Urinary Flashcards

(47 cards)

1
Q

what is urinary retention

A

Inability to voluntary urinate

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2
Q

what is urinary incontinence

A

Involuntary leakage of urine and can range in severity and nature

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3
Q

what is stress incontinence

A

onvoluntary leakage on effort e.g sneeze, cough

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4
Q

what is urgency incontinence

A

involunarty leakage which is preeceeded by a sudden compelling desire to pass urine

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5
Q

what type drugs are used to treat urinary frequency

A
antimuscarinics: DOTS
oxybutynin
tolterodine
Darlifenacin
Solfenacin
Then
Propantheline
TCA e.g imipramine
Mirabegron- beta 3 adrenoreceptor however prolongs qt interval
so antimuscarinics first line then
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6
Q

which drug is used in stress incontinence especially in women

A

treatment of moderate to severe stress incontinence in women only. ant withdraw abruptly

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7
Q

why are MR preps precribed more than immediate release preps of antimuscarinics

A

MR has less side effects

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8
Q

why is oxybutinin a good antimuscarinic for urinary incontinence

A

reduces symptoms of urgency and urge incontinence and also increases bladder capacity

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9
Q

what is noncturnal enuresis and what meds are used to treat it
when should it be reviewed and how long should it be used for

A

bed wetting common in children up to 5 years old
non drug- reassurance, advice on fluid intake, reqard systems etc
for children who don’t respond well to treatment they can use the enuresis alram- have lower relaspe rate than drug treatment when discontinued
drug- desmopressin oral or sublingual first line, or imipramine for children who don’t respond
children over 5 shouldnt use alarm
treatment asseseed after 4 weeks and continued for 3 months if effective

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10
Q

what is a common side effect of desmopressin

A

hyponatraemia due to too much water dilution

nausea

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11
Q

what is the counselling associated with desmopressin

A

hyponatraemic convulsions- warn pts to avoid fluid overload- including swimming- and stop desmopressin during an episode of vomiting or diarrhoea which lead to loss of sodium until fluid ballance is normal

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12
Q

cautions associated with desmopressin

A

avoid intransal route due to increased side efefcts

limit fluid intake to minimum for 1 hr before desmopressin and 8 hours after

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13
Q

what is the difference between acute and chronic retention

A

acute- sudden retention medical emergency. very painful and needs immediate catheteristaion
chronic- develops over time. painless. treated surgically or drugs- alpha blockers

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14
Q

what is urinary retention

A

inability to voluntarily urinate

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15
Q

what is the main cause of urinary retention in men

A

BPH
Enlarged prostate
can cause complications: renal imapirment or reccurent infection as well as urinary retention

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16
Q

what is the treatment for urinary retention and BPH

A

ALPHA BLOCKERS: alfuzosin, doxazosin, tamsulosin, prazosin, indoramin, terazosin

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17
Q

side effects of alpha blcokers used for urinary retention and BPH

A

Drowsiness and driving/skilled performing tasks

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18
Q

drugs used for BPH and retention

A

alpha blckers
then
5a reductuase inhibitors e.g finasteride or dutasterides used esp for pts with high risk of progression or raised PSA or enlarged prostate

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19
Q

can finasteride and dutasteride be used in pregnancy and what are the handling requirements for finasteride

A

both excreted in semen and teratogenic- use condom

women of childbearing potential should avoid handling of curshed or boken caps of finasteride

20
Q

patient and carer advice for finasteride and dutasteride

A

both can cause breast cancer- report breast cahangesmen and women

21
Q

MHRA for finasteride

A

reports of men experiencing depression or suicidl thoughts in men taking for hair loss (propecia)
stop immediately if depression develops

22
Q

moa of alpha blockers

A

relax smooth muscle and increase urinary flow rate and improvement in obstruction symptoms
alpha blocker can reduce BP-Pts on anti-hypertensives may reduce dose

