Enuresis persists, and the patient is placed on desmopressin acetate (DDAVP). This medication works which of the following mechanisms?
Desmopressin, or DDAVP, can be used intranasally in patients suffering from enuresis. This medication is a long-acting synthetic analogue of vasopressin. The medication acts at V2 receptors, which are found on renal tubule cells, and mediates an anti-diuretic effect by increasing water permeability and water reabsorption in the collecting tubules, leading to decreased urine output. It is effective in 70% of patients with increased nocturnal urine output. Detrusor muscle tone is under control of the parasympathetic system. DDAVP does not affect this system. Some sympathomimetic drugs may cause enough wakefulness so that the child perceives the urge to void . Dextroamphetamine sulfate is one such medication. The external sphincter is under somatic nervous control. This medication does not contribute to this system. Ref: Goldson E., Reynolds A. (2012). Chapter 3. Child Development & Behavior. In W.W. Hay, Jr., M.J. Levin, R.R. Deterding, J.J. Ross, J.M. Sondheimer (Eds),CURRENT Diagnosis & Treatment: Pediatrics, 21e.
Decrease detrusor muscle tone
Improves aleness of the patient during the sleep cycle
Increase external sphincter contraction
Increase water permeability and reabsorption in collecting tubules