Incontinence Drugs

Question 1

N+V treatment in pregnancy

Answer 1

1. Promethazine (anti-histamine)
2. Ginger + P6 wrist accupuncture

Question 2

Stress Incontinence

Management

Answer 2

• Conservative
  
  • Loos weight, address cough
  • Pelvic floor muscle training 3m physio
  • Vaginal ‘cones’/ sponges
• Medical
  
  • Duloxetine SNRI - enhances sphincter control via CNS
• Conservative
  
  • Tension-free vaginal tape (TVT)
    [over pubis]
  • Trans-obturator tape (TOT)
    [through obturator foramen]
  • Injectable periurethral bulking agents

Question 3

Urge incontinence

Management

Answer 3

• Conservative
  
  • Bladder retaining min 6wks (inc time between voids)
• Medical
  
  • Antimuscarinics
    
    • Oxybutynin
    • Tolterodine (less dry mouth)
    • Solifenacin
  • Post-menopause: Intravaginal Oestrogens
• Surgical
  
  • Neuromodulation + S3 nerve stimulation
  • Botolinum toxin A injections (idiopathic only)
  • Augmentation cystoplasty

Question 4

Antimuscarinics

• Mechanism
• Indications
• SEs

Answer 4

Mechanism - block muscarinic acetylcholine receptors

Indications

• Bradycardia
  
  • Atropine (blocks M2 parasym to SA node)
  • IM/SC: initial M1 presynaptic block prevents reuptake⇒ bradycardia
• Urge incontinence
  
  • Oxybutynin
  • Tolteradine
  • Solifenacin
• Bronchodilators
  
  • Ipratropium bromide
  • Triotropium
• Parkinsonism - tremor + rigidity
  
  • Procyclidine
  • Benztropine
  • Trihexyphenidyl (benzhexol)
• Anti-psychotic drug extra-pyramidal SEs
  
  • Procyclidine
• IBS anti-spasmodic (only works on bowel muscle)
  
  • Mebeverine
  • Alverine