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S3 Case 3 - Musculoskeletal > Pharmaceutical Care of Over Active Bladder (OAB) > Flashcards

Pharmaceutical Care of Over Active Bladder (OAB) Flashcards

1
Q

What is OAB?

A

Squeezes suddenly without you having control + when the bladder is not full

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2
Q

What is urinary frequency?

A

Perceived urination too often during the day
More than 8 voids a day = frequent

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3
Q

What is urgency?

A

Sudden compelling desire to urinate
Difficult delay

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4
Q

What is nocturia?

A

If woken at least once during sleep to urinate

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5
Q

What is enuresis?

A

Involuntary urination at night

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6
Q

When can OAB develop as a result of nerve-or brain-related disease?

A

Following stroke
Parkinson’s disease
Multiple sclerosis
After spinal cord injury

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7
Q

What is OAB associated with?

A

Increased risk of falling + sustaining a fracture

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8
Q

What are the risk factors for urinary incontinence in women?

A

Age
Postmenopausal urogenital changes
Overweight
No. of children
Poor obstetric care

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9
Q

What is the most common cause of lower urinary tract symptoms (LUTS) in men?

A

Benign prostate enlargement (BPH)

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10
Q

What are red flag symptoms in women?

A

Persisting bladder or urethral pain
Palpable bladder
Clinically benign pelvic mass
Associated faecal incontinence
Suspected neurological disease
Symptoms of voiding difficulty

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11
Q

What is the aim of non-pharmacological treatment?

A

Measures to control symptoms should be attempted before any other therapy + encouraged throughout treatment

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12
Q

What is the 1st line treatments?

A

Reduce symptoms by simple lifestyle changes = reduce urinary frequency + increase bladder volume

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13
Q

What are examples of behavioural treatments?

A

Bladder retraining
“Double voiding” = spending extra time at toilet
Biofeedback
Pelvic muscle exercises

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14
Q

What are pelvic muscle exercises?

A

Physical therapy kegel exercises = strengthen pelvic floor muscles = support uterus, bladder, small intestine + rectum

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15
Q

What is some lifestyle advice?

A

Drink enough fluids
Limit intake on fizzy drinks, caffeine + alcohol
Lose weight = BMI over 30
Stop smoking
Limit alcohol consumption

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16
Q

Why must they drink enough fluids?

A

Less H2O = more concentrated = irritation = more chance of infection

17
Q

What is bladder training?

A

1st line = min 6 weeks
Involves = pelvic muscle training, scheduled voiding intervals + distraction/relaxation techniques

18
Q

Before starting treatment what must be explained?

A

Likelihood of success
Adverse effects
Take at least 4 weeks
Long term effects - eg. anticholinergics

19
Q

What must you take in account for women when offering anticholinergics?

A

Coexisting conditions
Current use of other medication
Risk of adverse effects

20
Q

What is first line for pharmacological intervention?

A

Antimuscarinics (anticholinergics)

21
Q

What are examples of anticholinergics?

A

Oxybutynin
Tolterodine
Solifenacin

22
Q

What are the adverse effects of anticholinergics?

A

Constipation
Dizziness
Dry mouth
Vision disorders
Headaches
Urinary disorders

23
Q

What happens if first drug is not well-tolerated?

A

Offer another drug

24
Q

Who do we not offer oxybutynin to?

A

Frail older women
= risk of fall

25
Q

What can be offered instead if oral not tolerated?

A

Transdermal

26
Q

What is anticholinergic load + why is it important?

A

Cumulative effect of taking medication with anticholinergic properties
Lots of other medications have antimuscarinic action

27
Q

What other drugs have antimuscarinic action?

A

TCAs
Sedative antihistamines
Antipsychotics
Anticholinergic respiratory agents
Atropine
Ipratropium bromide

28
Q

What can a high anticholinergic load lead to?

A

Physical + cognitive impairment in older adults = feel side effects more

29
Q

What is Mirabegron?

A

Selective beta3 agonist

30
Q

What is Mirabegron licensed for?

A

Urinary frequency, urgency + urge incontinence associated with OAB

31
Q

When is Mirabegron recommended?

A

Antimuscarinic drugs are contraindicated or clinically ineffective

32
Q

When is Desmopressin considered?

A

To reduce troublesome nocturia in women with UI or OAB

33
Q

When is Desmopressin cautioned?

A

Women with cystic fibrosis
+ those over 65 with cardiovascular disease/hypertension

34
Q

What is Duloxetine?

A

SSRI

35
Q

When do you NOT use Duloxetine as 1st line?

A

Women with predominant stress UI

36
Q

What does duloxetine require?

A

Counselling on adverse effects

37
Q

What is OAB in older women associated with?

A

Falls
Hip fractures
Anxiety/depression
Social isolation
= decrease QoL

38
Q

What is frailty?

A

Decline in physiologic reserves = increase susceptibility to adverse events

S3 Case 3 - Musculoskeletal (14 decks)

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