Editing Functional: Nocturia (section)

=== History and Physical Exam ===

==== History ====
* '''Nocturia be a symptom of serious systemic illnesses including hypertension, diabetes, heart disease, and kidney disease'''
* '''<span style="color:#ff0000">Drug effects causing nocturia</span>'''
** '''<span style="color:#ff0000">Increased urine output (5):</span>'''
**# '''SSRIs''' (block antidiuretic hormone secretion)
**# '''Tetracycline''' (attenuates antidiuretic hormone via decreases in cAMP accumulation and action)
**# '''Calcium channel blockers''' (increases atrial natriuretic peptide, blocks sodium reabsorption in proximal convoluted tubule)
**# '''Lithium (drug-induced nephrogenic diabetes insipidus)'''
**# '''Diuretics: timing of diuretic administration should be mid-afternoon''', to allow for elimination of lower extremity excess body fluid during normal waking hours. Men with nocturnal polyuria may benefit from diuretic therapy 6 hours before sleep
** '''<span style="color:#ff0000">Insomnia and CNS effects</span>'''
*** '''CNS stimulants''': dextroamphetamine, methylphenidate
*** '''Antihypertensives''': α-Blockers, β-Blockers, methyldopa
*** '''Respiratory''': albuterol, theophylline
*** '''Decongestants''': phenylephrine, pseudoephedrine
*** '''Hormones:''' corticosteroids, thyroid
*** '''Psychotropics''': MAOIs, SSRIs, atypical antidepressants
*** '''Dopaminergic''' '''agonists:''' carbidopa
*** '''Antiepileptics:''' phenytoin
** '''<span style="color:#ff0000">Direct lower urinary tract effects</span>'''
*** '''Ketamine''': direct bladder toxin
*** Tiaprofenic acid (Surgam): toxic cystitis
*** Cyclophosphamide

==== Physical exam ====
* '''<span style="color:#ff0000">Peripheral edema</span>''' resulting from cardiac disease, nephrotic syndrome, venous insufficiency
* '''<span style="color:#ff0000">Obesity and short neck may be suggestive of obstructive sleep apnea</span>''' and be associated with nocturnal polyuria