Module 2 exam 1 lecture 2

Question 1

Urinary incontinence is

Answer 1

Involuntary leakage of urine
overactive bladder

Question 2

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

Answer 2

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

Question 3

types and frequency of UI in females

Answer 3

63%- urge
21%- stress
12% overflow

Question 4

Types and frequency of UI in males

Answer 4

59%- Urge
29%- overflow
0% stress

Question 5

How does bladder work?

Answer 5

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

Question 6

steps in bladder function

Answer 6

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

Question 7

which receptor supports detrusors relaxation and filling

Answer 7

B3

Question 8

How does neurologic stimulation initiate contraction

Answer 8

-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.

Question 9

What are some age related changes to the bladder and urethra

Answer 9

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

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

Question 10

overflow results from

Answer 10

results from blockage or inappropriate/inefficient sphincter relaxation

Question 11

what is stress

Answer 11

occurs in women, change in hormones or pelvic floor

Question 12

what is urge

Answer 12

Cholinergic receptor squeezes too often or at inappropriate time

Question 13

urge other name

Answer 13

overactive bladder

Question 14

urge caused by ? volume?

Answer 14

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

Question 15

sx of urges

Answer 15

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

Question 16

causes of urge

Answer 16

Neurologic or medication

Question 17

stress incontinence occurs when? symptoms? caused by?

Answer 17

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

Question 18

What does overflow incontinence result from

Answer 18

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

Question 19

overflow incontinence is most commonly caused bu

Answer 19

BPH or prostate blockage or kidney stone

Question 20

sx of overflow incontinence

Answer 20

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

Question 21

What is another name for neurogenic bladder

Answer 21

Atonic bladder

Question 22

What is neurogenic bladder?

Answer 22

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

Question 23

symptoms of neurogenic bladder. Possible complications

Answer 23

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

Iincrease in risk of UTI
increase risk of kidney stones

Question 24

What is functional incontinence? causes?

Answer 24

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

Question 25

Meds that cause frequency incontinence

Answer 25

diuretics
alpha blockers

Question 26

MEds that cause urgency

Answer 26

acetylcholinesterase inhibitors

Question 27

Meds that cause overflow

Answer 27

alpha-antagonists
anti-histamines

Question 28

non pcol therapy for incontinence

Answer 28

scheduled/timed voiding
kegels for pelvic floor muscle
avoid- caffeine, alcohol, h20 before bed
diapers
catheters

Question 29

Injection/surgery does not work on

Answer 29

functional

Question 30

Non pcol is the preferred tx option for which kinds of incontinence

Answer 30

overflow, stress, urge, functional, neurogenic

Question 31

urge incontinence can be treated by which pcol options

Answer 31

anticholinergic/antimuscarinic
B3 agonist
inj/surgery

Question 32

functional can be treated by

Answer 32

Non pcol only

Question 33

neurogenic can be treated by

Answer 33

inj/surgery
non pcol

Question 34

stress incontinence can be treated by

Answer 34

estrogen (topical)
alpha-agonist (small function)
SNRI (small function)
Inj or surgery

Question 35

overflow incontinence can be treated by

Answer 35

alpha-agonist (small function)
inj/surgery

Question 36

TX for urge UI in order

Answer 36

Non-pcol
pcol a)anticholinergic/antimuscarinic
b) B3- agonist
c) combination
Injection/surgery

Question 37

Anticholinergic drugs and ROA

Answer 37

oxybutyrin - oral, patch, gel
tolterodine- oral
solifenacin
darifenacin
trospium
fesoterodine

Question 38

adverse effects of anticholinergic drugs

Answer 38

dry mouth
constipation
fatigue, confusion
tachycardia

Question 39

B-3 agonist drugs

Answer 39

Mirabegron
vibegron

Question 40

side effects of B-3 drugs

Answer 40

Mirabegron- minor increase in BP, UTI
vibegron- uti

Question 41

efficacy of B3 agonist in UI

Answer 41

30-60% decrease in UI

Question 42

Max benefits of anticholinergics and B3 are in how long

Answer 42

2-4 weeks

Question 43

stress UI management

Answer 43

non-pcol (kegels)
SNRI- duloxetine increases sphincter tone
topical estrogen- women only 21 days on 7 days off
vaginal pessaries or surgery

Question 44

Overflow UI management

Answer 44

address obstruction
BPH- doxazosin/tamsulosin can relax sphincter (tamsulosin more selective)
catheter

Question 45

Neurogenic UI management

Answer 45

focus on non pcol mgmt
intermittent catheterization
botox or surgery
drugs not effective for neurogenic