intermediates eligible for duty-free treatment under the agreement is given in the Pharmaceutical Appendix to the Harmonized Tariff Schedule of the United States. The Pharmaceutical Appendix is periodically updated to provide duty relief for additional such products, including newly developed pharmaceuticals. This report provides advice on the third update to the agreement, in which approximately 1,300 products are proposed to receive duty-free treatment.
    [Show full text]
  • Texas Medication Aides Basic Course Curriculum for Nursing Facilities and Related Institutions
    Texas Medication Aides Basic course curriculum for Nursing Facilities and related institutions Effective Date: January 2017 Texas Health and Human Services Commisson (HHSC) Medication Aide Program, E‐416 P.O. Box 14930, Austin, Texas 78714‐9030 Communicate before you medicate! Helping people make the best of medications REVISED JUNE 2016 | Texas Health and Human Services Commisson (HHSC) HHSC Licensing and Credentialing TEXAS MEDICATION AIDE AND BASIC COURSE CURRICULUM 100‐hour curriculum Acknowledgements We would like to extend a very special thank you to the following people who worked many hours in revising and updating this curriculum. Your cooperation and dedication is appreciated. Darren Christian, R.N., Texas Health and Human Services Commisson, Elizabeth Demps, Texas Health and Human Services Commisson, Katherine Hafner, B.S, R.Ph, Fellow in the American Society of Consultant Pharmacists, Kim Lammons Texas Health and Human Services Commisson, Debi Majo, BSN R.N., TMF Health Quality Institute, Elizabeth McManamy, R.Ph, Texas Health and Human Services Commisson, Joyce Meredith, Texas Health and Human Services Commisson, Carolyn Reese, MSN, R.N., Blinn College, Brenda Renfro‐King, R.N., McLennan Community College, Jacqueline Smith, Texas Health and Human Services Commisson, Camden Frost, Texas Health and Human Services Commisson, Sean Steele, Texas Department on Aging and Disability Services, Sunny Stout, R.N., Senior Care Centers, Mavon Tidwell, R.N., Marble Falls High School, Kingsland Hills Care Center, Anne Trejo, Texas Health and Human Services Commisson. © 2016 Texas Health and Human Services Commisson (formerly Texas Department of Human Services) TEXAS HEALTH AND HUMAN SERVICES COMMISSION (HHSC) 1 TEXAS MEDICATION AIDE AND BASIC COURSE CURRICULUM 100‐hour curriculum Table of Contents: Medication Aide and basic course curriculum Unit I.
    [Show full text]
  • 11705 HCR Essential Closed State Exchange
    HCR Essential Key Notes BE = This medication is not covered in Pennsylvania under the Health Care Reform Comprehensive and Health Care Reform Progressive Formularies for Individual Plans and may not be covered for Group Plans. Contact Member Services for more information. EX = This medication is not covered in Pennsylvania or West Virginia under the Health Care Reform Comprehensive and Health Care Reform Progressive Formularies for Individual Plans and may not be covered for Group Plans. Contact Member Services for more information. PA = Coverage of this drug is subject to review by the plan and is based on Pharmacy policy. QL = Limits the amount of drug that a beneficiary may receive in a certain period. SP = To assist in the management of select specialty medications, some pharmacy benefit designs require the Status use of a preferred specialty $0 = Preventative Medication pharmacy. Please call the number on 1 = Tier 1 the back of your member ID card for 2 = Tier 2 assistance. 3 = Tier 3 ST = For a step therapy drug to be 4 = Tier 4 covered, the beneficiary will be first lowercase italics = Generic drugs NF = Non-Formulary required to try a therapeutically UPPERCASE = Brand name drugs Special Tier = Special Tier equivalent medication. Drug Status Notes Analgesic, Anti-Inflammatory Or Antipyretic Analgesic Opioid Agonists PA; ST; QL (120 UNITS per 25 ACTIQ NF days) PA; ST; QL (14 DAY SUPPLY ALFENTA NF per 30 days) Last Approved Date: 09/24/2021 Formulary Version: 92 1 Drug Status Notes PA; ST; QL (14 DAY SUPPLY alfentanil NF per 30 days)
    [Show full text]
  • Pharmacy Formulary
