Urinary Incont

Question 1

•T/F The primary motor input to the detrusor muscle comes from the S2-S4 spinal cord

Answer 1

• TRUE

Question 2

• What nerve impulses travel along the efferent fibers of the pelvic nerve?

Answer 2

• Parasympathetic

Question 3

Voluntary and Involuntary contractions of the detruser muscle are controlled by ________.

Answer 3

• Acetylcholine

- at Muscarinic receptors

Question 4

• What is the receptor M2/M3 muscarinic ratio for bsmooth muscle of the bladder?
• What receptor is responsible for Emptying the Bladder?

Answer 4

• 3:1
• M3
* Most meds are Antimuscarinic Anti-M3*

Question 5

Types of Incontinence
• Urethral blockage - unable to empty bladder

• Relaxed pelvic floor - increased abdominal pressure
• Bladder hypersensitivity (infection/ Neuro)

Answer 5

• Overflow (uncommon)
• Stress (uncommon in men)
• Urge

Question 6

• What is the cornerstone of Urinary Incontinence Tx?

Answer 6

• Non-Pharm and Non-Surgical

Question 7

• What is a secondary cause of Overflow Incontinence?

Answer 7

• BPH or Prostate cancer

Question 8

• What are 3 ways to Tx SUI?

Answer 8

1) alpha adrenergic relaxes the bladder neck
2) Enhance support for urethral epithelium
3) Uses serotonin and Norepinephrine in the micturition reflex

Question 9

T/F: Alpha adrenergic blockers like Terazosin, Doxazosin, Tamsulosin, Alfuzosin, and Silodosin relieve SUI symptoms?

Answer 9

• False

- Alpha adrenergic blockers agitate SUI

Question 10

• What are the 2 Urge Urinary Incontinence for overactive bladder?

Answer 10

• Frequency (8+/ day)

* Urgency

Question 11

• _____/______ drugs are proven to be most effective in UUI, by suppressing premature detrusor contractions, and enhance storage

Answer 11

• Anticholinergic / Antispasmodic

Question 12

• 1st Line Meds for UUI?

* 2nd Line Meds for UUI?

Answer 12

• Darifenacin, Fesoterodine, Oxybutynin, Solifenacin, Tolterodine
• Trospium

Question 13

• What is 1st Line Tx for Overactive Bladder in Adults

* What is 2nd Line Tx for Overactive Bladder in Adults

Answer 13

• Behavioral treatment

* Oral antimuscarinics (Darifenacin, Fesoterodine, Oxybutynin, Solifenacin, Tolterodine)

Question 14

RED COLOR

* Physical Therapy is used for ____/_____.

Answer 14

• Gait / Strength training

Question 15

RED COLOR

* What are 3 other non-pharm management?*

Answer 15

• Habit retraining
• Bladder training
• PFMT

Question 16

T/F: Can you treat UUI with Tricyclic antidepressants?

Answer 16

• True

- Imipramine, Nortriptyline, Desimpramine, Doxepin

Question 17

• What are Adverse Effects of Anticholinergic/ Antimuscarinic drugs?

Answer 17

• UI/GI retention
• Angioedema
• Myasthenia Gravis
• Narrow Angle Glaucoma
• AMS in elderly

Question 18

• What Beta 3 medication acts on the bladder smooth muscle (relaxes)
• Why is attractive?

Answer 18

• Mirabegron

* Lacks cognitive side effects that cholinergic agents have

Question 19

• What is a major adverse effect of Mirabegron?

Answer 19

• Increase BP

Question 20

T/F: Mirabegron is metabolized CYP2D6 enzymes?

Answer 20

• True

* begron has 6 letters*

Question 21

• What medication temporarily paralyzes muscle?

* Used in Detrusor muscle overactivity from neurologic conditions or overactive bladder?

Answer 21

• Botulism injections

• Lasts 6-8 months
• ADEs seem 3-7 days after injection

Question 22

• What are the 3 goals for SUI treatment?

Answer 22

1) improve urethral closure by alpha adrenergic receptors on smooth muscle.
2) Enhance support of urethral epithelium
3) Enhance serotonin and norepinephrine effect of the micturition reflex

Question 23

T/F: is Duloxetine approved to use in the US to increase urethral sphincter muscle tone?

Answer 23

False: only approved for use in Europe

Question 24

• What are side effects of Alpha adrenergic meds for SUI?

Answer 24

• HTN
• HA
• Xerostomia
• Stroke (w/ Phenylpropanolamine)
• Insomnia
• Restlessness
* Dont use in narrow-angle glaucoma*

Question 25

T/F: can you use Estrogen-vaginal applications or Imipramine (pediatric bedwetter) for SUI

Answer 25

TRUE

Question 26

• What can you use for Overflow (Atonic Bladder)?

Answer 26

• Bethanecol (Cholinergic)

BPH treatments