Urinary Incont Flashcards
•T/F The primary motor input to the detrusor muscle comes from the S2-S4 spinal cord
• TRUE
• What nerve impulses travel along the efferent fibers of the pelvic nerve?
• Parasympathetic
Voluntary and Involuntary contractions of the detruser muscle are controlled by ________.
• Acetylcholine
- at Muscarinic receptors
- What is the receptor M2/M3 muscarinic ratio for bsmooth muscle of the bladder?
- What receptor is responsible for Emptying the Bladder?
• 3:1
• M3
* Most meds are Antimuscarinic Anti-M3*
Types of Incontinence
• Urethral blockage - unable to empty bladder
- Relaxed pelvic floor - increased abdominal pressure
- Bladder hypersensitivity (infection/ Neuro)
- Overflow (uncommon)
- Stress (uncommon in men)
- Urge
• What is the cornerstone of Urinary Incontinence Tx?
• Non-Pharm and Non-Surgical
• What is a secondary cause of Overflow Incontinence?
• BPH or Prostate cancer
• What are 3 ways to Tx SUI?
1) alpha adrenergic relaxes the bladder neck
2) Enhance support for urethral epithelium
3) Uses serotonin and Norepinephrine in the micturition reflex
T/F: Alpha adrenergic blockers like Terazosin, Doxazosin, Tamsulosin, Alfuzosin, and Silodosin relieve SUI symptoms?
• False
- Alpha adrenergic blockers agitate SUI
• What are the 2 Urge Urinary Incontinence for overactive bladder?
- Frequency (8+/ day)
* Urgency
• _____/______ drugs are proven to be most effective in UUI, by suppressing premature detrusor contractions, and enhance storage
• Anticholinergic / Antispasmodic
- 1st Line Meds for UUI?
* 2nd Line Meds for UUI?
- Darifenacin, Fesoterodine, Oxybutynin, Solifenacin, Tolterodine
- Trospium
- What is 1st Line Tx for Overactive Bladder in Adults
* What is 2nd Line Tx for Overactive Bladder in Adults
- Behavioral treatment
* Oral antimuscarinics (Darifenacin, Fesoterodine, Oxybutynin, Solifenacin, Tolterodine)
RED COLOR
* Physical Therapy is used for ____/_____.
• Gait / Strength training
RED COLOR
* What are 3 other non-pharm management?*
- Habit retraining
- Bladder training
- PFMT
T/F: Can you treat UUI with Tricyclic antidepressants?
• True
- Imipramine, Nortriptyline, Desimpramine, Doxepin
• What are Adverse Effects of Anticholinergic/ Antimuscarinic drugs?
- UI/GI retention
- Angioedema
- Myasthenia Gravis
- Narrow Angle Glaucoma
- AMS in elderly
- What Beta 3 medication acts on the bladder smooth muscle (relaxes)
- Why is attractive?
- Mirabegron
* Lacks cognitive side effects that cholinergic agents have
• What is a major adverse effect of Mirabegron?
• Increase BP
T/F: Mirabegron is metabolized CYP2D6 enzymes?
• True
* begron has 6 letters*
- What medication temporarily paralyzes muscle?
* Used in Detrusor muscle overactivity from neurologic conditions or overactive bladder?
• Botulism injections
- Lasts 6-8 months
- ADEs seem 3-7 days after injection
• What are the 3 goals for SUI treatment?
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
T/F: is Duloxetine approved to use in the US to increase urethral sphincter muscle tone?
False: only approved for use in Europe
• What are side effects of Alpha adrenergic meds for SUI?
• HTN • HA • Xerostomia • Stroke (w/ Phenylpropanolamine) • Insomnia • Restlessness * Dont use in narrow-angle glaucoma*
T/F: can you use Estrogen-vaginal applications or Imipramine (pediatric bedwetter) for SUI
TRUE
• What can you use for Overflow (Atonic Bladder)?
• Bethanecol (Cholinergic)
BPH treatments
