Lect 9 Flashcards
urge urinary incontinence
overactive bladder (OAB)
stress urinary incontinence
urethra cannot impede urine flow
mixed
combo of UUI and SUI
overflow incontinence
bladder underactivity
bladder outlet obstruction (BOO)
functional
unrelated to urethral or bladder capability
causes and precipitating factors
LOOK AT SLIDE
urge urinary incontinence sx
urinary frequency (>8 times/day) and urgency
nocturia (>1 micturition/night)
vol usually large due to complete emptying of bladder
stress urinary incontinence
urethral underactivity
stress urinary incontinence sx
UI during activities that increase the intraabdominal pressure (running, coughing, sneezing, lifting)
usually small vol, proportional to the level of activity
overflow incontinence
bladder is filled to capacity, but unable to empty
what can cause BOO?
BPH, prostate cancer, DM, denervation
overflow incontinence sx
difficulty initiating stream
dribbling
small amts of urine leaking constantly
overflow incontinence sx
difficulty initiating stream
dribbling
small amts of urine leaking constantly
what is 1st line tx in urge urinary incontinence?
anticholinergic agents/antispasmodics (oxybutynin or tolterodine or oxybutynin IR/ Ditropan)
anticholinergic agents/ antispasmotic MOA
decrease efferent PS nerve impulses to the detrusor muscle
suppress premature detrusor contractions, enhance bladder storage, relieving sx
whats the gold standard anticholinergic agent for use in UI?
Ditropan (oxybutynin IR)
ADR’s for Ditropan
ORTHOSTATIC HYPOTENSION, sedation, weight gain, constipation, confusion, tachycardia
elderly= potentially inappropriate
alternative 1st line tx antichol for UI
- oxybutynin ER (Ditropan XL)= less incidence of ADR’s than IR
- tolterodine (Detrol, Detrol LA)
- fesoterodine (Toviaz)
which antichol is available OTC?
oxybutynin transdermal (Oxytrol)
common ADR’s in antichol
dry mouth, dry eyes, constipation, headache, blurred vision, dyspepsia
alternative antichol agents
- solifenacin (Vesicare)
- darifenacin (Enablex)
- trospium (Sanctura, Sanctura XR)= statistically equivalent to oxybutynin and tolterodine; higher incidence of adverse effects in elderly
beta3 agonist
mirabegron (Myrbetriq)
mirabegron
newest agent= consider for use in those intolerant to antichol agents
ADR’s= high BP, tachycardia
what are TCA reserved for in urge urinary incontinence?
those w/ a concurrent indication (peripheral neuropathy, depression)
ADR’s of TCA
orthostatic hypotension
which TCA are preferred due to decreased side effects?
desipramine and nortriptyline
first line pharm tx for stress urinary incontinence?
duloxetine (Cymbalta)
SUI therapy
ACP guidelines recommend against tx with pharm therapy
alpha-adrenergic agents
used in SUI
ex= pseudoephedrine, phenylephrine
topical estrogens
used in SUI w/ urethritis or vaginitis due to estrogen deficiency
benefit not seen w/ systemic tx
treatment for bladder underactivity in overflow incontinence
intermittent self-catheterization 3-4X daily
bethanechol (short-term use only; avoid in asthma/ heart disease)
treatment for BOO in overflow incontinence
relief of the obstruction
can be pharm
