Exam 4 - Geriatrics

Question 1

most common type of urinary incontinence

a. stress
b. overflow
c. urge
d. mixed

Answer 1

c. urge

Question 2

which receptors support detrusor relaxation/filling?

a. alpha 1
b. alpha 2
c. beta 1
d. beta 2
e. beta 3

Answer 2

e. beta 3

Question 3

what muscle squeezes the bladder to release urine?

Answer 3

detrusor muscle

Question 4

urge incontinence is also known as __________ __________

Answer 4

overactive bladder

Question 5

which type of incontinence is described below?

-urethral blockage
-bladder unable to empty properly

a. urge
b. stress
c. overflow

Answer 5

c. overflow

Question 6

which type of incontinence is described below?

-relaxed pelvic floor
-inc abdominal pressure

a. urge
b. stress
c. overflow

Answer 6

b. stress

Question 7

which type of incontinence is described below?

-bladder oversensitivity from infection
-neurological disorders

a. urge
b. stress
c. overflow

Answer 7

a. urge

Question 8

normal bladder function:
1. stretch receptors notify brain that bladder is full and needs to be emptied
a. B3 receptors support _______ relaxation/filling
2. neurological stimulation initiates contraction
a. _____ receptor in the dome
b. _____ receptors in the base and proximal urethra
3. _____ relaxes allowing release of urine

Answer 8

detrusor
ACh
alpha-adrenergic
sphincter

Question 9

causes of urge urinary incontinence (2)

Answer 9

-neurological
-medications

(ex. of medication: acetylcholinesterase inhibitors for Alzheimer’s)

Question 10

symptoms of urge incontinence (2)

Answer 10

-urgency (unpredictable or unable to control)
-frequency (excessive feelings of urination)

Question 11

which type of urinary incontinence is caused hyperactivity of detrusor muscle causing sudden and poorly predictable voiding?

a. urge
b. stress
c. overflow

Answer 11

a. urge

Question 12

which type of urinary incontinence is caused by outlet incompetence (external urethral sphincter) with abdominal pressure?

a. overflow
b. stress
c. urge

Answer 12

b. stress

Question 13

does stress incontinence occur more in women or men?

Answer 13

women

Question 14

risk factors of stress incontinence (2)

Answer 14

-multiple childbirths
-estrogen deficiency

Question 15

stress incontinence can be exacerbated or caused by what class of drugs?

Answer 15

alpha-antagonists

Question 16

stress incontinence’s symptoms (small volume urine loss) is classically associated with

Answer 16

caffeine and alcohol

Question 17

which incontinence results from outlet obstruction or inability to or uncoordinated detrusor constriction?

a. urge
b. overflow
c. stress

Answer 17

b. overflow

Question 18

overflow incontinence is most commonly from ___ or prostatic blockage of urethra

Answer 18

BPH

Question 19

abdominal discomfort or pain, frequency, and feeling the need to void shortly after voiding are symptoms of which urinary incontinence?

a. urge
b. stress
c. overflow

Answer 19

c. overflow

Question 20

what is neurogenic (atonic) bladder?

Answer 20

disruption in neurologic innervation of the bladder and inability or uncoordinated detrusor constriction

(basically urinary problems due to brain, spinal cord, or nerve problems; a bladder whose muscles don’t fully contract)

Question 21

what is functional incontinence?

Answer 21

inability to get to the bathroom in a timely fashion

(caused by physical impairment, dementia, UTI, sedating medications, etc)

Question 22

what drugs can inc frequency of bladder? (2)

Answer 22

diuretics
alpha antagonists

Question 23

what drug class can cause urge incontinence?

Answer 23

acetylcholinesterase inhibitors

Question 24

what drug classes can cause overflow incontinence? (2)

Answer 24

alpha antagonists and antihistamines

(alpha antagonist ex. terazosin, tamsulosin)

Question 25

true or false: pelvic floor muscle strengthening (Kegels) can be done to help urinary incontinence

Answer 25

true

Question 26

oxybutynin, tolterodine, solifenacin, darifenacin, trospium, fesoterodine, mirabegron (Myrbetriq), and vibegron (Gemtesa) can be used to treat which incontinence? a. urge b. stress c. overflow

Answer 26

a. urge

Question 27

for urge incontinence management, medications take how many weeks to see benefit?

