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CDM 4 Exam 1 > Lecture 1 - Urinary Incontinence & BPH > Flashcards

Lecture 1 - Urinary Incontinence & BPH Flashcards

1
Q

Who is urinary incontinence more common in?

A

Women, due to having babies

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2
Q

Reversible causes & Management of incontinence…DRIIPP

A

Delirium
Restricted mobility, injury, restraint
Infection
Stool Impaction
Polyuria
Pharmaceuticals

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3
Q

Urge Urinary Incontinence (UUI)

A

involuntary voiding preceded by brief warning

Causes: Detrusor muscle instability, involuntary contraction

Overactive bladder = w/ or w/o urge incontinence

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4
Q

UUI Treatment

A

Nonpharm = 1st (Lifestyle/ Surgery)

Pharm = 4-6 week response, switch if no response

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5
Q

Non-pharm Treatment UUI

A

Diet = monitor fluid, caffeine, bladder irritants (artificial sweetener, spicy food)

Exercise and weight loss
Smoking cessation
Scheduling regimens
Muscle Rehab
Surgery

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6
Q

UUI Treatment, Anticholingeric side effects

A

Dry mouth
visual disturbances
Constipation
Dry skin

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7
Q

UUI Treatment, Anticholinergic precautions

A

Arrythmias
CVD
GI issues
Dementia
elderly

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8
Q

UUI Treatment, Anticholinergic precautions CI

A

GI obstruction
closed & narrow angle glaucoma

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9
Q

Toxidrome Poem for Anticholinergic

A

Blind as a bat
Mad as a hatter
Red as a beet
Hot as a hare
Dry as a bone
The bowel and bladder lose their tone
and the heart runs alone

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10
Q

Solifenacin Info

A

M3 selectivity > M2

non-inferior to oxybutynin, superior to tolterodine

SE: less than oxybutynin/tolterodine, more than darifenacin

Dose: 5mg/day max, renal impairment < 30, mod/severe hepatic impairment

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11
Q

Darifenacin info

A

truly selective M3

non inferior oxybutynin,superior tolterodine

SE: less than oxybutynin

Dose: no renal dose adjust, if moderate hepatic impairment then max 7.5mg/day

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12
Q

UUI Treatment efficacy

A

Doesn’t decrease events by much
most agents used 4-8 weeks to see effect
continuation rats drop drastically over time

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13
Q

Mirabegron (Myrbetriq) drug class

A

B3 agonist

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14
Q

Mirabegron (Myrbetriq) Drug interactions

A

moderate CYP2D6
substate of 2D6, 3A4, p-gp

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15
Q

Mirabegron (Myrbetriq) Dosing

A

50mg/day

25mg/day if eGFR 15-30

Not studied < 15

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16
Q

Mirabegron (Myrbetriq) SE/CI

A

HTN (avoid if severe, uncontrolled > 180/110)
Nasopharyngitis
UTI
Constipation
Tachycardia
Headache

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17
Q

Mirabegron (Myrbetriq) efficacy

A

Full effect in 4-8 weeks

Good in combo w/ solifenacin but more SE

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18
Q

Vibegron (Gemetsa) drug class

A

B3-agonist

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19
Q

Vibegron (Gemetsa) info

A

not recommended eGFR < 15
no CYP2D6 interactions, or BBB pen**

20
Q

Vibegron (Gemetsa) SE

A

Headache
Nasopharyngitis
Diarrhea
Nausea

21
Q

Drug w/ highest efficacy for UUI

A

Botox, 1.6-1.9 episodes per day

injected into 20 sites via urethra every 6-12 weeks

22
Q

Stress Urinary Incontinence (SUI) causes

A

weak pelvic floor muscles
Sphincter incompetence
Trauma/damage to urethra
Women»>Men

23
Q

Stress Urinary Incontinence triggers

A

coughing
sneezing
laughing
exercising
weight lifting

24
Q

Pelvic Floor muscle training

A

helpful for prevention of postpartum SUI

most effective = 3X10 sets, hold 10 sec

25
Q

FDA approved drugs for SUI?

A

None in USA, off-label duloxetine due to suicidal risk…can be used if person is also depressed n used for that too

26
Q

Overflow Urinary Incontinence Treatment

A

surgery
self-catheterization
some drugs

27
Q

Functional barrier incontinence

A

person unable or unwilling to reach the toilet

28
Q

Functional barrier treatments

A

move barriers
PT
assistive deices
scheduled or prompted toileting

29
Q

how to treat Mixed UI

A

initial therapy depends on predominate symptoms

30
Q

counseling tips for incontinence

A

reduce fluid intake during day
avoid caffeinated Bev
minimize artificial sweeteners, acidic and spicy foods

31
Q

Moderate to severe BPH TXM options

A

Behavioral/lifestyle modifications
Med therapy
Procedural options

32
Q

a-adrenergic antagonists mOA

A

prostate smooth muscle tone mediated via a1-receptor

inc tone leads to reduction in flow rate/inc LUTS

Blockage of receptor leads to improvement of flow rate/LUTS

33
Q

Which a-antagonists are more uroselective?

A

3rd gen….

Tamsulosin = Flomax
Alfuzosin = Uroxatral
Silodosin = Rapaflo

34
Q

a-antagonist info

A

reduce symptoms 5-9pts in IPSS scores, within about a week

Dont affect prostate size
Once daily dosing (except prazosin)

Go to agents

35
Q

A-antagonist SE

A

Vasodilatory
Ejaculatory dysfunction
HA, Dizziness, asthenia, respiratory/nasal congestion

36
Q

A-antagonist DI

A

caution in combo w/ PDE5inhib

37
Q

Main goal of 5a-reductase inhib

A

shrink prostate

also shown to dec BPH progression

38
Q

5a-reductase inhib important info

A

a-blockers work quicker and better on symptoms
5a-reductase take weeks/months to work

39
Q

5a-reductase inhib SE

A

Preg category X
Gynecomastia, dementia, depression links
Sexual side effects
PFS = side effects after stopping finasteride

40
Q

Combo therapy used for….

A

pts with enlarged prostate
use a-blocker with 5a-reductase

combo better than solo drugs, but comes with more SE

41
Q

Combo therapy cut offs

A

LUTS symptoms +
PSA > 1.5ng
Prostate size > 30cc, 40g on imaging, palpable on DRE

42
Q

Mod/Severe LUTS, Prostate < 40 or PSA < 1.4 use…

A

a-blockers

43
Q

Mod/Severe LUTS, Prostate > 40 or PSA 1.4

A

5a antagonist or 5a reductase + a-blocker

44
Q

Mod/Severe LUTS, ED

A

phosphodiesterase inhib or 5a reductase + a-blocker

45
Q

Mod/Severe LUTS, predominante irritative voiding symptoms

A

add anticholinergic or B3 agonist to a-blocker or 5a-reductase

CDM 4 Exam 1 (12 decks)

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