Chapter 52: Urinary Incontinence Flashcards
Urge incontinence is associated with
Neuropathy
What is stress incontinence
Urine leaks out during any form of exertion
What is the most common cause of overflow incontinence
BPH
The detrusor muscle is innervated mainly by the ___ nervous system
parasympathetic (Ach acts on muscarinic receptors)
Which receptor is responsible for both emptying contractions as well as involuntary bladder contractions
M3
Risk factors for overactive bladder
Age > 40 years
Diabetes
Prior vaginal delivery
Drugs that increase incontinence
First-line to improve overactive bladder symptoms
Behavioral therapies (pelvic floor muscle exercises - Kegel exercises)
First-line drugs for urge/mixed incontinence
Anticholinergics (e.g., oxybutinin)
B3 receptor agonist (i.e., mirabegron)
Which formulation of anticholinergics are preferred for OAB
ER due to a lower risk of dry mouth
Anticholinergics should be avoided in
elderly 65+ due to risk of delirium and cognitive impairment (BEERS criteria)
Oxybutinin XL brand name
Ditropan CL
Oxybutinin patch brand name
Oxytrol
How often is oxybutinin patch applied
twice weekly
Tolterodine brand name
Detrol
How should trospium be taken
on empty stomach
Solifenacin brand name
Vesicare
Anticholinergic CI
narrow angle glaucoma
Anticholinergic warnings
agitation, confusion, drowsiness, blurred vision
Anticholinergic SE
dizziness, drowsiness (greatest with oxybutinin), xerostomia, constipation, dry mouth, dry eyes, blurred vision, urinary retention, sedation, cognitive impairment
Ditropan XL counseling point
OROS formulation - ghost tablet
Oxybutinin patch and gel cause less
dry mouth
Which anticholinergic is also available OTC
oxybutinin patch
Which drug has a lower incidence of dry mouth and can be used in patients who cannot tolerate anticholinergics
Mirabegron
Mirabegron MOA
relaxes detrusor muscle and increases bladder capacity by activating B3 receptors
