Overactive Bladder Flashcards by Jimmy Hayden

Incontinence

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

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Type of incontinence that can be treated with meds

urge incontinence

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

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

parasympathetic nervous system

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

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What is the M3 receptor responsible for in the bladder?

emptying contractions

involuntary bladder contractions

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1st line treatment for OAB:

behavioral therapy

bladder training
Kegel exercises
dietary restrictions
etc

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Preferred agents for OAB

anticholinergic drugs

Beta-3 agonist

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WHich formulation of anticholinergic agents are preferred?

Extended release agent

less incidence of dry mouth

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

Solifenacin
darifenacin
fesoterodine

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Oxybutynin brands

Ditropan
Oxytrol (patch)
Gelnique (gel)

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Side effects of anticholinergics

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

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OTC anticholinergic product

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

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Oxybutynin dose

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

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Detrol dose

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

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Sanctura

Trospium
20 mg BID
ER: 60 mg daily

Take on an empty stomach

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Vesicare

Solifenacin
5-10 mg daily

More selective agent

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Darifenacin

Enablex

7.5 - 15 mg daily

More selective agent; causes more constipation

Fesoterodine

Toviaz

4-8 mg daily

More selective agent

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

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

Mirabegron brand and MOA

Myrbetriq

Beta 3 agonst: relaxes detrusor muscle and increases bladder capacity

Mirabegron has similar efficacy to anticholinergics (t/f)

TRUE

and causes less dry mouth

Mirabegron dosing

25-50 mg daily

CRcl 15-29: 25 mg

Mirabegron side effects

Hypertension
UTI
HA
constipation
dizziness

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

TRUE

Mirabegron metabolism

Moderate CYP2D6 inhibitor

caution with certain antidepressants, metoprolol, digoxin

3rd line option for OAB

Onabotulinumtoxin A (Botox)

Botox dosing

given intradetrusor 100 units total, injected across 20 different sites given every 12 + weeks

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

TRUE Just don't use AG's

First med approved for adults with nocturia

Desmopressin (Noctiva)

Desmopressin MOA

antidiuretic hormone analog, decreases urine production

Desmopressin warnings

severe hyponatremia can develop due to fluid retention | avoid in pts who are at increased risk fir hyponatremia

Pts who are at increased risk for hyponatremia

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

Desmopression dose

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

Where can the Oxytrol patch be applied?

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

Where can Gelnique be applied?

abdomen upper arms/shoulders thighs

Noctiva storage info

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