Module 2 exam 1 lecture 2 Flashcards

1
Q

Urinary incontinence is

A

Involuntary leakage of urine
overactive bladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what percent of LTC pts have urinary incontinence? What percentage of hospitalized older adults have incontinence?

A

60% of LTC pts
30% of hospitalized
More common in females than males

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

types and frequency of UI in females

A

63%- urge
21%- stress
12% overflow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Types and frequency of UI in males

A

59%- Urge
29%- overflow
0% stress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How does bladder work?

A

Bladder has smooth muscle surrounding it that squeezes the top of the bladder and squeezes urine out.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

steps in bladder function

A

stretch receptors notify brain that bladder is full and needs emptying
neurologic stimulation initiates contraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

which receptor supports detrusors relaxation and filling

A

B3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How does neurologic stimulation initiate contraction

A

-Ach receptors in the dome (top of bladder)
-Alpha adrenergic receptors in the sphincter found in the base of the proximal urethra relaxes the muscle to allow it to flow out.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are some age related changes to the bladder and urethra

A

Decrease bladder capacity/elasticity
increased spontaneous detrusor contractions
decreased sphincter compliance

all of these result in incomplete emptying and decreased ability to postpone urination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

overflow results from

A

results from blockage or inappropriate/inefficient sphincter relaxation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is stress

A

occurs in women, change in hormones or pelvic floor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is urge

A

Cholinergic receptor squeezes too often or at inappropriate time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

urge other name

A

overactive bladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

urge caused by ? volume?

A

hyperactivity of detrusor muscle causes sudden and poorly predictable voiding
large or small volume accidents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

sx of urges

A

Urgency- unpredictable or unabble to control
frequency- excessive feelings of urination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

causes of urge

A

Neurologic or medication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

stress incontinence occurs when? symptoms? caused by?

A

Happens when external urinary sphincter does not open to allow urine to leave. small volume leakage, can be exacerbated or caused by alpha-antagonists (also called outlet incontinence)

Can occur when laughing, caffeine or alcohol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What does overflow incontinence result from

A

results from outlet obstruction or inability for detrusor constriction or uncoordinated detrustor constriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

overflow incontinence is most commonly caused bu

A

BPH or prostate blockage or kidney stone

20
Q

sx of overflow incontinence

A

abdominal discomfort or pain
feeling the need to void shortly after voiding

21
Q

What is another name for neurogenic bladder

A

Atonic bladder

22
Q

What is neurogenic bladder?

A

disruption in neurogenic innervation of the bladder or inability or uncoordinated detrusor constriction

23
Q

symptoms of neurogenic bladder. Possible complications

A

small volume, loss of feeling like bladder is full, dribbling of urine

Iincrease in risk of UTI
increase risk of kidney stones

24
Q

What is functional incontinence? causes?

A

Inability to get to the bathroom on time.
caused by medication (sedating)
physical impairment/mental status
UTI

25
Meds that cause frequency incontinence
diuretics alpha blockers
26
MEds that cause urgency
acetylcholinesterase inhibitors
27
Meds that cause overflow
alpha-antagonists anti-histamines
28
non pcol therapy for incontinence
scheduled/timed voiding kegels for pelvic floor muscle avoid- caffeine, alcohol, h20 before bed diapers catheters
29
Injection/surgery does not work on
functional
30
Non pcol is the preferred tx option for which kinds of incontinence
overflow, stress, urge, functional, neurogenic
31
urge incontinence can be treated by which pcol options
anticholinergic/antimuscarinic B3 agonist inj/surgery
32
functional can be treated by
Non pcol only
33
neurogenic can be treated by
inj/surgery non pcol
34
stress incontinence can be treated by
estrogen (topical) alpha-agonist (small function) SNRI (small function) Inj or surgery
35
overflow incontinence can be treated by
alpha-agonist (small function) inj/surgery
36
TX for urge UI in order
Non-pcol pcol a)anticholinergic/antimuscarinic b) B3- agonist c) combination Injection/surgery
37
Anticholinergic drugs and ROA
oxybutyrin - oral, patch, gel tolterodine- oral solifenacin darifenacin trospium fesoterodine
38
adverse effects of anticholinergic drugs
dry mouth constipation fatigue, confusion tachycardia
39
B-3 agonist drugs
Mirabegron vibegron
40
side effects of B-3 drugs
Mirabegron- minor increase in BP, UTI vibegron- uti
41
efficacy of B3 agonist in UI
30-60% decrease in UI
42
Max benefits of anticholinergics and B3 are in how long
2-4 weeks
43
stress UI management
non-pcol (kegels) SNRI- duloxetine increases sphincter tone topical estrogen- women only 21 days on 7 days off vaginal pessaries or surgery
44
Overflow UI management
address obstruction BPH- doxazosin/tamsulosin can relax sphincter (tamsulosin more selective) catheter
45
Neurogenic UI management
focus on non pcol mgmt intermittent catheterization botox or surgery drugs not effective for neurogenic
46