Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Endo/Eye/Derm - Women/Men > EXAM 2 Urinary Incontinence and Pregnancy Dr. Dowling > Flashcards

EXAM 2 Urinary Incontinence and Pregnancy Dr. Dowling Flashcards

You may prefer our related Brainscape-certified flashcards:
Dermatology Board Prep flashcards
1
Q

What is the first-line treatment for urinary incontinence?

A

Nonpharmacolgic treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Second-line treatment for urge incontinence

A

Antimsucarinics

beta-3 agonists

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Second-line treatment for stress incontinence

A

-Duloxetine (SSRI)
-topical estrogen
-alpha agonists

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Types of Urinary Incontinence

A

-Urge Urinary Incontinence (UUI): the bladder is to reactive to urine, smooth (detrusor) muscle contract -> urge
-> symptom of overactive bladder

-StressUrinary Incontinence (SUI)
-> involuntary leakage during exertion (sneezing, coughing)

-Overflow Incontinence (OI)
-> incomplete emptying of bladder -> leads to frequent loss of urine

-Mixed Incontinence: Combi of UUI, SUI, OI

-Functional Incontinence
-> result of decreased mobility or low physical functioning -> decreased awareness of signals to urinate (cognitive issue or immobility), the body doesn’t recognize the signals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which muscle of the bladder is involved in urge urinary incontinence

A

detrusor smooth muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which structure of the urinary system is involved in stress urinary incontinence (SUI)?

A

Urethra

the structure that keeps urine in place before voiding is weakened -> loss of urine due to abdominal pressure (sneezing, coughing, laughing)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Which type of urinary incontinence is a consequence of BPH?

A

Overflow Incontinence (OI)

patients cant void completely -> over time urine accumulates in the bladder and breaks through the urethra -> Overflow -> continuous or frequent loss of a stream of urine during daily activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Do we see Overflow Inncontinece in man or women?

A

In men: due to enlarged prostate -> causing incomplete emptying

maybe seen in women: physiologic effect or medical side effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How do the muscles of the bladder and the urethra behave before voiding?

A

Bladder: relaxed

Urethra: contracted and closed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How do the muscles of the bladder and the urethra behave in urgency incontinence?

A

Bladder contracts , inappropriate signals (may be too early)

the urethra is still closed -> but the contraction pushes the urine out

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How do the muscles of the bladder and the urethra behave in stress continence?

A

Bladder: relaxed

the urethra is not restricted as is should be –> leakage (drops) of urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What might contribute to a weakening of the urethra?

A

in women: childbirth, trauma over time

in men: prostate surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How do alpha-receptor agonists cause urine incontinence?

A

Urethral contraction

-> urinary retention (more common in men)
-> overflow incontinence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How do alpha-receptor antagonists cause urine incontinence?

A

Urethral relaxation -> stress incontinence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

In which disease state are alpha-antagonists beneficial?

A

BPH

-alpha-blocker (Tamsulosin)
-5-alpha reductase inhibitor (finasteride)
-PDE-4 inhibitor (Tadalafil)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which drugs cause reduced bladder contractility resulting in urinary retention?

A

side-effect induced reduction in bladder contractility
-Calcium channel blocker
-Narcotic analgesics
-Antipsychotics

effect of reduction in bladder contractility used for treatment in disease states
-Anticholinergics
-beta-3 agonist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which drug may cause Urethral relaxation and reduced bladder contractility at the same time?

A

TCA

alpha antagonist effect: urethral relaxation (stress incontinence)
anticholinergic effect: reduced bladder contractility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Which drugs cause Polyuria resulting in urgency and frequency?

A

-diuretics
-alcohol

-acetylcholinesterase inhibitors
-> (bind to muscarinic receptors -> inducing contraction of detrusor muscles, also activating parasympathetic nervous system by inhibiting ACh esterase (more ACh)

19
Q

How do sedative hypnotics affect urinary incontinence?

A

Delirium
immobility -> may cause functional incontinence

caution with the use of: benzos, zolpidem (ambien), lunesta

20
Q

How does an ACEi cause urinary incontinence?

A

Cough as a side effect of ACEi
-> stress incontinence

21
Q

Which drugs are used in the treatment of overactive bladder (UUI)?

A

(drugs are 2nd line)
-antimuscarinics
-beta-3 agonists
-oxybutynin patch or gel

use extended-release if possible (lower anticholinergic ADE: dry mouth, dry eyes, constipation…)

22
Q

Which receptor is responsible for bladder contractility and is a drug target for antimuscarinics in the treatment of overactive bladder?

