Lect 9

Question 1

urge urinary incontinence

Answer 1

overactive bladder (OAB)

Question 2

stress urinary incontinence

Answer 2

urethra cannot impede urine flow

Question 3

mixed

Answer 3

combo of UUI and SUI

Question 4

overflow incontinence

Answer 4

bladder underactivity

bladder outlet obstruction (BOO)

Question 5

functional

Answer 5

unrelated to urethral or bladder capability

Question 6

causes and precipitating factors

Answer 6

LOOK AT SLIDE

Question 7

urge urinary incontinence sx

Answer 7

urinary frequency (>8 times/day) and urgency
nocturia (>1 micturition/night)
vol usually large due to complete emptying of bladder

Question 8

stress urinary incontinence

Answer 8

urethral underactivity

Question 9

stress urinary incontinence sx

Answer 9

UI during activities that increase the intraabdominal pressure (running, coughing, sneezing, lifting)
usually small vol, proportional to the level of activity

Question 10

overflow incontinence

Answer 10

bladder is filled to capacity, but unable to empty

Question 11

what can cause BOO?

Answer 11

BPH, prostate cancer, DM, denervation

Question 12

overflow incontinence sx

Answer 12

difficulty initiating stream
dribbling
small amts of urine leaking constantly

Question 13

overflow incontinence sx

Answer 13

difficulty initiating stream
dribbling
small amts of urine leaking constantly

Question 14

what is 1st line tx in urge urinary incontinence?

Answer 14

anticholinergic agents/antispasmodics (oxybutynin or tolterodine or oxybutynin IR/ Ditropan)

Question 15

anticholinergic agents/ antispasmotic MOA

Answer 15

decrease efferent PS nerve impulses to the detrusor muscle

suppress premature detrusor contractions, enhance bladder storage, relieving sx

Question 16

whats the gold standard anticholinergic agent for use in UI?

Answer 16

Ditropan (oxybutynin IR)

Question 17

ADR’s for Ditropan

Answer 17

ORTHOSTATIC HYPOTENSION, sedation, weight gain, constipation, confusion, tachycardia
elderly= potentially inappropriate

Question 18

alternative 1st line tx antichol for UI

Answer 18

• oxybutynin ER (Ditropan XL)= less incidence of ADR’s than IR
• tolterodine (Detrol, Detrol LA)
• fesoterodine (Toviaz)

Question 19

which antichol is available OTC?

Answer 19

oxybutynin transdermal (Oxytrol)

Question 20

common ADR’s in antichol

Answer 20

dry mouth, dry eyes, constipation, headache, blurred vision, dyspepsia

Question 21

alternative antichol agents

Answer 21

• solifenacin (Vesicare)
• darifenacin (Enablex)
• trospium (Sanctura, Sanctura XR)= statistically equivalent to oxybutynin and tolterodine; higher incidence of adverse effects in elderly

Question 22

beta3 agonist

Answer 22

mirabegron (Myrbetriq)

Question 23

mirabegron

Answer 23

newest agent= consider for use in those intolerant to antichol agents
ADR’s= high BP, tachycardia

Question 24

what are TCA reserved for in urge urinary incontinence?

Answer 24

those w/ a concurrent indication (peripheral neuropathy, depression)

Question 25

ADR’s of TCA

Answer 25

orthostatic hypotension

Question 26

which TCA are preferred due to decreased side effects?

Answer 26

desipramine and nortriptyline

Question 27

first line pharm tx for stress urinary incontinence?

Answer 27

duloxetine (Cymbalta)

Question 28

SUI therapy

Answer 28

ACP guidelines recommend against tx with pharm therapy

Question 29

alpha-adrenergic agents

Answer 29

used in SUI

ex= pseudoephedrine, phenylephrine

Question 30

topical estrogens

Answer 30

used in SUI w/ urethritis or vaginitis due to estrogen deficiency
benefit not seen w/ systemic tx

Question 31

treatment for bladder underactivity in overflow incontinence

Answer 31

intermittent self-catheterization 3-4X daily

bethanechol (short-term use only; avoid in asthma/ heart disease)

Question 32

treatment for BOO in overflow incontinence

Answer 32

relief of the obstruction

can be pharm