Ge Flashcards
State the treatment of urgency incontinence in women:
Women should be offered bladder training for at-least 6 weeks as first line treatment
Oxybutynin, tolterodine or darifenacin can be used after bladder training has been done
Mirabegron second line
State the treatment of stress incontinence:
Women should trial supervised pelvic floor muscle training for at least 3 months which should include at least 8 contractions performed 3 times per day
Note: duloxetine is not recommended as first line treatment for women with stress incontinence, however it may be used a second line treatment where pelvic floor training has failed
How do antimuscarinic drugs help in urinary frequency and incontinences?
Reduce symptoms of urgency and urge incontinence and increase bladder capacity
How does oxybutynin work?
Has a direct relaxant effect on urinary smooth muscle
What is the monitoring requirement for antimuscarinic drugs?
Every 4-6 weeks until symptoms stabilise and then every 6-12 months
Which TCA can cause cardiac side effects?
Imipramine
What is mirabegron and what is it used for?
Beta3 agonist and is used with overactive bladder
What is the non-drug treatment for nocturnal enuresis?
Enuresis alarm
The bedwetting alarm is made to go off at the first sign of moisture. The alarm will play sounds when it goes off. Some of the alarms will also vibrate
What is the drug treatment for nocturnal enuresis?
Oral/SL desmopressin (5+) when alarm use is inappropriate or undesirable.
Assessed after 4 weeks and continued for 3 months
Desmopressin + oxybutynin/tolterodine (unlicensed) under specialist care and treatment continued for 3 months
Imipramine under specialist care
What is a side effect of desmopressin?
Hyponatraemic convulsions
What advice would you give for patients treated for primary nocturnal enuresis?
Avoid fluid overload - including during swimming
Restrict fluid intake 1 hour before and 8 hours after desmopressin Stop desmopressin in vomiting/diarrhea and avoid in drugs that increase vasopressin secretion i.e., TCAs
State some side effects of antimuscarinics?
Constipation, tachycardia, dry mouth, dyspepsia, dizziness, headache, vomiting, vision disorders, urinary disorders
What are the dose adjustments due to interactions for solifenacin?
Maximum is 5 mg once daily with concurrent use of potent inhibitors of CYP3A4
Maximum 5 mg daily if egfr is less than 30 ml
Solifenacin is a medicine used to treat symptoms of an overactive bladder. These can include: a sudden and urgent need to pee (urinary urgency) needing to pee more often than usual (urinary frequency
it is an antimuscarinic
There are other antimuscarinics that can be used for overactive bladder: oxybutynin. tolterodine.
potent inhibitors of CYP3A4 include: Clarithromycin. Diltiazem. Erythromycin. Fluconazole. Grapefruit juice.
Itraconazole.
Ketoconazole.
Posaconazole. Voriconazole. Verapamil.
What is the treatment of acute urinary retention?
Alpha-adrenoreceptor blocker should be given for at-least 2 days
Acute retention is painful and requires immediate treatment by catheterisation.
Before the catheter is removed an alpha-adrenoceptor blocker (such as alfuzosin hydrochloride, doxazosin, tamsulosin hydrochloride, prazosin, indoramin or terazosin) should be given for at least two days to manage acute urinary retention .
Acute urinary retention is a medical emergency characterised by the abrupt development of the inability to pass urine (over a period of hours).
Chronic urinary retention is the gradual (over months or years) development of the inability to empty the bladder completely, characterised by a residual volume greater than one litre or associated with the presence of a distended or palpable bladder.
What drug increases detrusor muscle contraction?
Bethanechol chloride
Detrusor muscle contraction is when the muscle in the bladder wall squeezes, pushing urine out of the bladder. It’s what makes you feel the urge to pee and helps you empty your bladder.
State the treatment of acute urinary retention in a man:
Alpha-blocker, modified release alfusozin 10 mg a day in men over 65 years of age
What is the treatment of benign prostatic hyperplasia?
Alpha-blocker, alfuzosin, doxazosin, tamsulosin or terazosin
andfor moderate to severe voiding symptoms: give 5a-reductase inhibitor
(finasteride/dutasteride): given in patients with an enlarged prostate, raised prostate specific antigen concentration, those considered at high risk of progression i.e., elderly
Alpha-blocker + 5a reductase inhibitor if symptoms are bothersome moderate to severe voiding symptoms and prostatic enlargement
Benign prostatic hyperplasia (BPH) is when the prostate gland, which is below the bladder in men, becomes bigger than normal. This can squeeze the urethra, making it harder to pee and causing symptoms like frequent urination or trouble starting urination. It’s common as men age.
Severe voiding symptoms refer to significant difficulties or problems experienced during urination
State some common side effects of alpha-blockers?
Postural hypotension, dizziness, blurred vision, tachycardia, palpitations, dry mouth
What are the counselling points for alpha-blockers?
Take first dose at night due to risk of possible first-dose postural hypotension
What is mirabegron contra-indicated in?
Severe high uncontrolled high blood pressure > 180 / > 110
What are the conception and contraception advice whilst taking mirabegron as a female?
Contraception advised in women of child-bearing potential
What should be monitored whilst taking mirabegron?
Blood pressure
What are the indications for dutasteride and finasteride?
benign prostatic hyperplasia
BPH
Finasteride has another indication what is it?
Androgenetic alopecia in men (finasteride 1mg, NOT the 5mg strength!)
Androgenetic alopecia is a genetically predetermined disorder due to an excessive response to androgens.
What are the common side effects of dutasteride/finasteride?
Sexual dysfunction and breast disorder
