Micturition Drugs Flashcards
what are the two stages of micturition?
passive storage
active voiding of urine
what are the common clinical signs of incontinence?
urine dribbling
loss of voluntary control
what are the common clinical signs of abnormal micturition?
disruption of the urine stream
stranguria
dysuria
what is the most frequently diagnosed micturition disorder?
urethral sphincter mechanism incompetence
what can estrogens be used for?
hormone responsive incontinence
how do estrogens work with urinary incontinence?
increases resting urethral muscle tone of female urethra
binds to cytosol binding protein receptor: stimulates DNA, RNA, protein synthesis
what can testosterone be used for?
hormone responsive incontinence
what is the mechanism of action of testosterone?
activates testosterone and estrogen receptors
conversion to estradiol and activation of certain estrogen receptors
what is phenylpropanolamine?
alpha adrenergic agonist
what are the indications for phenylpropanolamine?
urethral sphincter mechanism incompetence: hormone responsive and stress
what are the contraindications for phenylpropanolamine?
glaucoma
diabetes mellitus
hypertension
what is the mechanism of action of tricyclic antidepressant agents?
inhibition of norepinephrine re-uptake at synaptic level and results in increased urethral tone
what are some causes of detrusor hyperspasticity?
inflamed or irritated bladder
spinal cord disease
idiopathic
what are some indications for propantheline bromide?
detrusor hyperspasticity
urge incontinence
what are some indications for flavoxate hydrochloride?
detrusor hyperspasticity
urge incontinence
what is an indication of oxybutinin?
detrusor hyperspasticity
what is the mechanism of action of oxybutinin?
anticholinergic
direct acting smooth muscle relaxant
how does bethanechol chloride work?
parasympathetic and muscarinic drug
directly stimulates parasympathetic cholinergic receptors
stimulates ganglia to a lesser extent
what is an indication for bethanechol chloride?
detrusor atony
when should you not use bethanechol chloride?
with urethral obstruction
what are prazosin and tamsulosin?
alpha-adrenergic blockers
what is diazepam?
skeletal muscle relaxant
what is dantrolene?
skeletal muscle relaxant
what is baclofen?
skeletal muscle relaxant
which nerves innervate the bladder?
hypogastric nerve
pelvic nerve
which nerve innervates the external urethral sphincter?
pudendal nerve
which parasympathetic nerves have to do with urination?
pelvic nerve
pudendal nerve
what does the hypogastric nerve innervate in the urinary system?
bladder
internal urethral sphincter
what are some voiding disorders?
functional outflow obstruction
mechanical outflow obstruction
atonic bladder
what are some storage disorders?
urethral sphincter mechanism incompetence
ectopic ureters
detrusor instability
which drugs are used to treat female hormone responsive incontinence?
diethylstilbestrol- old
estriol (incurin)
what are the side effects of estrogens?
induce signs of estrus
bone marrow toxicity (hypoplasia, aplasia)
what drugs are used to treat male hormone responsive incontinence?
testosterone crypionate
testosterone propianate
methyltestosterone
what are the side effects of testosterone?
none noted
what is the mechanism of action of phenylpropanolamine?
stimulates both alpha and beta adrenergic receptors
may act directly with alpha1 (proximal urethra) and beta2 (bladder)
may have indirect effect: norepinephrine
relaxes detrusor muscle (beta) and increases tone of urethral sphincter (alpha)
what are the side effects of phenylpropanolamine?
occasional nausea
inappetance
hypertension
increased intraocular pressure
what are some tricyclic antidepressant agents?
imipramine
clomipramine
what are the side effects of propantheline bromide?
vomiting
dry mouth
sedation
constipation
increased intraocular pressure
what is the mechanism of action of flavoxate hydrochloride?
anticholinergic
direct acting smooth muscle relaxant
what are the side effects of flavoxate hydrochloride?
vomiting
increased intraocular pressure
tachycardia
what are the side effects of oxybutinin?
diarrhea
sedation
aggravation of hyperthyroidism
aggravation of cardiac disease
aggravation of prostatic disease
what is detrusor atony like?
dribbling urine
large distended bladder, easily expressed
decreased or absent perineal reflex
what are the side effects of bethanechol?
vomiting
diarrhea
salivation
anorexia
do not use with urethral obstruction
what are the side effects of phenoxybenzamine?
hypotension
miosis
reflex tachycardia
inhibits contraction nicitating membrane
what is used for urethral spasticity?
alpha adrenergic blocking agent
what are prazosin, tamsulosin, and terazosin?
alpha adrenergic blockers
what do prazosin and tamsulosin cause?
alpha adrenergic block
centrally mediated decrease in somatic input to external urethral sphincter
what is diazepam used for?
functional urethral obstruction due to increased external urethral sphincter tone
what are the side effects of baclofen?
weakness
vomiting
inappetance
what does baclofen do?
decreases muscle tone by a depressive effect on the CNS
inhibits medullary interneurons and spinal reflexes
decreases spasticity by reducing activity of gamma efferent neurons