23
Q

what is caution with alpha blockers

A

elderly and pts having cataract surgery- floppy iris syndrome

24
Q

what conditions are contra-indicated in alpha blocker use

A

postural hypotension and micturition syncope-fainting on urinating

25
what is overflow incontinence
Bladder not completely emptied and becomes over distended (|swollen sue to pressure on the inside). Leads to frequent loss of small qiantitites of urine
26
what are the four types of urinary incontinence
stress urgency mixed- urgency and stress overflow
27
what are risk factors for incontinence in women
``` obesity constipation family acei causing cough alpha adrenergic blockers: relax bladder and urethra lack of supporting tissue pregnancy ```
28
which clinical condictiions increase risk of urinary incontinence
lower urinary tract - UTI, Urinary obstruction, oestrogengen deficiency nervous system conditions- stroke, dementia, diabaetes or hypercalcaemia
29
side effects of which drugs can increase occurence of incontinence
``` drugs causing constipation diuretics alcohol caffine cholinesterase inhibitors ```
30
whta is first line for incontinence for how long and when should it be reviewed
bladder training for 6 weeks then if not effective: IR Oxybutynin, tolteridine or darifenacin review after 4 weeks if still not effective increase the dose or change to an alternate anticholinergic or MR Oxybuytynin or MR tolteridone, solfenacin, fesoterodine or tropium
31
what form of oxybutynin can be used if pt cant tolerate oral treatment for urgency incontinence
transdermal oxybutynin
32
when should IR oxybutynin not be used
frail older women at risk of sudden deterioration in their physical or mental health
33
what medication can be used in patients who cant tolerate anticholinergics for urinary incontinence
mirabegron
34
medication of choice in women who have nocturia
desmopressin
35
what is the treatment for stress incontinence
supervised pelvic muscle training for 3 months | second line = duloxetine if women doesnt wnat surgery
36
what is the treatment for mixed incontience
bladder training for 6 weeks and supervised pelvic floor muscle training for at least 3 months if frequency is a problem and the training isnt enough then consider drug streatment
37
commoon side effects of antimuscarinics? when should usage be reviewed when newly started? pt and carer advice
dry mouth, dizziness, constipation, urinary retention, blurred vison heightedned with other antimuscarinics should be reviewed within a month of starting to assess response and side effects affects performance of skilled tasts
38
what type of drug is required to give to a patient before removing the catheter
alpha adrenoreceptor blocker should be given at least 2 days before catherisation to manage urinary retention e.g tamsulosin, doxazosin, prazosin, indoramin, terazosin or alfuzosin
39
when should use of alpha adrenergic blockers be reviewed when used in urnary retention
after 4-6 weeks then every 6-12 months
40
in chronic urinary retention what is the treatment
Intermittent catherisation before indwelling catherisation | mod to severe = alpha adrenorector blocker
41
what is treatment for BPH
Watchful waiting for pts with low symptoms | second- alpha adrenorecptor blocker
42
moa of alpha adrenoreceptor blockers
alpha 1 adrenorecptor blocker relax smooth muscle in bph produceing increase in urinary flow rate
43
when should a 5a reductase inhibitor be used in BPH
pt with enlarged prostate, raised PSA and at risk of progression should use a 5a reductase inhibitor such as finasteride or dutasteride
44
MOA of 5a reductase
inhibits the enzyme 5 alpha reductase which would metabolise testoterone into potent dihydrotesteosterone
45
most common side ffects of 5a reductase for BPH
sexual dysfunction and decreased libido | male breast cancer- report changes such as discharge
46
Side effects of 5a reductase when used for male pattern boldness
depression and suicidal thoughts depression associted with Proscar brand of finasteride stop finasteride and inform healthcare orofessional if depression/suicidal
47
pt and carere advice associatd with 5a reductase
excreted in semen so used a condom | women of childbearing potential should avoid handling crushed or broken tablets