Urinary Flashcards
what is urinary retention
Inability to voluntary urinate
what is urinary incontinence
Involuntary leakage of urine and can range in severity and nature
what is stress incontinence
onvoluntary leakage on effort e.g sneeze, cough
what is urgency incontinence
involunarty leakage which is preeceeded by a sudden compelling desire to pass urine
what type drugs are used to treat urinary frequency
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
which drug is used in stress incontinence especially in women
treatment of moderate to severe stress incontinence in women only. ant withdraw abruptly
why are MR preps precribed more than immediate release preps of antimuscarinics
MR has less side effects
why is oxybutinin a good antimuscarinic for urinary incontinence
reduces symptoms of urgency and urge incontinence and also increases bladder capacity
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
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
what is a common side effect of desmopressin
hyponatraemia due to too much water dilution
nausea
what is the counselling associated with desmopressin
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
cautions associated with desmopressin
avoid intransal route due to increased side efefcts
limit fluid intake to minimum for 1 hr before desmopressin and 8 hours after
what is the difference between acute and chronic retention
acute- sudden retention medical emergency. very painful and needs immediate catheteristaion
chronic- develops over time. painless. treated surgically or drugs- alpha blockers
what is urinary retention
inability to voluntarily urinate
what is the main cause of urinary retention in men
BPH
Enlarged prostate
can cause complications: renal imapirment or reccurent infection as well as urinary retention
what is the treatment for urinary retention and BPH
ALPHA BLOCKERS: alfuzosin, doxazosin, tamsulosin, prazosin, indoramin, terazosin
side effects of alpha blcokers used for urinary retention and BPH
Drowsiness and driving/skilled performing tasks
drugs used for BPH and retention
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
can finasteride and dutasteride be used in pregnancy and what are the handling requirements for finasteride
both excreted in semen and teratogenic- use condom
women of childbearing potential should avoid handling of curshed or boken caps of finasteride
patient and carer advice for finasteride and dutasteride
both can cause breast cancer- report breast cahangesmen and women
MHRA for finasteride
reports of men experiencing depression or suicidl thoughts in men taking for hair loss (propecia)
stop immediately if depression develops
moa of alpha blockers
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
what is caution with alpha blockers
elderly and pts having cataract surgery- floppy iris syndrome
what conditions are contra-indicated in alpha blocker use
postural hypotension and micturition syncope-fainting on urinating
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
what are the four types of urinary incontinence
stress
urgency
mixed- urgency and stress
overflow
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
which clinical condictiions increase risk of urinary incontinence
lower urinary tract - UTI, Urinary obstruction, oestrogengen deficiency
nervous system conditions- stroke, dementia,
diabaetes or hypercalcaemia
side effects of which drugs can increase occurence of incontinence
drugs causing constipation diuretics alcohol caffine cholinesterase inhibitors
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
what form of oxybutynin can be used if pt cant tolerate oral treatment for urgency incontinence
transdermal oxybutynin
when should IR oxybutynin not be used
frail older women at risk of sudden deterioration in their physical or mental health
what medication can be used in patients who cant tolerate anticholinergics for urinary incontinence
mirabegron
medication of choice in women who have nocturia
desmopressin
what is the treatment for stress incontinence
supervised pelvic muscle training for 3 months
second line = duloxetine if women doesnt wnat surgery
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
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
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
when should use of alpha adrenergic blockers be reviewed when used in urnary retention
after 4-6 weeks then every 6-12 months
in chronic urinary retention what is the treatment
Intermittent catherisation before indwelling catherisation
mod to severe = alpha adrenorector blocker
what is treatment for BPH
Watchful waiting for pts with low symptoms
second- alpha adrenorecptor blocker
moa of alpha adrenoreceptor blockers
alpha 1 adrenorecptor blocker relax smooth muscle in bph produceing increase in urinary flow rate
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
MOA of 5a reductase
inhibits the enzyme 5 alpha reductase which would metabolise testoterone into potent dihydrotesteosterone
most common side ffects of 5a reductase for BPH
sexual dysfunction and decreased libido
male breast cancer- report changes such as discharge
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
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
