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PHRM 844 Therapeutics > Exam 4 - Geriatrics > Flashcards

Exam 4 - Geriatrics Flashcards

1
Q

most common type of urinary incontinence

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

A

c. urge

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2
Q

which receptors support detrusor relaxation/filling?

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

A

e. beta 3

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3
Q

what muscle squeezes the bladder to release urine?

A

detrusor muscle

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4
Q

urge incontinence is also known as __________ __________

A

overactive bladder

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5
Q

which type of incontinence is described below?

-urethral blockage
-bladder unable to empty properly

a. urge
b. stress
c. overflow

A

c. overflow

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6
Q

which type of incontinence is described below?

-relaxed pelvic floor
-inc abdominal pressure

a. urge
b. stress
c. overflow

A

b. stress

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7
Q

which type of incontinence is described below?

-bladder oversensitivity from infection
-neurological disorders

a. urge
b. stress
c. overflow

A

a. urge

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8
Q

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

A

detrusor
ACh
alpha-adrenergic
sphincter

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9
Q

causes of urge urinary incontinence (2)

A

-neurological
-medications

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

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10
Q

symptoms of urge incontinence (2)

A

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

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11
Q

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

a. urge
b. stress
c. overflow

A

a. urge

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12
Q

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

a. overflow
b. stress
c. urge

A

b. stress

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13
Q

does stress incontinence occur more in women or men?

A

women

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14
Q

risk factors of stress incontinence (2)

A

-multiple childbirths
-estrogen deficiency

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15
Q

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

A

alpha-antagonists

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16
Q

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

A

caffeine and alcohol

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17
Q

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

a. urge
b. overflow
c. stress

A

b. overflow

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18
Q

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

A

BPH

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19
Q

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

A

c. overflow

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20
Q

what is neurogenic (atonic) bladder?

A

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)

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21
Q

what is functional incontinence?

A

inability to get to the bathroom in a timely fashion

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

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22
Q

what drugs can inc frequency of bladder? (2)

A

diuretics
alpha antagonists

23
Q

what drug class can cause urge incontinence?

A

acetylcholinesterase inhibitors

24
Q

what drug classes can cause overflow incontinence? (2)

A

alpha antagonists and antihistamines

(alpha antagonist ex. terazosin, tamsulosin)

25
Q

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

A

true

26
Q

oxybutynin, tolterodine, solifenacin, darifenacin, trospium, fesoterodine, mirabegron (Myrbetriq), and vibegron (Gemtesa) can be used to treat which incontinence?

a. urge
b. stress
c. overflow

A

a. urge

27
Q

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

A

4 weeks

28
Q

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

A

false (this can worsen accidents/episodes)

29
Q

how does duloxetine 40 mg BID help stress urinary incontinence?

A

increases sphincter tone to prevent leaks

30
Q

stress urinary incontinence medications (4 of them)

A

-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)

31
Q

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

A

21 days on, 7 days off

32
Q

what medication class can be used for overflow UI?

A

alpha-adrenergic blockers (if BPH)

(doxazosin or tamsulosin)

33
Q

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

A

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

34
Q

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

A

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

35
Q

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

A

neurogenic

36
Q

what is augmentation cystoplasty?

A

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

37
Q

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

A

UTIs
kidney stones

38
Q

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

A

dry mouth, constipation

(can’t see, can’t spit, can’t pee, can’t shit)

39
Q

review efficacy of drugs for UI after ___ to ___ weeks

A

4 to 8

40
Q

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

A

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

41
Q

physiological changes associated with aging:

_____ baroreceptor response/activity
_____ heart rate variability

A

dec
reduced

42
Q

PK changes with aging:

___ Vd and ___ conc of water-soluble drugs (atenolol)

A

dec; inc

43
Q

PK changes with aging:

___ Vd and ___ T1/2 of lipid-soluble drugs (rifampin)

A

inc; inc

44
Q

PK changes with aging:

___ clearance and ___ T1/2 of most hepatically-cleared drugs (propanolol)

A

dec; inc

45
Q

PK changes with aging:

___ clearance and ___ T1/2 of most renally-cleared drugs (atenolol)

A

dec; inc

46
Q

advanced care directives include what 3 things?

A

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

47
Q

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)

A

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

48
Q

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)

A

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

49
Q

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)

A

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

50
Q

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

A

preferences for resuscitation

51
Q

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

A

medical interventions (intubation, dialysis, hospitalization)

52
Q

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

A

antibiotics

53
Q

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

A

artificial nutrition

PHRM 844 Therapeutics (28 decks)

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