Overactive bladder Flashcards
What are the different forms of urinary incontinence?
What goes wrong in overactive bladder?
What are treatments for it?
Urge is associated with neuropathy, Stress is urine leaks out during any exertion, mixed is both, functional is cognitive or social or physical but no abnormality. Overflow is often caused by BPH.
Detrusor muscle is store and expel muscle and it goes bad, parasympathetic, acetylcholine acting on muscarinic receptors. Inappropriate stimulation causing involuntary contractions. M3 receptor emptying contractions as well as involuntary bladder contractions.
Behavioral therapies are 1st line, kegel exercises (pelvic floor muscle), can also use anticholinergic and beta 3 receptor exercises.
What to know about the anticholinergic drugs?
What to know about Oxybutynin?
What to know about trospium and solifenacin?
Also called antimuscarinic. Extended-release formulations are preferred due to a lower rate of dry mouth, drugs more selective for M3 have fewer CNS side effects and beers criteria recommended avoiding these.
IR, Xl (Ditropan XL), Patch (Oxytrol RX and OTC). CI’d in narrow angle glaucoma, watch for agitation, confusion, drowsiness, dizziness, blurred vision, caution if performing mental alertness tasks.Dizziness, drowsiness greatest with oxybutynin, xerostomia, constipation, ditropan XL is an OROS formulation, Patch and gel cause less dry mouth. OTC available for women.
Solifenacin is Vesicare, Trospium needs to be taken on an empty stomach.
How do you manage dry mouth?
What is the beta 3 agonist that helps and what to know about it?
What to know about nocturia treatment?
try ER formulations, try gel or patch of oxybutynin, mirabegron has a lower incidence of dry mouth. Avoid mouthwashes with alcohol, suck on ice chips or sugar free candy or chew sugar free gum to help with dry mouth.
Mirabegron, Watch for hypertension, it relaxes the detrusor muscle. Causes less dry mouth.
Desmopressin is treatment. Monitor serum Na and BBW of hyponatremia.