    Pharmacy Formulary Applicable to: Medi-Cal Alliance Care IHSS Health Plans June 1, 2021 This formulary and other plan-specific coverage documents are accessible online at: http://www.ccah-alliance.org/pharmacy.html Link to the Medi-Cal and Alliance Care IHSS members’ homepage: http://ccah-alliance.org/members.html Notice: This formulary is subject to change and all previous versions of the formulary are no longer in effect. Notice of non-discrimination Discrimination is against the law. Central California Alliance for Health (the Alliance) complies with applicable federal and State civil rights laws and does not discriminate (exclude or treat people differently) on the basis of race, color, national origin, creed, ancestry, religion, language, age, marital status, sex, sexual orientation, gender identity, health status, physical or mental disability, or identification with any other persons or groups defined in Penal Code 422.56, and the Alliance will provide all Covered Services in a culturally and linguistically appropriate manner. The Alliance: Provides free aids and services to people with disabilities to communicate effectively with us, such as: Qualified sign language interpreters Written information in other formats (braille, large print, audio, accessible electronic formats, and other formats) Provides free language services to people whose primary language is not English, such as: Qualified interpreters Information written in other languages If you need these services, contact Member Services. If you believe that the Alliance
    [Show full text]
  • Sustainable Nitrogen Management in Denmark…………………………………………………………………………………
    Innovative solutions for SUSTAINABLE MANAGEMENT OF NITROGEN Conference proceedings © 2017 Aarhus University and the dNmark.org Research Alliance ISBN 978-87-93398-82-5 Reference: Dalgaard T, Olesen JE, Schjørring JK, Jensen LS, Vejre H, Andersen PS, Gundersen P, Jacobsen BH, Jensen JD, Hasler B, Termansen M, Hertel O, Brock S, Kronvang B, Svenning JC, Sigsgaard T, Hansen B, Thorling L, Højberg AL, Wiborg IA, Piil K, Kjeldsen C, Graversgaard M, Hutchings N, de Vries W, Christensen J and Mukendi T (2017) Innovative solutions for sustainable management of nitrogen. Proceedings from the International conference, Aarhus, Denmark, 25-28 June 2017, and the following United Nations Economic Commission for Europe Task Force on Reactive Nitrogen Meeting (TFRN-12), 29-30 June 2017. Aarhus University, Denmark. ISBN 978-87-93398-82-5. 142 p. Scientific editors: Tommy Dalgaard, Aarhus University, Department of Agroecology Jørgen E. Olesen, Aarhus University, Department of Agroecology Jan K. Schjørring, University of Copenhagen, Department of Agriculture and Ecology Lars Stoumann Jensen, University of Copenhagen, Department of Agriculture and Ecology Henrik Vejre, University of Copenhagen, Department of Geoscience, Natural Resources and Planning Peter Stubkjær Andersen, Department of Geoscience, Natural Resources and Planning Per Gundersen, University of Copenhagen, Department of Geoscience, Natural Resources and Planning Brian H. Jacobsen, University of Copenhagen, Institute of Food and Resource Economics Jørgen Dejgaard Jensen, University of Copenhagen,
    [Show full text]
  • Florencio Zaragoza Dörwald Lead Optimization for Medicinal Chemists
    Florencio Zaragoza Dorwald¨ Lead Optimization for Medicinal Chemists Related Titles Smith, D. A., Allerton, C., Kalgutkar, A. S., Curry, S. H., Whelpton, R. van de Waterbeemd, H., Walker, D. K. Drug Disposition and Pharmacokinetics and Metabolism Pharmacokinetics in Drug Design From Principles to Applications 2012 2011 ISBN: 978-3-527-32954-0 ISBN: 978-0-470-68446-7 Gad, S. C. (ed.) Rankovic, Z., Morphy, R. Development of Therapeutic Lead Generation Approaches Agents Handbook in Drug Discovery 2012 2010 ISBN: 978-0-471-21385-7 ISBN: 978-0-470-25761-6 Tsaioun, K., Kates, S. A. (eds.) Han, C., Davis, C. B., Wang, B. (eds.) ADMET for Medicinal Chemists Evaluation of Drug Candidates A Practical Guide for Preclinical Development 2011 Pharmacokinetics, Metabolism, ISBN: 978-0-470-48407-4 Pharmaceutics, and Toxicology 2010 ISBN: 978-0-470-04491-9 Sotriffer, C. (ed.) Virtual Screening Principles, Challenges, and Practical Faller, B., Urban, L. (eds.) Guidelines Hit and Lead Profiling 2011 Identification and Optimization ISBN: 978-3-527-32636-5 of Drug-like Molecules 2009 ISBN: 978-3-527-32331-9 Florencio Zaragoza Dorwald¨ Lead Optimization for Medicinal Chemists Pharmacokinetic Properties of Functional Groups and Organic Compounds The Author All books published by Wiley-VCH are carefully produced. Nevertheless, authors, Dr. Florencio Zaragoza D¨orwald editors, and publisher do not warrant the Lonza AG information contained in these books, Rottenstrasse 6 including this book, to be free of errors. 3930 Visp Readers are advised to keep in mind that Switzerland statements, data, illustrations, procedural details or other items may inadvertently be Cover illustration: inaccurate.
