Urinary Incontinence Flashcards
Why is UI higher is women than men?
- pregnancy/childbirth
- menopause
What type of UI is most common in men?
urge incontinence
What type of UI is most common in women?
stress incontinenece
What can UI lead to?
- rashes
- pressure ulcers
- UTIs
Where is urine made?
kidneys
Where is urine stored?
bladder
Which muscle surrounds the bladder and helps empty the bladder?
detrusor muscle
Where is the involuntary sphincter?
internal at the base of the bladder
Where is the voluntary sphincter?
external surrounds urethra
Which type of NT and receptor is responsible for detrusor muscle contraction?
NT- Ach
M3 receptor
At what volume does the detrusor muscle begin to contract and the internal sphincter begins to relax?
~200mL
At what volume does the detrusor muscle begin to force open the internal?
~500mL
What is the last thing that stops urination from occurring?
external sphincter
What are risk factors for UI?
- female
- > 40 y/o
- overweight
- smoking
- family history (urge)
- other comorbid conditions
What are the transient causes of UI?
- Delirium
- Infection (UTI)
- Atrophic urethritis/ vaginitis
- Pharmaceuticals
- Psychological (depression)
- Excessive urine output (HF/ hyperglycemia
- Restricted mobility
- Stool impaction
What foods/ drinks can contribute to UI?
- alcohol
- caffeine
- carbonated drinks
- artificial sweeteners
- chocolate
- spicy
- citrus/acidic food
- diuretics, sedatives,laxatives
- large doses of vit. C
What drugs can cause UI?
- diuretics
- psychotropics
- narcotics
- alpha blockers
- CCBs
- anticholinergics
- alpha agonist
- beta agonist
What can cause persistent UI?
- pregnancy
- childbirth
- menopause
- hysterectomy
- enlarged prostate
- obstruction
- neurologic disorder
What is urge incontinence?
“bladder overactivity” involuntary loss of urine
What is urge incontinence related to?
uninhibited detrusor muscle
What are the s/s of urge incontinence?
- urgency
- > 8 voids/day
- > 1 void/ night
- enuresis (bed wetting)
What are risk factors for urge incontinence?
- increased age
- neurologic disease
- diabetes
- smoking
What is stress incontinence?
urethral under activity; urethral/ external sphincter and/or bladder neck weakness; small amounts of urine loss during intra-abdominal pressure increases
What are risk factors for stress incontinence?
- pregnant/ childbirth
- menopause
- atrophic vaginities
- increased age
- obesity
What are s/s of stress incontinence?
- incontinence while sneezing, coughing, laughing, bending,etc
- NO incontinence while sleeping
What is overflow incontinence?
urethral overactivity and bladder underactivity; bladder becomes overly full but person has no urge to urinate
What are common causes of overflow incontinence?
- bladder outlet obstruction (BPH, neoplasm)
- diabetic neuropathy
- spinal cord injuries
- multiple sclerosis
- hysterectomy
What are s/s of overflow incontinence?
- lower abdominal fullness
- hesitancy, straining, decreased force of the stream
- incomplete bladder emptying
- frequency/urgency
- increased post-void residual
What is functional incontinence?
inability of a normally continent person to reach the toilet in time to avoid accident
What are s/s of functional incontinence?
accidents on the way to the toilet and early morning
What is the most common type of mixed incontinence in older women?
stress +urge
What are first-line therapies for UI?
- avoid trigger foods/ drinks
- weight reduction (stress/urge)
- smoking cessation
- avoid meds that exacerbate incontinence
- schedule voiding
6, pelvic floor exercises (stress/urge)
What nonpharm therapies can be used for women with stress incontinence?
- vaginal weight training
- pessaries/ bladder neck support
What pharm agents are used for stress incontinence (off-label)?
- intravaginal estrogens
- adrenergic agonists
- duloxetine
- vaginal pessary/ urethral insert
- surgery
What is the MOA of vaginal estrogens?
treat atrophic vaginitis and increase urethral tone
What are SEs with intravaginal estrogens?
