T4-Bladder

Question 1

Explain the patho behind peeing.

Answer 1

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

Question 2

What is the MOA for drugs that treat OAB?

Answer 2

You block the ACh, so it never is released to the M3 receptor, so you don’t void

Question 3

OAB affects ___% of Americans

Answer 3

33

Question 4

OAB is most prevalent in older populations. What age is it most prevalent for women? men?

Answer 4

women= less than 40
men= greater than 70

Question 5

T/F: OAB is unpredictable and embarrassing.

Answer 5

True

Question 6

What are the major symptoms of OAB?

Answer 6

Urgency (sudden urge to go)
Frequency (8+ times/d)
Nocturia (2+ times/night)
Urge incontinence (didn’t make it)

Question 7

What is the first treatment you do for OAB? second?

Answer 7

Behavioral therapy; Mediations (only started if behavior therapy doesn’t work)

Question 8

What are examples of behavioral therapy?

Answer 8

Scheduled voiding times (don't drink after a certain time at night)
Kegal exercises (strength pelvic floor muscles)
Timing fluid intake
Avoiding caffeine

Question 9

What are the 4 medications for OAB?

Answer 9

Tolterodine (NOT M3 selective)
Oxybutynin (crosses BBB easily)
Darifenacin (greatest M3 selectivity)
Solifenacin

Question 10

Tolterodine, Oxybutynin, Darifenacin, and Solifenacin are also given for _____.

Answer 10

Bladder spasms caused by trauma, UTI, and surgery

*bladder spasms are extremely painful!!

Question 11

What are the adverse effects of OAB meds?

Answer 11

Dry mouth

Anticholinergic side effects?

Question 12

Adverse effects: Dry mouth

Why would there be dry mouth for a medication that affects the bladder?!

Answer 12

There are M3 receptors in the salivary glands as well

Question 13

Adverse effects: When would we see anticholinergic effects?

Answer 13

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

Question 14

What drug is NOT M3 selective?

Answer 14

Tolterodine

Question 15

What drug has the greatest M3 selectivity?

Answer 15

Darifenacin

Question 16

What are 3 ways we can reduce side effects of MOB drugs?

Answer 16

1. Use long acting forms (ER, patches)
2. Avoid ones that cross the BBB (oxybutynin, patch forms)
3. Use drugs that are M3 selective! (Darifenacen is the most M3 selective!)

Question 17

What are the RARE adverse effects of OAB drugs?

Answer 17

1. Anhidrosis

2. Increased intraocular pressure

Question 18

Rare adverse effect: What is anhidrosis. What is client teaching about this?

Answer 18

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)

Question 19

Rare adverse effect: Who should NOT take a OAB drug?

Answer 19

Glaucoma patients since the OAB drugs have a rare effect of Increased intraocular pressure

Question 20

Client teaching. What are 3 important topics to discuss with patients?

Answer 20

1. Dry mouth: sugar free candy is ok to eat, do oral care, and drink sips of H20 throughout the day
2. Patches: Keep away from heat sources, put on clean-dry-intact-hair free skin, avoid bony prominence
3. Anhidrosis: Be careful about exerting yourself in HOT weather!!!W

Question 21

Why might the oxybutynin patch be preferred over a tablet?

Answer 21

• 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

Question 22

Who should NOT take OAB drugs?

Answer 22

Drugs that have anticholinergic effects

• antihistamines
• TCAs
• Phenothiazines

*cause excessive mucarnic blockage if combined