    [Show full text]
  • Innovative Solutions for Sustainable Management of Nitrogen, Aarhus, Denmark
    A landscape ecological perspective on the regulation of N, P and organic matter in the Danish agri-environment Andersen, Erling; Vejre, Henrik; Dalgaard, Tommy; Andersen, Peter Stubkjær; Olesen, Jørgen Eivind; Christensen, Andreas Aagaard Publication date: 2017 Document version Publisher's PDF, also known as Version of record Citation for published version (APA): Andersen, E., Vejre, H., Dalgaard, T., Andersen, P. S., Olesen, J. E., & Christensen, A. A. (2017). A landscape ecological perspective on the regulation of N, P and organic matter in the Danish agri-environment. 118. Poster session presented at Innovative solutions for sustainable management of nitrogen, Aarhus, Denmark. Download date: 01. okt.. 2021 Innovative solutions for SUSTAINABLE MANAGEMENT OF NITROGEN Conference proceedings © 2017 Aarhus University and the dNmark.org Research Alliance ISBN 978-87-93398-82-5 Reference: Dalgaard T, Olesen JE, Schjørring JK, Jensen LS, Vejre H, Andersen PS, Gundersen P, Jacobsen BH, Jensen JD, Hasler B, Termansen M, Hertel O, Brock S, Kronvang B, Svenning JC, Sigsgaard T, Hansen B, Thorling L, Højberg AL, Wiborg IA, Piil K, Kjeldsen C, Graversgaard M, Hutchings N, de Vries W, Christensen J and Mukendi T (2017) Innovative solutions for sustainable management of nitrogen. Proceedings from the International conference, Aarhus, Denmark, 25-28 June 2017, and the following United Nations Economic Commission for Europe Task Force on Reactive Nitrogen Meeting (TFRN-12), 29-30 June 2017. Aarhus University, Denmark. ISBN 978-87-93398-82-5. 142 p.
    [Show full text]
  • Medicaid Health Plan Common Formulary
    8/1/2021 Michigan Department of Health and Human Services Medicaid Health Plan Common Formulary Contents Drugs Reimbursed through Fee-For-Service Benefit (Carve-Out) ............................................................................................................................... 2 Products Covered As A Medical Benefit ....................................................................................................................................................................... 2 Medicaid Health Plans May Be Less Restrictive ........................................................................................................................................................... 2 Standard Prior Authorization Form .............................................................................................................................................................................. 3 Non-Formulary Prior Authorization Requests .............................................................................................................................................................. 3 Michigan Pharmaceutical Product List ......................................................................................................................................................................... 3 Mandatory Generic Drug Policy for products whose drug class(es) are not present on the Single Preferred Drug List. ......................................... 3 Unit Dose Packaging .....................................................................................................................................................................................................
    [Show full text]
  • National Drug List Drug List — Four Tier Drug Plan
    National Drug List Drug list — Four Tier Drug Plan Your prescription benefit comes with a drug list, which is also called a formulary. This list is made up of brand-name and generic prescription drugs approved by the U.S. Food & Drug Administration (FDA). The following is a list of plan names to which this formulary may apply. Additional plans may be applicable. If you are a current Anthem member with questions about your pharmacy benefits, we're here to help. Just call us at the Pharmacy Member Services number on your ID card. Solution PPO 1500/15/20 $5/$15/$50/$65/30% to $250 after deductible Solution PPO 2000/20/20 $5/$20/$30/$50/30% to $250 Solution PPO 2500/25/20 $5/$20/$40/$60/30% to $250 Solution PPO 3500/30/30 $5/$20/$40/$60/30% to $250 Rx ded $150 Solution PPO 4500/30/30 $5/$20/$40/$75/30% to $250 Solution PPO 5500/30/30 $5/$20/$40/$75/30% to $250 Rx ded $250 $5/$15/$25/$45/30% to $250 $5/$20/$50/$65/30% to $250 Rx ded $500 $5/$15/$30/$50/30% to $250 $5/$20/$50/$70/30% to $250 $5/$15/$40/$60/30% to $250 $5/$20/$50/$70/30% to $250 after deductible Here are a few things to remember: o You can view and search our current drug lists when you visit anthem.com/ca and choose Prescription Benefits. Please note: The formulary is subject to change and all previous versions of the formulary are no longer in effect.
    [Show full text]
  • Urine Heaven
    URINE HEAVEN Joe Bartges, DVM, PhD, DACVIM, DACVN Professor of Medicine and Nutrition The Acree Endowed Chair of Small Animal Research [email protected] Amanda Callens, BS, LVT Veterinary Nurse, Nephrology and Urology [email protected] Phone: 865-755-3359 FAX: 865-974-5733 The University of Tennessee Veterinary Medical Center Knoxville, TN 37996-4544 Urine Trouble: Chronic Kidney Disease (CKD) Joe Bartges, DVM, PhD, DACVIM, DACVN Professor of Medicine and Nutrition The Acree Endowed Chair of Small Animal Research The University of Tennessee General Key Points: • CKD implies irreversible renal failure that remains stable for a period of time, but ultimately progresses • Incidence increases with increasing age in dogs and cats * Although many things can cause chronic kidney disease, by the time chronic kidney disease is diagnosed the cause(s) is/are not present and not treatable. It can occur as a result of: * Congenital renal disease * Acquired diseases – hypotension, drugs, toxins, hypotension, infections, cancer * Periodontal disease has been linked to renal histologic changes in dogs * Feline immunodeficiency virus infection has been linked to renal disease in cats * Kidneys are involved with whole body homeostasis; therefore, CKD affects general well-being * Clinical signs involve primarily * Change in water balance: polyuria / polydipsia (PU / PD) * Gastrointestinal signs (vomiting, hyporexia / anorexia, halitosis) * Signs of chronic disease (weight loss, loss of body condition, unkempt appearance) * Laboratory evaluation reveals *
    [Show full text]