Pharmaceutical Care of Over Active Bladder (OAB) Flashcards
What is OAB?
Squeezes suddenly without you having control + when the bladder is not full
What is urinary frequency?
Perceived urination too often during the day
More than 8 voids a day = frequent
What is urgency?
Sudden compelling desire to urinate
Difficult delay
What is nocturia?
If woken at least once during sleep to urinate
What is enuresis?
Involuntary urination at night
When can OAB develop as a result of nerve-or brain-related disease?
Following stroke
Parkinson’s disease
Multiple sclerosis
After spinal cord injury
What is OAB associated with?
Increased risk of falling + sustaining a fracture
What are the risk factors for urinary incontinence in women?
Age
Postmenopausal urogenital changes
Overweight
No. of children
Poor obstetric care
What is the most common cause of lower urinary tract symptoms (LUTS) in men?
Benign prostate enlargement (BPH)
What are red flag symptoms in women?
Persisting bladder or urethral pain
Palpable bladder
Clinically benign pelvic mass
Associated faecal incontinence
Suspected neurological disease
Symptoms of voiding difficulty
What is the aim of non-pharmacological treatment?
Measures to control symptoms should be attempted before any other therapy + encouraged throughout treatment
What is the 1st line treatments?
Reduce symptoms by simple lifestyle changes = reduce urinary frequency + increase bladder volume
What are examples of behavioural treatments?
Bladder retraining
“Double voiding” = spending extra time at toilet
Biofeedback
Pelvic muscle exercises
What are pelvic muscle exercises?
Physical therapy kegel exercises = strengthen pelvic floor muscles = support uterus, bladder, small intestine + rectum
What is some lifestyle advice?
Drink enough fluids
Limit intake on fizzy drinks, caffeine + alcohol
Lose weight = BMI over 30
Stop smoking
Limit alcohol consumption
Why must they drink enough fluids?
Less H2O = more concentrated = irritation = more chance of infection
What is bladder training?
1st line = min 6 weeks
Involves = pelvic muscle training, scheduled voiding intervals + distraction/relaxation techniques
Before starting treatment what must be explained?
Likelihood of success
Adverse effects
Take at least 4 weeks
Long term effects - eg. anticholinergics
What must you take in account for women when offering anticholinergics?
Coexisting conditions
Current use of other medication
Risk of adverse effects
What is first line for pharmacological intervention?
Antimuscarinics (anticholinergics)
What are examples of anticholinergics?
Oxybutynin
Tolterodine
Solifenacin
What are the adverse effects of anticholinergics?
Constipation
Dizziness
Dry mouth
Vision disorders
Headaches
Urinary disorders
What happens if first drug is not well-tolerated?
Offer another drug
Who do we not offer oxybutynin to?
Frail older women
= risk of fall
What can be offered instead if oral not tolerated?
Transdermal
What is anticholinergic load + why is it important?
Cumulative effect of taking medication with anticholinergic properties
Lots of other medications have antimuscarinic action
What other drugs have antimuscarinic action?
TCAs
Sedative antihistamines
Antipsychotics
Anticholinergic respiratory agents
Atropine
Ipratropium bromide
What can a high anticholinergic load lead to?
Physical + cognitive impairment in older adults = feel side effects more
What is Mirabegron?
Selective beta3 agonist
What is Mirabegron licensed for?
Urinary frequency, urgency + urge incontinence associated with OAB
When is Mirabegron recommended?
Antimuscarinic drugs are contraindicated or clinically ineffective
When is Desmopressin considered?
To reduce troublesome nocturia in women with UI or OAB
When is Desmopressin cautioned?
Women with cystic fibrosis
+ those over 65 with cardiovascular disease/hypertension
What is Duloxetine?
SSRI
When do you NOT use Duloxetine as 1st line?
Women with predominant stress UI
What does duloxetine require?
Counselling on adverse effects
What is OAB in older women associated with?
Falls
Hip fractures
Anxiety/depression
Social isolation
= decrease QoL
What is frailty?
Decline in physiologic reserves = increase susceptibility to adverse events