A

M3 receptors

but also located in salivary glands, lower bowl, ciliary smooth muscle

23
Q

The blockage of which muscarinic receptors will cause CNS side effects?

A

M1 receptor

Antimuscarinics may not M-receptor specific

-> ADE: dry mouth, dizziness, constipation, blurred vision, urinary retention

24
Q

When are antimuscarinics contraindicated?

A

patients with:
-hypersensitivity
-urinary retention
-narrow-angle glaucome

25
Q

Name the antimuscarinics

A

Oxybutynin (Ditropan, Oxytrol, Gelnique)
Tolterodine (Detrol)

Darifenacin (Enablex)
Solifenacin (Vesicare)
Fesoterodine (Toviaz)

Trospium chloride (Sanctura)

!know Brand names!

26
Q

Where does oxybutinin act in UI treatment?

A

decreases the contraction of the smooth muscle in the bladder

decreases urgency and frequency
but increases urinary retention (more storage, may be a disadvantage in BPH)

27
Q

Special population to be cautios

A

-elderly due to side effects (note this is also the population that suffers from urinary incontinence)

-renal and hepatic impairments - may need dose adjustments

28
Q

How should antimuscarinics be titrated

A

slowly

IR: every 1-2 months
ER: Weekly

29
Q

Which formulation is associated with fewer side antimuscarinic side effects?

A

ER formulation

30
Q

How does Tropium chloride different from other antimuscarinics?

A

-doesnt penetrate the BBB as easy
-no CYP metabolism -> less side effects

31
Q

MOA of beta-3 agonists

A

REMEMBER: alpha-blocker cause contraction of detrusor muscle

beta-3 agonist increases sympathetic action and causes detrusor relaxation -> increased bladder storage

32
Q

What are the used beta-3 agonists

A

-begrons

Mirabegron ER (Myrbetriq)
ADE: HTN, headache, urinary retention, UTI, nasopharyngitis
-> CYP2D6 inhibitor

Vibegron (Gemtesa)
diarrhea, nausea, headache, urinary retention, UTI, nasopharyngitis

33
Q

What is the first line treatment for stress-induced incontinence?

A

Pelvic Floor muscle training PFMT (Kegel excercises) for at least 3 months

34
Q

2nd line treatment for SUI

A

Duloxetine (off-label)
topical/intravaginal estrogen
alpha agonist
surgery

35
Q

How does Duloxetine work in incontinence therapy?

A

increases sphincter muscle tone
-> redused frequency of episodes of incontinence

-ADE: nausea, some increase in BP

36
Q

How does estrogen work in incontinence therapy?

A

manage post-menopausal and estrogen withdrawal symptoms
-> Strength of the urethra decreases with menopause

topical creams, vaginal ring, vaginal inserts works best (oral estrogen may make it worse)

37
Q

How long should vaginal topicals be used?

A

topical: Vagifem

daily for 2 weeks
then once weekly

should only be used in patients with menopausal-induced continence

38
Q

How do Alpha agonists work in UR treatment?

A

increases urethral closure pressure
-moderate efficacy and many ADE

ADE: HTN, headache, dry mouth, nausea, insomnia, restlessness

39
Q

What type of incontinence is involved in patients taking zolpidem or benzos and having incontinence only at night?

A

Functional incontinence

it seems like the sedative-hypnotics prevents them from waking when they need to urinate
-> consider D/C the hypnotic and change the drug

40
Q

A 50 yo female patient experiences urine leakage when coughing, what is the recommended treatment?

A
  1. Pelvic Floor muscle training PFMT, if it fails ->
  2. evalutae for menopause -> estrogen topical
  3. Duloxetine (SNRI)

alpha-agonist: moderate efficacy - last line

41
Q

A 48 yo female experiences urinating at night and daytime, losing large amounts of urine before reaching the toilet

A

Urgent urinary incontinence -> overactive bladder (too much contraction of detrusor muscle)

treatment:
antimuscarinics or beta-3 agonists

42
Q

What are concerns when using antimuscarinics and how to mitigate them?

A

age (elderly)
-dry mouth, constipation, dizzines, urinary retention

-use topical oxybutynin to mitigate the side effects

43
Q

What are concerns when using beta-3 agonists and how to mitigate them?

A

-begrons; Mirabegron, Vibegron

HTN, urinary retention, UTI, nasopharyngitis

Endo/Eye/Derm - Women/Men (30 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions