Genito - Urinary System Flashcards
What is used for stress incontinence
Duloxetine (for women only)
Do not withdraw suddenly
Definitions
- urinary retention
- urinary incontinence
- stress incontinence
- urgency incontinence
- Urinary retention: Inability to voluntarily urinate.
- Urinary incontinence: Involuntary leakage of urine and can range in severity and nature.
- Stress incontinence: Involuntary leakage on effort and exertion(e.g sneezing or coughing).
- Urgency incontinence: Involuntary leakage which is accompanied by a sudden compelling desire to pass urine that is difficult to delay.
What is used first line for urinary frequency or incontinence
‘DOT’
- darifenacin
- oxybutynin
- tolterodine
What is used second line for urinary frequency or incontinence
Mirabegron
What type of drug is mirabegron?
Beta 3 adrenoreceptor agonist
Major Side effect of mirabegron
QT prolongation
Other drugs used in urinary frequency and incontinence
Tricyclic antidepressant
Eg. Imipramine
How do antimusaranic drugs work?
Reduce symptoms of urgency and urge incontinence and increase bladder capacity.
M/r preparations have less side effects
What is nocturnal enuresis in children
Bedwetting at night whilst sleeping
Children expected to stop at 5 years old
Treatment for nocturnal enuresis in children
- Non-drug treatments; advice on fluid intake, enuresis alarms and reward systems
- Desmopressin 200mcg OD - max 400mcg OD oral or sublingual
- Imipramine for children who do not respond to treatment
Common Side effect of desmopressin
- Hyponatraemia
- nausea
Counselling for decompression
- Risk of hyponatraemic convulsion
- avoid fluid over load
- STOP during an episode of vomiting or diarrhoea which leads to loss of sodium
Caution with desmopressin
- Avoid intranasal route due to increase Side effect.
- Limit fluid intake to minimum from 1 hour before dose until 8 hours afterwards
Difference between acute and chronic urinary retention
Acute - painful and requires immediate treatment
Chronic - painless and gradually develop over months or years.
What is used to treat urinary retention
Alpha blockers;
- alfuzosin
- doxazosin
- indoramin
- prazosin
- tamsulosin
- terazosin
What is used to treat urinary retention in patients
- with enlarged prostate,
- raised PSA concentration and
- considered high risk of progression
5A reductase inhibitors;
- finasteride
- dutasteride
Patient counselling with 5A reductase inhibitors
Excreted in semen, use a condom if sexual partner is pregnant or likely to become pregnant
Handling and storage of 5A reductase inhibitors
Women of childbearing potential should avoid handling crushed or broken tablets of finasteride or leaking capsules of dutasteride
Signs to report with 5A reductase inhibitors
Can cause breast cancer; report any breast changes
MHRA warning with finasteride
Reports of depression and suicidal thoughts in men taking propecia for male pattern hair loss.
Stop immediately if depression develops
Alpha blockers in hypertension
They can reduce blood pressure
Patients on anti-hypertensives may need dose reduction and supervision
Caution with alpha blockers
- In elderly
- patients having cataract surgery - floppy iris syndrome
When are alpha blockers contraindicated
Postural hypotension
Micturition syncope (faint on urinating)
Side effect of alpha blockers
- Dry mouth
- dizziness
- postural hypotension
- drowsiness
