PHARM_urinary incontinence

Question 1

the sympathetic nervous system activates which receptors to relax the bladder muscle?

Answer 1

Beta-3

Question 2

the SNS activates which receptors to constrict the urethral smooth muscle?

Answer 2

alpha-1

Question 3

the parasympathetic nervous system activates which receptor which causes bladder contraction?

Answer 3

M3

Question 4

the somatic function of the pudendal nerve activates which receptor to constrict the external urethral sphincter?

Answer 4

cholinergic nicotinic

Question 5

blocking what receptors in the salivary glands causes dry mouth?

Answer 5

M1
M3
M4

Question 6

blocking what receptors in cardiac tissue causes tachycardia and palpitations?

Answer 6

M2

Question 7

Blocking what receptors in the eyes causes dry eyes and blurry vision?

Answer 7

M3

M5

Question 8

blocking what receptors in the GI tract causes slowing of transit time (constipation) and has effects on sphincter tone & gastric acid secretion

Answer 8

M1
M2
M3

Question 9

blocking M1, M2, M3, M4, M5 receptors in the brain and CNS has what effects?

Answer 9

effects on memory, cognition and psychomotor speed, confusion, delirium, hallucinations, sleep disruption

Question 10

blocking what receptors in the detrusor muscle of the bladder causes decreased contraction and urinary retention?

Answer 10

M2 (opposes Beta-receptor)

M3 (direct effect)

Question 11

what are some of the peripheral effects of anticholinergic drugs?

Answer 11

dry mouth
mydriasis
constipation
urinary retention
tachycardia

Question 12

what are some of the central effects of anticholinergic drugs?

Answer 12

sedation
confusion/delirium
hallucinations
slowed cognitive function
sleep disruption

Question 13

which antimuscarinic drug used in urinary retention is a quaternary amine and doesn’t cross the BBB?

Answer 13

trospium

Question 14

which antimuscarinic drug has significant M3 selectivity?

Answer 14

darifenacin (but not clinically relevant)

Question 15

all the antimuscarinic drugs used in urinary incontinence are oral except which drug?

Answer 15

trospium

Question 16

all the antimuscarinic drugs have significant CYP metabolism in the liver except which drug?

Answer 16

trospium

Question 17

which antimuscarinic drug has a really short half lives and thus can be given as an ER formulation?

Answer 17

oxybutynin

Question 18

what are some of the adverse effects of antimuscarinics when treating urinary incontinence?

Answer 18

urinary retention, especially in BPH
CV: palpitations, tachycardia and prolonged QTc
GI: mild constipation to severe obstructions (alters absorptions of concurrent oral drugs)

Question 19

what are some of the contraindications to antimuscarinic therapy?

Answer 19

angle closure or narrow-angle glaucoma

• urinary & gastric obstruction
• need for mental alertness
• Alzheimer’s type dementia (can worsen already existing cholinergic deficit)

Question 20

which type of antimuscarinic drug preparation reduces the risk of dry mouth without any apparent loss of efficacy?

Answer 20

ER delivery

Question 21

the urothelium acts on ___________ receptors to sensitize mechanoreceptive affarent nerve endings.

Answer 21

NK2

Question 22

which sympathomimetic drug has significant CYP3A4 metabolism and works on beta-3 receptors to increase bladder capacity by relaxing detrusor s.m.?

Answer 22

mirabegron

Question 23

what happens when you take mirabegron with food?

Answer 23

you decrease the bioavailability

Question 24

which sympathomimetic has a very long half-life?

Answer 24

mirabegron

Question 25

what happens to the urinary excretion of pseudoephedrine & ephedrine when the urine becomes more acidic?

Answer 25

increases the urinary excretion of pseudoephedrine and ephedrine

Question 26

what are some of the adverse effects of mirabegron?

Answer 26

increased BP | tachycardia

Question 27

what are some of the adverse effects of pseudoephedrine and ephedrine?

Answer 27

HTN, tachyarrhythmia, A-fib -insomnia symptoms of CNS stim *MAOI interaction

Question 28

name a drug that is used to strengthen the cholinergic-mediated detrussor muscle contraction.

Answer 28

neostigmine

Question 29

how frequently is neostigmine administered?

Answer 29

several times a day

Question 30

neostigmine MOA

Answer 30

inhibits Acetylcholinesterase, augments action of ACh at both muscarinic and nicotinic receptors

Question 31

what are some of the adverse effects of neostigmine?

Answer 31

``` AV block bradyarrhythmia cardiac arrest cardiac dysrhythmia hypotension syncope tachycardia (responsive to hypotension) ```

Question 32

describe the adverse effects of opiates?

Answer 32

urinary retention | -mediated by mu & delta receptors in sacral cord inhibiting parasympathetic outlfow and hence detrussor activation

Question 33

how do you reverse the detrusor relaxation?

Answer 33

opiate antagonists, although reversal of analgesia

Question 34

which CYP enzyme metabolizes mirabegron?

Answer 34

CYP3A4

Question 35

about how long is the half-life of mirabegron?

Answer 35

about 50 hours