Geriatrics (Urinary Incontinence)

Question 1

Urinary Incontinence

Answer 1

-involuntary leakage of urine
-OAB
-stress
-overflow
-more common in females

Question 2

QOL issues w UI

Answer 2

-loss of independence
-self esteem
-other med complications

Question 3

Normal bladder function

Answer 3

1. Stretch receptors tell brain to empty bladder (B3)
2. Neurologic stimulation = contraction (Ach receptors on top and alpha receptors in base)
3. Sphincter relaxes

Question 4

Aging of bladder

Answer 4

-dec capacity and elasticity
-inc spontaneous contractions
-dec sphincter compliance

Question 5

Age results on bladder

Answer 5

-incomplete emptying
-dec ability to hold it

Question 6

Types of UI

Answer 6

-urge
-stress
-overflow
-neurlogic

Question 7

Urge UI (OAB)

Answer 7

-OAB
-hyperactivity of DETRUSSOR muscle
-sudden peeing
-urgency and freq inc
-causes can be neurologic or meds (Ach inhibitors for alzheimers)

Question 8

Stress UI

Answer 8

-outlet incompetence w ab pressure
-women > men
-small accidents
-childbirth and estrogen deficiency inc risk
-a-ANTAgonists can make worse
-alcohol and caffeine can make worse

Question 9

Overflow incontinence

Answer 9

-outlet obstruction or inability to or uncordinated DETRUSOR constriction
-common in BPH or prostatic blockage
-ab pain
-freq peeing
-feeling need to go after going

Question 10

Neurogenic (atonic) bladder

Answer 10

-disruption in neurologic innervation of bladder
-inability or uncoordinated detrusor constriction
-maybe atony of bladder muscle (stroke, neuropathy, spinal cord injury)

Question 11

Neurogenic Bladder sx

Answer 11

-small accidents
-small volume
-loss of feeling bladder full
-urine dribbling
-freq, urgency
-inc risk of UTI and kidney stones

Question 12

Functional incontinence

Answer 12

-inability to use bathroom in timely fashion
-physical impairment, mental illness, UTI, meds (sedating)

Question 13

Meds that inc frequency of urination

Answer 13

-diuretics
-alpha-ANTAgonists

Question 14

Meds that inc urgency of urinattion

Answer 14

-Ach inhibitors

Question 15

Meds that inc overflow

Answer 15

-a-antagonists
-antihistamines

Question 16

UI treamtent

Answer 16

-NON-PHARM works for all!
-pharm
-injections/surgery

Question 17

Non-pharm UI tx

Answer 17

-scheduled voiding
-kegel
-avoid coffee, alc, caffeine, water before bed
-absorbent products (diapers)
-catheters

-can reduce sx 50%

Question 18

Pharma options UI tx

Answer 18

-anticholinergics/antimuscarinic (urge)
-B3-agonists (urge)
-topical estrogen (stress)
-a-agonist (stess)
-a-antagonists (overflow)
-SNRI (stress)

Question 19

Urge UI tx

Answer 19

-give meds 4 weeks to work
-50% vs 30% reduction active vs placebo (response varies)
-65% experience AE
-stopping abrutly might cause worse accidents

Question 20

Urge UI tx admin

Answer 20

-do not crush or chew
-patch applied twice weekly rotating sites

Question 21

example case

Answer 21

-Rx can dec episodes from 5 to 2
-nonpharm can dec episodes 5 to 3
-side effects
-costs

Question 22

Stress UI tx

Answer 22

1. Kegel
2. Duloxetine 40mg BID
3. Topical Estrogen
4. A-AGonists (rare)
   -vag pessaries/surgery

Question 23

Duloxetine

Answer 23

-stress UI tx
-40mg BID
-inc sphincter tone to prevent leaks

Question 24

Topical estrogen (vaginal atrophy)

Answer 24

-stress UI tx
-estrogen vaginal cream
-insert via applicator
-21 days on/ 7 days off

Question 25

Overflow UI tx

Answer 25

1. Address the obstruction
2. A-blockers (if BPH)
3. Catheter

Question 26

A-Adrenergic Blockers

Answer 26

-Overflow UI tx in BPH
-Doxazosin 1-4mg qd
-Tamsulosin 0.4mg qd (more selective less hypotension)

Question 27

Neurogenic UI tx

Answer 27

-no pharma management effective
-focus on non-pharma
-intermittent catheterization
-Botulinum A toxin injections
-Surgery

Question 28

Intermittent catheterization

Answer 28

-thin tubes collecting urine
-rubber latex, silicone, PVC

Question 29

Catheter types

Answer 29

-intermittent straight
-Indwelling (Foley)
-Condom
-Suprapubic

Question 30

UI tx monitoring

Answer 30

-efficacy after 4-8 weeks
-SE mostly dose-dependent
-consider stoping rx as often as they are prescribed

Question 31

B3 agonist side effects

Answer 31

-minor inc in BP
-UTI

Question 32

anticholinergic/antimuscarinic side effects

Answer 32

-dry mouth
-constipation
-fatigue/confusion