8 responding to uti Flashcards
How is stress incontinence managed?
- Pelvic floor muscle training
- duloxetine
- topical vaginal oestrogen therapy
How does duloxetine work?
it’s an SSRI,
relaxes detrusor muscle and increases external sphincter activity.
What causes stress incontinence?
- Damage to bladder wall and neck
How is urge incontinence managed?
- Pelvic floor muscle training
- reduction of excess fluids
- topical vaginal oestrogen to reverse atrophy
- m3 muscarinic blockers (men)
What do M3 muscarinic receptor antagonists do?
Block activation of detrusor muscle through PS nerve
What is a side effect of muscarinic antagonists?
Tachycardia
What causes urge incontinence?
Overstimulation of detrusor muscle
What lifestyle advice should you offer to women to manage incontinence
- Reduce caffeine and alcohol intake
- reduce weight
- stop smoking
- drink water
What pharmacological treatment can you offer women for incontinence ?
- Antimuscarinics (solifenancin and oxybutynin)
- oestrogens
- treat constipation if any
What is given for nocturnal urine production in kids?
Desmopressin
What causes LUTS in men?
Enlarged prostate putting pressure on urethra
What type of receptors are found in the bladder neck and prostate?
Alpha adrenoceptors (predominantly alpha 1)
What type of drug is tamsulosin?
Alpha 1 blocker
What does tamsulosin do?
- Inhibit contraction of prostate and bladder neck
- increases urine flow rate
- doesn’t affect prostate size
who can have tamsulosin as P medication
45-75 years old, symptoms for over 3 months, no symptoms of infection or blood, no other medical conditions
What is the dosage for tamsulosin?
400mcg MR capsule for up to 6 weeks then refer
What are common side effects of tamsulosin?
- Dizziness
- tiredness
- retrograde ejaculation
What POM meds are offered for prostate hyperplasia ?
5 alpha reductase inhibitors like finasteride and dutasteride and antimuscarinics
How do 5ARIs work?
Inhibit metabolism of testosterone to DHT (which is a more potent driver of prostate growth)
When should you refer for cystitis?
- If longer than a week
- new sexual partner
- frequent recurrence
- has other symptoms of diabetes
How does cystitis resolve?
Spontaneously itself in 2-3 days
What advice should you give for cystitis?
- Avoid delays and empty bladder completely
- drink fluids
- wash perineal area
- pee after sex
What treatment is given for cystitis?
- Alkanising agents (potassium or sodium citrate)
- cranberry juice (little evidence)
How do alkanising agents work?
They alter urine pH to relieve burning sensation
When should alkanising agents be avoided?
In pregnancy or people with hypertension due to high Na
How does cranberry juice work?
reduces adherence of bacteria to ureoepithelial cells in bladder and urethra and reduces incidence of infections
What antibacterial agent is given?
3 day course of trimethoprim 200mg 12 hourly on PGD or nitrofurantoin 50mg 6 hourly
