urinary incontinence

Question 1

types of urinary incontinence

Answer 1

functional
urge
stress
overflow
mixed

Question 2

what is functional incontinence

Answer 2

inability to use the toilet
mostly in limited mobility ex broken hip, or mental status changes ex dementia

Question 3

how is functional incontinence treated

Answer 3

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

Question 4

what is urge incontinence

Answer 4

inability to delay voiding= sudden loss of large volume of urine, feels a strong urgency

Question 5

treatment options for urge incontinence include what 3 drug classes

Answer 5

anticholinergics
beta 3 agonists
TCAs

Question 6

what is stress incontinence

Answer 6

usually women– loss of a small volume of urine upon coughing, sneezing, laughing etc

Question 7

what are treatment options for stress incontinence

Answer 7

topical estrogens
duloxetine
sudafed

Question 8

what is overflow incontinence

Answer 8

constantly losing small volume of urine– there is residual urine, distended bladder, sense of incomplete voiding

Question 9

what are treatment options for overflow incontinence

Answer 9

cholinergics (rarely)
alpha 1 antagonists

Question 10

what are some drugs that can CAUSE urinary incontinence

Answer 10

ACE inhibitors
diuretics
lithium
alpha adrenergic agonists: decongestants
and alpha adrenergic antagonists
anticholinergics
calcium channel blockers
narcotics
sedatives, ex benzos

Question 11

what are the B3 agonists

Answer 11

mirabegron
vibegron

Question 12

mirabegron dosing considerations

Answer 12

renally adjust

Question 13

mirabegron pearl

Answer 13

do not use in severe uncontrolled hypertension (180/110)

emphasize need for periodic BP monitoring

Question 14

B3 agonists side effects

Answer 14

nasopharyngitis, UTIs, etc

mirabegron increases blood pressure

Question 15

TCA for urge incontinence, and when do we use it?

Answer 15

imipramine
we reserve it for patients with additional indications like depression

Question 16

imipramine side effects

Answer 16

EKG changes, orthostatic hypotension

Question 17

which anticholinergics are not recommended for urge incontinence

Answer 17

flavoxate
propantheline
not effective and high incidence of AEs

Question 18

what is the gold standard drug for urge incontinence, and the other first lines

Answer 18

IR oxybutynin is gold standard
ER oxybutynin is alternative first line

tolterodine can be considered 1st line as well

Question 19

what are all of the anticholinergics for urge incontinence

Answer 19

oxybutynin in its various forms
tolterodine
trospium chloride
solifenacin succinate
darifenacin ER
fesoterodine fumarate

Question 20

which anticholinergic needs to be taken on an empty stomach

Answer 20

trospium

Question 21

how to use oxybutynin patch

Answer 21

apply 2x weekly to stomach, hips or butt

Question 22

how to use oxybutynin gel

Answer 22

apply daily to stomach, thigh, or upper arm
rotate the site

Question 23

tolterodine drug interacts

Answer 23

separate from antacids

Question 24

which anticholinergic needs to be renally dosed

Answer 24

fesoterodine

Question 25

which anticholinergic interacts with CYP inhibitors like ketoconazole, itraconazole, clarithromycin

Answer 25

fesoterodine

Question 26

what to know for estrogens for stress incontinence

Answer 26

only TOPICAL
best if patient with urethritis or vaginitis due to estrogen deficiency
works in 4-6 weeks
ORAL NOT RECOMMENDED

Question 27

duloxetine pearls

Answer 27

serotonin & norepi reuptake inhibitor
if stopping, decrease by 50% for 2 weeks before dc
causes sleep disturbance

Question 28

what is the cholinergic for overflow incontinence (rarely used)

Answer 28

bethanechol