Overactive Bladder Flashcards
Incontinence
lack of control in urination (about 1/3 of pts with OAB experience incontinence)
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
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
What is the M3 receptor responsible for in the bladder?
emptying contractions
involuntary bladder contractions
1st line treatment for OAB:
behavioral therapy
bladder training
Kegel exercises
dietary restrictions
etc
Preferred agents for OAB
anticholinergic drugs
Beta-3 agonist
WHich formulation of anticholinergic agents are preferred?
Extended release agent
less incidence of dry mouth
Agents that are more selective for the M3 receptor have fewer CNS side effects. What agents are selective?
Solifenacin
darifenacin
fesoterodine
Oxybutynin brands
Ditropan
Oxytrol (patch)
Gelnique (gel)
Side effects of anticholinergics
dizziness and drowsiness (less with selective agents) dry mouth constipation dry eyes/blurred vision urinary retention
OTC anticholinergic product
Oxytrol for women
oxybutynin patch for women 18+ y/o
1 patch every 4 days
Oxybutynin dose
IR: 5 mg BID-TID
XL: 5-30 mg daily
Detrol dose
tolterodine
IR: 1-2 mg BID
ER: 2-4 mg daily
Sanctura
Trospium
20 mg BID
ER: 60 mg daily
Take on an empty stomach
Vesicare
Solifenacin
5-10 mg daily
More selective agent
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
