Urinary

Question 1

what is urinary retention

Answer 1

Inability to voluntary urinate

Question 2

what is urinary incontinence

Answer 2

Involuntary leakage of urine and can range in severity and nature

Question 3

what is stress incontinence

Answer 3

onvoluntary leakage on effort e.g sneeze, cough

Question 4

what is urgency incontinence

Answer 4

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

Question 5

what type drugs are used to treat urinary frequency

Answer 5

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

Question 6

which drug is used in stress incontinence especially in women

Answer 6

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

Question 7

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

Answer 7

MR has less side effects

Question 8

why is oxybutinin a good antimuscarinic for urinary incontinence

Answer 8

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

Question 9

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

Answer 9

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

Question 10

what is a common side effect of desmopressin

Answer 10

hyponatraemia due to too much water dilution

nausea

Question 11

what is the counselling associated with desmopressin

Answer 11

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

Question 12

cautions associated with desmopressin

Answer 12

avoid intransal route due to increased side efefcts

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

Question 13

what is the difference between acute and chronic retention

Answer 13

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

Question 14

what is urinary retention

Answer 14

inability to voluntarily urinate

Question 15

what is the main cause of urinary retention in men

Answer 15

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

Question 16

what is the treatment for urinary retention and BPH

Answer 16

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

Question 17

side effects of alpha blcokers used for urinary retention and BPH

Answer 17

Drowsiness and driving/skilled performing tasks

Question 18

drugs used for BPH and retention

Answer 18

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

Question 19

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

Answer 19

both excreted in semen and teratogenic- use condom

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

Question 20

patient and carer advice for finasteride and dutasteride

Answer 20

both can cause breast cancer- report breast cahangesmen and women

Question 21

MHRA for finasteride

Answer 21

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

Question 22

moa of alpha blockers

Answer 22

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

Question 23

what is caution with alpha blockers

Answer 23

elderly and pts having cataract surgery- floppy iris syndrome

Question 24

what conditions are contra-indicated in alpha blocker use

Answer 24

postural hypotension and micturition syncope-fainting on urinating

Question 25

what is overflow incontinence

Answer 25

Bladder not completely emptied and becomes over distended (|swollen sue to pressure on the inside). Leads to frequent loss of small qiantitites of urine

Question 26

what are the four types of urinary incontinence

Answer 26

stress urgency mixed- urgency and stress overflow

Question 27

what are risk factors for incontinence in women

Answer 27

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

Question 28

which clinical condictiions increase risk of urinary incontinence

Answer 28

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

Question 29

side effects of which drugs can increase occurence of incontinence

Answer 29

``` drugs causing constipation diuretics alcohol caffine cholinesterase inhibitors ```

Question 30

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

Answer 30

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

Question 31

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

Answer 31

transdermal oxybutynin

Question 32

when should IR oxybutynin not be used

Answer 32

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

Question 33

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

Answer 33

mirabegron

Question 34

medication of choice in women who have nocturia

Answer 34

desmopressin

Question 35

what is the treatment for stress incontinence

Answer 35

supervised pelvic muscle training for 3 months | second line = duloxetine if women doesnt wnat surgery

Question 36

what is the treatment for mixed incontience

Answer 36

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

Question 37

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

Answer 37

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

Question 38

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

Answer 38

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

Question 39

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

Answer 39

after 4-6 weeks then every 6-12 months

Question 40

in chronic urinary retention what is the treatment

Answer 40

Intermittent catherisation before indwelling catherisation | mod to severe = alpha adrenorector blocker

Question 41

what is treatment for BPH

Answer 41

Watchful waiting for pts with low symptoms | second- alpha adrenorecptor blocker

Question 42

moa of alpha adrenoreceptor blockers

Answer 42

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

Question 43

when should a 5a reductase inhibitor be used in BPH

Answer 43

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

Question 44

MOA of 5a reductase

Answer 44

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

Question 45

most common side ffects of 5a reductase for BPH

Answer 45

sexual dysfunction and decreased libido | male breast cancer- report changes such as discharge

Question 46

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

Answer 46

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

Question 47

pt and carere advice associatd with 5a reductase

Answer 47

excreted in semen so used a condom | women of childbearing potential should avoid handling crushed or broken tablets