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Renal Week 3 > Bladder Function and Pharmacology > Flashcards

Bladder Function and Pharmacology Flashcards

1
Q

What anticholinergics are commonly used in in diseases of bladder function?

A
  • Darifenacin
  • Fesoterodine
  • Oxybutynin
  • Solifenacin
  • Tolterodine
  • Trospium
  • Botulinum Toxin
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2
Q

What Sympathomimetics are commonly used in diseases of Bladder function?

A
  • Mirabegron
  • Pseudoephedrine
  • Ephedra, Ma Huang
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3
Q

What Ancillary drugs are commonly used in disease of Bladder function?

A
  • Methionine

* Bovine Collagen Implant

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4
Q

What drugs are used in the Management of Urinary Retention?

A
  • Bethanechol
  • Neostigmine
  • Methylnaltrexone
  • Naloxone
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5
Q

In what type of incontinence would you use antimuscarinic drugs?
• how do they work?
• Name them.

A

Use for:
• URGE incontinence

*these work by BLOCKING the M3 receptor that stimulates the bladder (detrussor) to contract

  • Darifenacin
  • Fesoterodine
  • Oxybutynin
  • Solifenacin
  • Tolterodine
  • Trospium
  • Botulinum Toxin
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6
Q

In what type of incontinence would you use cholinomimetic drugs?
• how do they work?
• Name them.

A

Opiate Induced Urinary Retention is treated with Cholinoimetics

Bethanecol

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7
Q

In what type of incontinence would you used Alpha-agonist drugs?
• how do they work?
• Name them.

A

Use for:
• STRESS incontenence

*these work by AGONIZING ß3 causing relaxation of the detrussor and AGONIZING alpha-1 to stimulate internal urethral sphincter contraction

Drugs:
• Mirabegron
• Ephedra
• Pseudoephedra

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8
Q

Explain the mechanism of action of Botox.

A

Botox blocks SNAREs are prevents ACh release

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9
Q

Explain the mechanism of action of methionine.

A

Creates AMMONIA FREE urine by acidifying urine pH

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10
Q

Explain the mechanism of action of collagen.

A

Helps to support the external urethral sphincter

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11
Q

What is opiate-induced urinary retention and how is it treated clinically?

A

Opiate Induced Urinary Retention is treated with Cholinoimetics

Bethanecol

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12
Q

What is the action of the M3 receptor stimulation on the bladder?
• neurotransmitter used?
• Nerve that secretes it?

A

Pelvic n. uses Ach to stimulated M3 can cause BLADDER CONTRACTION

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13
Q

What is the action of ß3 receptor stimulation on the bladder?
• Neurotransmitter used?
• Nerve that secretes it?

A

Hypogastric n. releases NE to simulate SMOOTH MUSCLE RELAXATION

• Don’t want to have to pee while you’re trying to fight

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14
Q

What is the action of Alpha-1 receptors stimulation on the bladder?
• Neurotransmitter used?
• Nerve that secretes it?

A

Hyopgastric n. releases NE to simulate URETHRAL CONTRACTION

• again keeps you from peeing while fighting

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15
Q

What is the action of the nicotinic receptor stimulation on the urethra?
• Neurotransmitter used?
• Nerve that secretes it?

A

Pudendal n. acts at UG diaphragm to release Ach causing Contraction of the External Urethral Spincter

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16
Q

What are the most commonly prescribed drugs for urinary incontinence?

A

Antimuscarinic Drugs

• Tolterodine and Oxybutynin

17
Q

What is the 1st line of care in people with urinary incontinence?

A

Behavioral Therapy, Pt. education, fluid management, bladder retraining, Pelvic floor exercises

Bottom line is there is a lot you want to do before starting someone on drugs because of side effects

18
Q 
Where do the following drugs act: 
• Darifenacin
• Oxybutynin
• Trospium 
• Tolterodine
  • what receptor do they act on?
    • Key feature of each?
A

Non-Selective Muscarinic Antagonists

Once daily Dosing:
• Darifenacin
• Oxybutyrin

Neglible CYP metabolism:
• Trospium

Extended release Availability:
• Tolterodine
• Oxybutyrin

19
Q

What is the point of giving muscarinic drugs that are extendend release?
• which two have this availability?

A

Extended Release:
• Tolterodine
• Oxybutyrin

Reduces the MAJOR MUSCARINIC ANTAGONIST side effect of DRY MOUTH

20
Q

What is the most common reason for people to stop using Muscarinic Receptor Therapy?
• Name the drugs used in this therapy?

