Genito-urinary system (medium) Flashcards
what are the 3 different types of urinary incontinence
stress: involuntary leakage from exertion/ sneezing/ coughing
urgency: urgent need to urinate
mixed: both urgency and stress but one usually dominates
non drug management for urinary incontinence
reduce caffeine
reduce weight if BMI >30
modify fluid intake
bladder training for 6 weeks for urgency incontinence
pelvic floor muscle training for 3 months for stress incontinence
what is the drug management for urgency incontinence (1st and 2nd line)
1st line: antimuscarinics: oxybutynin, tolterodine, darifenacin…
2nd line: beta agonist: mirabegron 50mg OD
drug management for stress incontinence
surgery or duloxetine
1st line for nocturnal enuresis (bed wetting)
after lifestyle management (fluid intake, toilet behaviour, rewards system…)
enuresis alarms:
- review after 4 weeks
- continue until 2 weeks of uninterrupted dry nights
drug management for nocturnal enuresis (1st, 2nd and 3rd line)
1st line: desmopressin
- use S/L or oral - not intranasal due to increased side effects
- no potent and longer DOA than vasopressin
2nd line: desmopressin +/- antimuscarinic (oxybutynin/ tolterodine)
3rd line: imipramine
management of acute urinary retention during emergency
immediate catheterisation - alleviates the pain
alpha blocker: doxazosin, alfuzosin, tamsulosin
what can cause urinary retention
antimuscarinics, TCAs, sympathomimetics
treatment of chronic urinary retention
catheter
treatment of BPH and the doses
alpha blocker- relaxes the smooth muscle
doxazosin: 1mg OD can be increased to 8mg OD
tamsulosin: 400mcg OD
5a reductase inhibitor - used if enlarged prostate/ risk of progression or hypotensive
finasteride: 5mg OD
dutasteride: 500mcg OD
MHRA warning for finasteride
reports of depression and suicidal thoughts
stop immediately and report
side effects of alpha blockers
postural hypotension - take before bed and lie down if dizzy/ fatigue dizziness, tachycardia palpitations blurred vision
contraindications of alpha blockers
micturition syncope (fasting after urination) postural hypotension
side effects of 5a reductase inhibitors
breast disorders- report lumps, nipple pain/ discharge - could be male breast cancer
sexual dysfunction: ejaculation disorders, impotence
depression - MHRA warning
cautions of 5a reductase inhibitors
avoid handling in women of childbearing potential
condoms should be used if women pregnant/ could become pregnant
excreted in semen