Incontinence Flashcards
1
Q
Antimuscarinic- Genitourinary uses
Oxybutynin, Tolterodine, Solifenacin
Common indications
A
- To reduce urinary frequency, urgency and urge incontinence in overactive bladder, as a first-line pharmacological treatment if bladder training is ineffective
2
Q
Antimuscarinic- Genitourinary uses
Oxybutynin, Tolterodine, Solifenacin
MOA
A
- Antimuscarinic drugs bind to muscarinic receptors, where they act as a competitive inhibitor of ACh.
- Contraction of the smooth muscle of the bladder is under parasympathetic control.
- Blocking muscarinic receptors, therefore, promotes bladder relaxation, increasing bladder capacity.
- In patients with overactive bladder, this may reduce urinary frequency, urgency and urge incontinence.
- Antimuscarinic useful in treating, overactive bladder tend to be relatively selective for the M3-receptor, which is the main muscarinic receptor subtype in the bladder.
3
Q
Antimuscarinic- Genitourinary uses
Oxybutynin, Tolterodine, Solifenacin
Adverse effects
A
- Predictably from their antimuscarinic action, dry mouth is common
- Other classic antimuscarinic side effects such as tachycardia, constipation and blurred vision are also common
- Urinary retention may occur if there is bladder outflow obstruction
4
Q
Antimuscarinic- Genitourinary uses
Oxybutynin, Tolterodine, Solifenacin
Warnings
A
- Antimuscarinics are contraindicated in the context of urinary tract infections.
- Urinalysis is, therefore, an important part of assessment before prescribing treatment of an overactive bladder.
- Central nervous system side effects (drowsiness and confusion) can be particularly problematic in the elderly and especially patients with dementia.
- Antimuscarinics should be used with caution in patients susceptible to angle-closure glaucoma, in whom they can precipitate a dangerous rise in intraocular pressure.
- They should be used with caution in patients at risk of arrhythmias (e.g. those with significant cardiac disease) for obvious reasons, those at risk of urinary retention.
5
Q
Antimuscarinic- Genitourinary uses
Oxybutynin, Tolterodine, Solifenacin
Interactions
A
- Adverse effects are more pronounced when combined with other drugs that have antimuscarinic effects, such as tricyclic antidepressants
6
Q
Antimuscarinic- Genitourinary uses
Oxybutynin, Tolterodine, Solifenacin
Communication
A
- Explain that you are offering a treatment that relaxes the bladder
- This will reduce the need to pass water
7
Q
Desmopressin
Indications
A
- Diabetes insipidus
- Primary nocturnal enuresis
- Post-operative polyuria or polydipsia
- Renal function testing
- Mild to moderate haemophillia and von willebrand’s disease
- Fibrinolytic response testing
8
Q
Desmopressin
MOA
A
- In its main biological effects, desmopressin does not differ from vasopressin.
- Desmopressin however has a high anti-diuretic effect whereas the uterotonicand vasopressor actions are very low.
9
Q
Desmopressin
Contra-indications
A
- Cardiac insufficiency
- Conditions treated with diuretics
- History of hyponatraemia
- Polydipsia in alcohol dependence
- Syndrome of inappropriate ADH secretion (SiADH)
10
Q
Desmopressin
Cautions
A
- Avoid fluid overload
- CVD
- Conditions aggravated by water retention
- Cystic fibrosis
- Elderly- risk of hyponatraemia and renal impairment
- Epilepsy
- HTN
- High fluid intake
11
Q
Desmopressin
Adverse effects
A
- Headache
- Abdo pain
- Nausea
- weight gain
- Hyponatraemia- in serious cases convulsions
12
Q
Desmopressin
Interactions
A
- Substances which are known to induce SIADH
- TCA, SSRI, Chlorpromazine, CBZ
- These may cause addiitive antidiuretic effect leading to an increased risk of water retention/hyponatraemia
- NSAIDs may induce water retention and/or hyponatraemia
- Concomitant use of loperamide increase plasma concentration 3 flod
13
Q
Desmopressin
Monitoring
A
- BP
- Weight
- U&E- particularly Na
- RR- sign of fluid overload
- Oedema