A

DRY MOUTH

Drugs: 
• Darifenacin
• Trospium
• Oxybutynin
• Tolterodine
21
Q

What adverse effects should you monitor in someone taking muscarinic antagonists?
• Name Them.

A
  • Urinary Retention
  • CV effects - may include palpitations, tachycardia, prolonged QT interval
  • GI effects - Mild constipation to severe obstruction
Drugs: 
• Darifenacin
• Trospium
• Oxybutynin
• Tolterodine
22
Q

In what patients should you Monitor Urinary Retention especially closely in?

A

• People with BPH

Drugs:
• Darifenacin
• Trospium
• Oxybutynin 
• Tolterodine
23
Q

What are the contraindications for Muscarinic Antagonist use?

A
  • Angle Closure / Narrow Angle Glaucoma
  • Urinary and Gastric Obstruction
  • Need for mental alertness
  • Alzheimer’s type Dementia
24
Q

Why might someone want to use Botox to treat Urinary incontinence?
• who is it most effective in?

A
  • Benefit is long lasting, lasts for several months

* Botox - most effective in patients who responded to anticholinergics but couldn’t tolerate the adverse effects

25
Q

Botox

• MOA

A
  • Inhibits Afferent Cholinergic Impulses by inhibiting SNARE-complex-dependent proteins
  • Phenotypic change in SUBurothelial tissue to ablate the excitatory effect of local chemical mediators
26
Q

Where do the following drugs act?
• Mirabegron
• Pseudoephedrine
• Ephedra, Ma Huang

*how does mirabegron differ from the others?

A

These drugs agonize ß3 and alpha 1 receptors to relax bladder and contract internal urethral sphincter respectively

How is Mirabegron different?
• long acting drug that undergoes extensive hepatic metabolism
• others are minimally broken down and are shorter acting

27
Q

What is a common side effect to all of the sympathomimetic drugs used in urinary incontinence?
• name the drugs.

A

Drugs:
• Mirabegron
• Ephedra
• Pseudoephedra

Side Effect: 
SYMPATHETIC STIMULATION
• HTN
• Tachycardia-Tachyarrythmia 
• Anxiety - Restlessness - nervousness - insomnia
28
Q

Methionine
• MOA
• Administration
• use in urinary incontence

A

Makes yo Piss Stank-less
• Controls odor, dermatitis, and ulceration

• Take with Food, Milk, or other liquid

MOA:
• Creates Ammonia-Free urine by acidifying urine pH

29
Q

Bovine Collagen
• MOA
• Who is it used for?
• Interactions?

A

MOA:
• Injected into the submucosal tissue of urethra and/or bladder neck
• Forms a soft cohesive network of Fibers around Urethral Lumen

Interactions:
• Don’t give with IMMUNOSUPPRESIVE therapy or CORTICOSTEROIDS

30
Q

Bovine Collagen

What are some adverse rxns?

A
  • Urinary Retention
  • Hematuria
  • Injection Site Rxn
  • Worsening Incontinence
  • Erythema
  • Urticaria
  • Abscess formation
31
Q

What drugs are used to MAKE YOU PEE MORE?
(in urinary retention)
• what do these drugs act on?
• Administration frequency?

A

Bethanechol - MUSCARNIC agonist

Neostigmine - Acetylcholinesterase inhibitor

**Both of these drugs must be administered several times per day

32
Q

Bethanechol
• MOA
• Adverse Effects

A

MOA:
• CHOLINESTERASE-RESISTANT muscarinic agonist

ADVERSE EFFECTS: 
CV - lightheadedness, syncope
GI - Diarrhea, stomach cramps
Neurologic - dizziness
Opthalmic - Excessive tear production, miosis
33
Q

Neostigmine
• MOA
• Adverse Effects

A

MOA:
• Acetylcholinesterase Inhibitor

Adverse Effects: 
• AV block, Brady-arrhythmia
• Cardiac Arrest, Cardiac Dysrythmia
• HypOtension, Syncope
• Tachycardia
34
Q

Opiate Adverse Effects on Urination

• how do we manage these problems in people who need to take opiates chronically?

A

Opiate Effects:
• Mu (µ) and Delta (∆) receptors are acted on in sacral cord inhibiting parasympathetic OUTFLOW
• DETRUSSOR doesn’t get activated

Management:
• Opiate Antagonists
• Bethanechol

35
Q

Which of the anticholenergic drugs are M3 specific?

A

• M3 specific = Darifenacin –> no obvious benefit to this specificity

Renal Week 3 (16 decks)

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