urinary incontinence Flashcards
types of urinary incontinence
functional
urge
stress
overflow
mixed
what is functional incontinence
inability to use the toilet
mostly in limited mobility ex broken hip, or mental status changes ex dementia
how is functional incontinence treated
mostly use of urinary incontinence supplies: undergarments, pads to protect clothing etc
can use skin protectants like barrier ointments for skin irritation, but if pressure ulcers need to see PCP
what is urge incontinence
inability to delay voiding= sudden loss of large volume of urine, feels a strong urgency
treatment options for urge incontinence include what 3 drug classes
anticholinergics
beta 3 agonists
TCAs
what is stress incontinence
usually women– loss of a small volume of urine upon coughing, sneezing, laughing etc
what are treatment options for stress incontinence
topical estrogens
duloxetine
sudafed
what is overflow incontinence
constantly losing small volume of urine– there is residual urine, distended bladder, sense of incomplete voiding
what are treatment options for overflow incontinence
cholinergics (rarely)
alpha 1 antagonists
what are some drugs that can CAUSE urinary incontinence
ACE inhibitors
diuretics
lithium
alpha adrenergic agonists: decongestants
and alpha adrenergic antagonists
anticholinergics
calcium channel blockers
narcotics
sedatives, ex benzos
what are the B3 agonists
mirabegron
vibegron
mirabegron dosing considerations
renally adjust
mirabegron pearl
do not use in severe uncontrolled hypertension (180/110)
emphasize need for periodic BP monitoring
B3 agonists side effects
nasopharyngitis, UTIs, etc
mirabegron increases blood pressure
TCA for urge incontinence, and when do we use it?
imipramine
we reserve it for patients with additional indications like depression
imipramine side effects
EKG changes, orthostatic hypotension
which anticholinergics are not recommended for urge incontinence
flavoxate
propantheline
not effective and high incidence of AEs
what is the gold standard drug for urge incontinence, and the other first lines
IR oxybutynin is gold standard
ER oxybutynin is alternative first line
tolterodine can be considered 1st line as well
what are all of the anticholinergics for urge incontinence
oxybutynin in its various forms
tolterodine
trospium chloride
solifenacin succinate
darifenacin ER
fesoterodine fumarate
which anticholinergic needs to be taken on an empty stomach
trospium
how to use oxybutynin patch
apply 2x weekly to stomach, hips or butt
how to use oxybutynin gel
apply daily to stomach, thigh, or upper arm
rotate the site
tolterodine drug interacts
separate from antacids
which anticholinergic needs to be renally dosed
fesoterodine
which anticholinergic interacts with CYP inhibitors like ketoconazole, itraconazole, clarithromycin
fesoterodine
what to know for estrogens for stress incontinence
only TOPICAL
best if patient with urethritis or vaginitis due to estrogen deficiency
works in 4-6 weeks
ORAL NOT RECOMMENDED
duloxetine pearls
serotonin & norepi reuptake inhibitor
if stopping, decrease by 50% for 2 weeks before dc
causes sleep disturbance
what is the cholinergic for overflow incontinence (rarely used)
bethanechol
