T4-Bladder Flashcards
Explain the patho behind peeing.
When the brain wants to send a signal to the bladder to contract, it uses ACh to be released to a M3 receptor in the bladder which causes you to void
What is the MOA for drugs that treat OAB?
You block the ACh, so it never is released to the M3 receptor, so you don’t void
OAB affects ___% of Americans
33
OAB is most prevalent in older populations. What age is it most prevalent for women? men?
women= less than 40 men= greater than 70
T/F: OAB is unpredictable and embarrassing.
True
What are the major symptoms of OAB?
Urgency (sudden urge to go)
Frequency (8+ times/d)
Nocturia (2+ times/night)
Urge incontinence (didn’t make it)
What is the first treatment you do for OAB? second?
Behavioral therapy; Mediations (only started if behavior therapy doesn’t work)
What are examples of behavioral therapy?
Scheduled voiding times (don't drink after a certain time at night) Kegal exercises (strength pelvic floor muscles) Timing fluid intake Avoiding caffeine
What are the 4 medications for OAB?
Tolterodine (NOT M3 selective)
Oxybutynin (crosses BBB easily)
Darifenacin (greatest M3 selectivity)
Solifenacin
Tolterodine, Oxybutynin, Darifenacin, and Solifenacin are also given for _____.
Bladder spasms caused by trauma, UTI, and surgery
*bladder spasms are extremely painful!!
What are the adverse effects of OAB meds?
Dry mouth
Anticholinergic side effects?
Adverse effects: Dry mouth
Why would there be dry mouth for a medication that affects the bladder?!
There are M3 receptors in the salivary glands as well
Adverse effects: When would we see anticholinergic effects?
If the drug isn’t selective to M3 receptors we may see some anticholinergic effects. This doesn’t happen often though bc many drugs are M3 selective
What drug is NOT M3 selective?
Tolterodine
What drug has the greatest M3 selectivity?
Darifenacin
What are 3 ways we can reduce side effects of MOB drugs?
- Use long acting forms (ER, patches)
- Avoid ones that cross the BBB (oxybutynin, patch forms)
- Use drugs that are M3 selective! (Darifenacen is the most M3 selective!)
What are the RARE adverse effects of OAB drugs?
- Anhidrosis
2. Increased intraocular pressure
Rare adverse effect: What is anhidrosis. What is client teaching about this?
Not sweating; sweating is the bodys natural way of helping us cool off. If we get too hot and sweat, and have anhidrosis we could over heat and that can lead to a HEAT STROKE!!! (and rhabdo)
Rare adverse effect: Who should NOT take a OAB drug?
Glaucoma patients since the OAB drugs have a rare effect of Increased intraocular pressure
Client teaching. What are 3 important topics to discuss with patients?
- Dry mouth: sugar free candy is ok to eat, do oral care, and drink sips of H20 throughout the day
- Patches: Keep away from heat sources, put on clean-dry-intact-hair free skin, avoid bony prominence
- Anhidrosis: Be careful about exerting yourself in HOT weather!!!W
Why might the oxybutynin patch be preferred over a tablet?
- Lipid soluble–absorbed through skin
- Absorption=slow and steady–patch produces low but stable blood levels of the drug
- Transdermal absorption bypasses metabolism in the intestinal wall
- Less side effects; well tolerated
Who should NOT take OAB drugs?
Drugs that have anticholinergic effects
- antihistamines
- TCAs
- Phenothiazines
*cause excessive mucarnic blockage if combined
