Pharm - Urinary Incontinence

Question 1

What are the goals of therapy for urge incontinence?

Answer 1

• reduce avg # of urinary incontinence episodes per day
• decrease # of micturition per day
• increase urine volume voided per micturition
• improve quality of life

Question 2

MOA of antimuscarinics for tx of urinary incontinence

Answer 2

Antagonize muscarinic receptors and suppress mature detrusor contractions, enhance bladder storage

Question 3

MOA of mirabegron (Myrbetriq) for tx of urinary incontinence

Answer 3

• B2-adrenergic agonist
• beta-e receptors play role in relaxing smooth muscle in the bladder
• increases bladder capacity by relaxing the detrusor muscle during storage phase of urinary bladder fill-void cycle by activation of B3-adrenergic receptors

Question 4

ADR of antimuscarinic drugs

Answer 4

• related to anticholinergic activity: dry mouth, constipation, HA, dry eyes, blurred vision, cognitive impairment, tachycardia, sedation, orthostatic hypotension
• topicals: erythema, pruritus at application site

Question 5

Contraindications to antimuscarinic drugs

Answer 5

• urinary retention, gastric retention, severely decreased GI motility, angioedema, myasthenia gravis, uncontrolled narrow angle glaucoma
• mental status changes (risk of fall in elderly or frail)
• worsening renal/hepatic condition

Question 6

1st generation antimuscarinic agents used to treat urinary incontinence

Answer 6

1st gen: oxybutynin, tolterodine, fesoterodine

Question 7

2nd generation antimuscarinic agents used to treat urinary incontinence

Answer 7

2nd gen: trospium, solifenacin, darifenacin

*these are less likely to impact CNS

Question 8

Role of vaginal estrogens in tx of stress incontinence

Answer 8

Used in peri- or post-menopausal women with either stress or urgency incontinence and vaginal atrophy

• best dosage form is topical
• may take up to 3 months to notice benefit

Question 9

Tx for urinary incontinence

Answer 9

• 1st line is lifestyle
• in stress UI: pelvis floor muscle training, NOT systemic pharm
• for mixed UI: pelvis floor training with bladder training
• for urgency UI: pharm management if bladder training unsuccessful
• weight loss and exercise are recommended

Question 10

Urgency UI pharm management

Answer 10

• anticholinergic/antimuscarinic are 1st line

- Mirabegron is an alternative for pts who can’t tolerate 1st line or have contraindications to them

Question 11

Contraindications for urinary incontinence products

Answer 11

Antimuscarinics: all products interact with potent CYP3A4 products (ketoconazole, itraconazole, clarithromycin, ritonavir)

Mirabegron: do NOT use in patients with severe or uncontrolled HTN.