Incontinence Drugs Flashcards
Name some antimuscarinics -
Oxybutynin, tolterodine
What do you have to think about before prescribing antimuscarinics?
Patients cognitive impairment eg dementia as antimuscarinic burden will make it worse
How do antimuscarinics work in the bladder?
They antagonise parasympathetic input on the detrusor muscle (m3 receptor) in the bladder, causing urinary retention
Which type of incontinence do anti muscarinics treat second line (after conservative training?
Urge incontinence
Who do you avoid giving oxybutynin to and why?
Older, frail women as risk of sudden deterioriation in physical and mental health
Side effects of antimuscarinics
Dry mouth, eyes and skin, drowsiness, constipation, tachycardia, abdominal pain, urinary retention. sinusitis, oedema, weight gain, glaucoma precipitation
Contraindications of antimuscarinics?
Uncontrolled UC, glaucoma, myasthenia gravis
What drug is second line for urge incontinence and how does it work?
Mirabegron - B3 receptor agonist, increasing sympathetic outflow to the detrusor muscle and increasing storage capacity of the bladder
Side effect of mirabegron?
Tachycardia
Contraindication of mirabegron?
Severe hypertension, caution in hepatic and renal impairment
When is topical oestrogen used?
Post menopausal urgency, frequency and nocturia.
When is duloxetine used?
As a second line treatment (after conservative therapy) for stress incontinence.
How does duloxetine work?
Inhibits the reuptake of serotonin and adrenaline, increasing activity of external urethra; sphincter during filling phase.
Which incontinence is duloxetine used for?
Stress incontinence
When is botox used?
When pharmacological treatment has failed, and patient wants to try something else
What is the first line drug for males with predominantly voiding symptoms?
Tamsulosin
What class is tamsulosin?
alpha blocker
What are contraindications for tamsulosin?
History of:
- Postural hypotension
- Micturition syncope
- Severe hepatic impairment
Caution if -
- eGFR <30
- After cataract surgery
- In the elderly
What are side effects of tamsulosin?
- Dizziness, postural hypotension, fatigue, sweating
Take first dose at bedtime and lie down if they feel any side effects
What is the second line drug for males with predominantly voiding symptoms?
Finasteride / Dutasteride
5-alpha reductase inhibitors
What are side effects of 5-alpha reductase inhibitors?
Sexual dysfunction - Reduced libido, impotence, ejaculation disorder
Breast tenderness
Council a patient that sexual dysfunction improves over time, and report any lumps or changes in the breast