Answer 27

4 weeks

Question 28

true or false: for urge incontinence, we can stop medications whenever we feel like it

Answer 28

false (this can worsen accidents/episodes)

Question 29

how does duloxetine 40 mg BID help stress urinary incontinence?

Answer 29

increases sphincter tone to prevent leaks

Question 30

stress urinary incontinence medications (4 of them)

Answer 30

-duloxetine 40 mg BID -topical estrogen (vaginal atrophy) -alpha-agonists (rare -pseduophed) -vaginal pessaries or surgery (vaginal pessaries are removable device inserted in vagina that used to treat UI or prolapse)

Question 31

when using topical estrogen for stress UI, how many days on and off should it be used?

Answer 31

21 days on, 7 days off

Question 32

what medication class can be used for overflow UI?

Answer 32

alpha-adrenergic blockers (if BPH) (doxazosin or tamsulosin)

Question 33

why is tamsulosin better than doxazosin for overflow UI management? (2 reasons)

Answer 33

-slightly more selective for bladder neck subtypes of alpha receptors -less hypotension

Question 34

true or false: for neurogenic UI, there is no pharmacological management that is routinely effective

Answer 34

true (focus on non-pharm, such as scheduled voiding)

Question 35

Intermittent catheterization, Botox injections or surgery can be used for which type of incontinence?

Answer 35

neurogenic

Question 36

what is augmentation cystoplasty?

Answer 36

surgery for neurogenic UI, where bladder walls and intestinal walls are connected to improve storage capacity

Question 37

neurogenic (atonic) bladder has increased risks of _____ and _____ _____

Answer 37

UTIs kidney stones

Question 38

main adverse effects of anticholinergics for urge UI (examples of drugs are oxybutynin, tolterodine, solifenacin)

Answer 38

dry mouth, constipation (can't see, can't spit, can't pee, can't shit)

Question 39

review efficacy of drugs for UI after ___ to ___ weeks

Answer 39

4 to 8

Question 40

atony of bladder muscle can be caused by what 3 things (from lecture)?

Answer 40

-stroke -neuropathy (including severe uncontrolled diabetes) -spinal cord injury

Question 41

physiological changes associated with aging: _____ baroreceptor response/activity _____ heart rate variability

Answer 41

dec reduced

Question 42

PK changes with aging: ___ Vd and ___ conc of water-soluble drugs (atenolol)

Answer 42

dec; inc

Question 43

PK changes with aging: ___ Vd and ___ T1/2 of lipid-soluble drugs (rifampin)

Answer 43

inc; inc

Question 44

PK changes with aging: ___ clearance and ___ T1/2 of most hepatically-cleared drugs (propanolol)

Answer 44

dec; inc

Question 45

PK changes with aging: ___ clearance and ___ T1/2 of most renally-cleared drugs (atenolol)

Answer 45

dec; inc

Question 46

advanced care directives include what 3 things?

Answer 46

-health care representative -psychiatric advance directive -power of attorney (POA)

Question 47

health care representative a. sets preferences re: mental illness during periods of incapacity b. financial or health care grants power to others you choose c. names someone to make decisions if you are unable (or prevents someone from making decisions for you)

Answer 47

c. names someone to make decisions if you are unable (or prevents someone from making decisions for you)

Question 48

psychiatric advance directive a. sets preferences re: mental illness during periods of incapacity b. financial or health care grants power to others you choose c. names someone to make decisions if you are unable (or prevents someone from making decisions for you)

Answer 48

a. sets preferences re: mental illness during periods of incapacity

Question 49

power of attorney a. sets preferences re: mental illness during periods of incapacity b. financial or health care grants power to others you choose c. names someone to make decisions if you are unable (or prevents someone from making decisions for you)

Answer 49

b. financial or health care grants power to others you choose

Question 50

physician orders for scope of treatment (POST): what is in section A?

Answer 50

preferences for resuscitation

Question 51

physician orders for scope of treatment (POST): what is in section B?

Answer 51

medical interventions (intubation, dialysis, hospitalization)

Question 52

physician orders for scope of treatment (POST): what is in section C?

Answer 52

antibiotics

Question 53

physician orders for scope of treatment (POST): what is in section D?

Answer 53

artificial nutrition