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NAPLEX - OUR cards > Overactive Bladder > Flashcards

Overactive Bladder Flashcards

1
Q

Incontinence

A

lack of control in urination (about 1/3 of pts with OAB experience incontinence)

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2
Q

Type of incontinence that can be treated with meds

A

urge incontinence

patient cannot hold urine long enough to reach the toilet; associated with a neuropathy

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3
Q

The detrusor muscle in the bladder is activated by which system?

A

parasympathetic nervous system

Acetylcholine
M2 and M3 receptors in the bladder 3:1 ratio

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4
Q

What is the M3 receptor responsible for in the bladder?

A

emptying contractions

involuntary bladder contractions

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5
Q

1st line treatment for OAB:

A

behavioral therapy

bladder training
Kegel exercises
dietary restrictions
etc

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6
Q

Preferred agents for OAB

A

anticholinergic drugs

Beta-3 agonist

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7
Q

WHich formulation of anticholinergic agents are preferred?

A

Extended release agent

less incidence of dry mouth

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8
Q

Agents that are more selective for the M3 receptor have fewer CNS side effects. What agents are selective?

A

Solifenacin
darifenacin
fesoterodine

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9
Q

Oxybutynin brands

A

Ditropan
Oxytrol (patch)
Gelnique (gel)

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10
Q

Side effects of anticholinergics

A 
dizziness and drowsiness (less with selective agents)
dry mouth 
constipation
dry eyes/blurred vision
urinary retention
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11
Q

OTC anticholinergic product

A

Oxytrol for women
oxybutynin patch for women 18+ y/o
1 patch every 4 days

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12
Q

Oxybutynin dose

A

IR: 5 mg BID-TID
XL: 5-30 mg daily

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13
Q

Detrol dose

A

tolterodine
IR: 1-2 mg BID
ER: 2-4 mg daily

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14
Q

Sanctura

A

Trospium
20 mg BID
ER: 60 mg daily

Take on an empty stomach

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15
Q

Vesicare

A

Solifenacin
5-10 mg daily

More selective agent

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16
Q

Darifenacin

A

Enablex

7.5 - 15 mg daily

More selective agent; causes more constipation

17
Q

Fesoterodine

A

Toviaz

4-8 mg daily

More selective agent

18
Q

Which anticholinergics need a dose reduction with strong 3A4 inhibitors? (4)

A

Tolteridone ER (2 mg max)
Solifenacin (5 mg)
Darifenacin (7.5 mg)
Fesoterodine (4 mg)

19
Q

Mirabegron brand and MOA

A

Myrbetriq

Beta 3 agonst: relaxes detrusor muscle and increases bladder capacity

20
Q

Mirabegron has similar efficacy to anticholinergics (t/f)

A

TRUE

and causes less dry mouth

21
Q

Mirabegron dosing

A

25-50 mg daily

CRcl 15-29: 25 mg

22
Q

Mirabegron side effects

A 
Hypertension
UTI
HA
constipation
dizziness
23
Q

Topical oxybutynin forms (gel, patch) cause less dry mouth than oral (t/f)

A

TRUE

24
Q

Mirabegron metabolism

A

Moderate CYP2D6 inhibitor

caution with certain antidepressants, metoprolol, digoxin

25
Q

3rd line option for OAB

A

Onabotulinumtoxin A (Botox)

26
Q

Botox dosing

A

given intradetrusor

100 units total, injected across 20 different sites

given every 12 + weeks

27
Q

Prophylatic antimicrobial therapy is recommended before giving botox injections t/f)

A

TRUE

Just don’t use AG’s

28
Q

First med approved for adults with nocturia

A

Desmopressin (Noctiva)

29
Q

Desmopressin MOA

A

antidiuretic hormone analog, decreases urine production

30
Q

Desmopressin warnings

A

severe hyponatremia can develop due to fluid retention

avoid in pts who are at increased risk fir hyponatremia

31
Q

Pts who are at increased risk for hyponatremia

A

Pts with CKD, HF
taking loop diuretics
systemic/inhaled corticosteroids

32
Q

Desmopression dose

A

1 spray (1.66 mcg) in one nostril 30 mins before bed (< 65 y/o and no risk of hyponatremia)

0.83 mcg if 65+ and/or risk of hyponatremia is present

33
Q

Where can the Oxytrol patch be applied?

A

Abdomen
hips
buttocks

remove patch prior to MRI
change patch every 3-4 days (rx) 4 days (otc)

34
Q

Where can Gelnique be applied?

A

abdomen
upper arms/shoulders
thighs

35
Q

Noctiva storage info

A

store unopened in fridge
once open can be left at room temp

Prime by spraying 5 times when using for the first time
Prime again if not used within 3 days

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