Bladder Flashcards
Bladder first
tier: exercise, lifestyle, and complementary therapies
Bladder second
tier: pharmacotherapies
Anti-muscarinic agents
Beta-adrenergic therapy
Initial agent depends on side effect profile and insurance coverage
Anti-muscarinics most
Most commonly prescribed
Anti-muscarinics act primarly
Act primarily by increasing bladder capacity and decreasing urgency through blockade of muscarinic receptor stimulation by acetylcholine during bladder storage
Anti-muscarinics start
Start lowest dose and titrate up (if needed) after 2 weeks
Anti-muscarinics f/u
Start lowest dose and titrate up (if needed) after 2 weeks
Anti-muscarinics CI
CI: uncontrolled tachyarrhythmias, myasthenia gravis, gastric retention and narrow angle-closure glaucoma
Anti-muscarinics AE
AE: urinary retention, dry mouth, constipation, blurred vision for near objects, tachycardia, drowsiness, and decreased cognitive function
Beta3-adrenoceptor agonist (mirabegron
Promotes selective beta receptor stimulation of the detrusor muscle to enhance smooth muscle relaxation.
Mirabegron - Initial medication and as different choice for patients who do not tolerate or respond to antimuscarinic medications
Are at risk for central nervous system side effects (eg, dementia), orr have a contraindication to antimuscarinic medication.
Mirabegron maybe useful
for patients already taking a cholinesterase inhibitor for whom it is preferable to avoid adding antimuscarinic agents.
Mirabegron has similar efficacy to
antimuscarinics but may be somewhat better tolerated.
Mirabegron - Close monitoring
Close monitoring – monitor for new-onset urinary retention by measuring at f/u in 4 to 6 weeks or has any new symptoms
Mirabegron adverse effects
– CI in severe or uncontrolled HTN
HTN – monitor BP
Dry mouth, constipation
Urinary retention
Can use anti-muscarinic and
beta 3 agonist medications together
BPH increases as men
age and can contribute to urinary symptoms that may benefit from medical or surgical treatment.
treatements for BPH
Lifestyle modifications
Alpha-adrenergic receptor blockers
Phosphodiesterase type 5 inhibitors
5-alpha reductase inhibitors to prevent progression
Alpha-adrenergic receptor blockers initial
therapy in most patients with LUTS/BPH
Alpha-adrenergic receptor blockers bladdder outlet
outlet obstruction (BOO) is primarily mediated by alpha-1 adrenergic receptors located on prostatic smooth muscle, which are upregulated in the stromal glandular hyperplasia seen in BPH.
Alpha-adrenergic receptor blockers blcoking
signaling through the alpha-adrenergic receptorsleads to relaxation of the smooth muscle of the bladder neck and the prostatic urethra.
Alpha-adrenergic blockers - SE
SE: dizziness and rhinitis; hypotension
Alpha-adrenergic blockers - Agents with greater
Agents with greater selectivity have fewer systemic SE but are associated with a higher frequency of retrograde or anejaculation (8 to 28 percent).
Alpha-adrenergic blockers patietns
prescribed alpha-1adrenergicblockers should be counseled about the possibility of intraoperative floppy iris syndrome (IFIS).
Phosphodiesterase type 5 inhibitors - used in men with
Used in men with BPH-related symptoms and ED
Phosphodiesterase type 5 inhibitors reproted adverse
Reported adverse effects with PDE5 inhibitors are relatively rare, with the more commonly reported effects consisting of headache, flushing, dyspepsia, nasal congestion, back pain, myalgias, and sinusitis.
Phosphodiesterase type 5 inhibitors there is an increased risk of
hypotension in patients also using certain alpha-adrenergic blockers
In men with low post-void residual urine volumes
and irritative symptoms, anticholinergics or beta-3 agonists are a reasonable alternative to alpha-1 adrenergic antagonists for initial medical therapy
In men with demonstrated benign prostatic enlargement (BPE), treatment with
In men with demonstrated benign prostatic enlargement (BPE), treatment with
For patients with low post-void residual urine
volumes and irritative symptoms (eg, frequency, urgency) that persist during monotherapy with an alpha-1 adrenergic antagonist or anticholinergic agents, we use combination treatment with alpha-1 adrenergic antagonists and anticholinergic agents or beta-3 agonists
