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Chapter 7 Genito-urinary system > Urinary > Flashcards

Urinary Flashcards

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
Q

what is overflow incontinence

A

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
Q

what are the four types of urinary incontinence

A

stress
urgency
mixed- urgency and stress
overflow

27
Q

what are risk factors for incontinence in women

A 
obesity
constipation
family
acei causing cough
alpha adrenergic blockers: relax bladder and urethra
lack of supporting tissue
pregnancy
28
Q

which clinical condictiions increase risk of urinary incontinence

A

lower urinary tract - UTI, Urinary obstruction, oestrogengen deficiency
nervous system conditions- stroke, dementia,
diabaetes or hypercalcaemia

29
Q

side effects of which drugs can increase occurence of incontinence

A 
drugs causing constipation
diuretics
alcohol
caffine
cholinesterase inhibitors
30
Q

whta is first line for incontinence for how long and when should it be reviewed

A

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
Q

what form of oxybutynin can be used if pt cant tolerate oral treatment for urgency incontinence

A

transdermal oxybutynin

32
Q

when should IR oxybutynin not be used

A

frail older women at risk of sudden deterioration in their physical or mental health

33
Q

what medication can be used in patients who cant tolerate anticholinergics for urinary incontinence

A

mirabegron

34
Q

medication of choice in women who have nocturia

A

desmopressin

35
Q

what is the treatment for stress incontinence

A

supervised pelvic muscle training for 3 months

second line = duloxetine if women doesnt wnat surgery

36
Q

what is the treatment for mixed incontience

A

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
Q

commoon side effects of antimuscarinics?
when should usage be reviewed when newly started?
pt and carer advice

A

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
Q

what type of drug is required to give to a patient before removing the catheter

A

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
Q

when should use of alpha adrenergic blockers be reviewed when used in urnary retention

A

after 4-6 weeks then every 6-12 months

40
Q

in chronic urinary retention what is the treatment

A

Intermittent catherisation before indwelling catherisation

mod to severe = alpha adrenorector blocker

41
Q

what is treatment for BPH

A

Watchful waiting for pts with low symptoms

second- alpha adrenorecptor blocker

42
Q

moa of alpha adrenoreceptor blockers

A

alpha 1 adrenorecptor blocker relax smooth muscle in bph produceing increase in urinary flow rate

43
Q

when should a 5a reductase inhibitor be used in BPH

A

pt with enlarged prostate, raised PSA and at risk of progression should use a 5a reductase inhibitor such as finasteride or dutasteride

44
Q

MOA of 5a reductase

A

inhibits the enzyme 5 alpha reductase which would metabolise testoterone into potent dihydrotesteosterone

45
Q

most common side ffects of 5a reductase for BPH

A

sexual dysfunction and decreased libido

male breast cancer- report changes such as discharge

46
Q

Side effects of 5a reductase when used for male pattern boldness

A

depression and suicidal thoughts
depression associted with Proscar brand of finasteride
stop finasteride and inform healthcare orofessional if depression/suicidal

47
Q

pt and carere advice associatd with 5a reductase

A

excreted in semen so used a condom

women of childbearing potential should avoid handling crushed or broken tablets

Chapter 7 Genito-urinary system (4 decks)

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