Chapter 52: Urinary Incontinence Flashcards
Urinary urgency
a sudden feeling of needing to urinate
urinary incontinence
involuntary leakage of urine
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
Overactive Bladder (OAB) cause
inappropriate stimulation of the muscarinic receptors on the detrusor muscle causing involuntary contractions and the feeling of urinary urgency
The detrusor muscle is innervated mainly by the ___ nervous system
parasympathetic (Ach acting on muscarinic receptors)
Which receptor is responsible for both emptying contractions as well as involuntary bladder contractions
M3
M2 and M3 on the bladder in 3:1 ratio
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), avoiding caffeine, fluid management, weight loss
First-line drugs for urge/mixed incontinence
Anticholinergics (e.g., oxybutynin)
B3 receptor agonist (i.e., mirabegron)
OnabotulinumtoxinA (Botox) high efficacy, very expensive so not 1st line
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 ER brand name
Ditropan XL
Oxybutinin patch brand name
Oxytrol
How often is oxybutinin patch applied
twice weekly
Tolterodine brand name
Detrol/ Detrol LA
How should trospium be taken
on empty stomach
Solifenacin brand name
Vesicare
Anticholinergic CI
uncontrolled 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
beta-3 receptor agonist that causes relaxation of the detrusor muscle (prevents contraction)
Mirabegron warning
urinary retention
Mirabegron SE
HTN
Which drug is used for nocturia
desmopressin (ADH analog)
Desmopressin MOA
temporarily decreases urine production (ADH analog)
Desmopressin BW
severe hyponatremia (life-threatening)
Desmopressin CI
fluid retention
Desmopressin monitoring
serum Na