- spotting
- breast tenderness
- nausea
What role do adrenergic agonists have in stress UI?
situationally prn
What adrenergic agonists are used for UI?
- pseudoephedrine
- phenylephrine
What is the MOA of adrenergic agonists for UI?
alpha-1 mediated smooth muscle contraction of the bladder neck and urethra to improve tone
What are SEs to adrenergic agonists?
- dizziness
- increased BP
- insomnia
- headache
What are CIs to adrenergic agonists?
- HTN
- Arrythmias
- coronary artery disease
- hyperthyroidism
- renal failure
What is the MOA of Duloxetine for UI?
5HT/NE reuptake inhibitor increases urethral tone by NE
What are SEs with Duloxetine?
- headache
- insomnia
- GI disturbances
- dry mouth
- dizziness
- fatigue
- increase BP
What medications treat overflow UI due to obstruction from BPH?
- alpha-1 antagonists
- 5-alpha reductase inhibitors
What medications treat overflow UI by stimulating detrusor muscle contractions?
Bethanechol (URECHOLINE)
What is the MOA of Bethanechol (URECHOLINE)?
stimulates parasympathetic nervous system; increases bladder muscle tone, causing contractions to stimulate urination
What are SEs with Bethanechol (URECHOLINE)?
- N/V/D
- flushing
- abdominal cramping
- salivation
What are CIs with Bethanechol (URECHOLINE)?
- asthma/COPD
- PUD
- epilepsy
- coronary artery disease
What is most commonly used to treat urge incontinence?
antimuscarinics
What antimuscarinics are used to treat urge incontinence?
- oxybutynin
- Tolterodine
- Fesoterodine
- Tropium chloride
- Solifenacin
- Darifenacin
What is the MOA of antimuscarinics for urge UI?
antagonist of M3 receptors in the detrusor muscle
What are SEs with antimuscarinics?
- anticholinergic
- cognitive impairment (M1)
- dizziness
- vision changes
- headache
- thirst
What patients should antimuscarinics be avoided in?
- delirium
- dementia
- chronic constipation
- cognitive impairment
Oxybutynin ER
DITROPAN XL
Oxybutynin gel
GELNIQUE
OTC Oxybutynin patch
OXYTROL
What population is OTC oxybutynin patch for?
women 18+ with 2+ sx
How often should the OTC oxybutynin patch be changed?
every 3-4 days
How long does it take to see the effectiveness of Oxybutynin? How long is a trial?
- a few weeks
- > /= 4 weeks to 12 weeks
What dosage form of muscarinic are associated with less SEs?
ER forms
Tolterodine
DERTROL; DETROL XL
What CYP enzymes metabolize Tolterodine leading to drug interactions?
- CYP2D6
- CYP3A4
What CrCl does Tolterodine require a dosage adjustment?
CrCl= 10-30
Fesoterodine
TOVIAZ
Why does Fesoterodine have have same drug interactions but fewer SEs than Tolterodine?
prodrug of Tolterodine
What advantages does the quaternary ammonium give Trospium Chloride?
less transport across the BBB leading to less cognitive impairment
Trospium Chloride
SANCTURA
What drugs possibly compete for active tubular secretion with Trospium Chloride?
- digoxin
- morphine
- metformin
- vancomycin
- dofetilide
What agents are selective antagonists for the M3 receptor?
- Solifenacin (VESICARE)
- Darifenacin (ENABLEX)
What CYP enzyme metabolizes Solifenacin leading to drug interactions?
CYP3A4
What CYP enzyme metabolizes Darifenacin leading to drug interactions?
- CYP2D6
- CYP3A4
What is the MOA of Mirabegron?
beta-3 adrenergic activation relaxes the detrusor muscle during the storage phase to increase bladder capacity
Mirabegron
MYRBETRIQ
What drug interactions does Mirabegron have?
- moderate CYP2D6 inhibitor
- use lowest dose of digoxin
What SEs does Mirabegron have?
- HTN
- UTI
- nasopharyngitis
- headache
What is the MOA of Vibegron?
beta-3 adrenergic activation relaxes the detrusor muscle during the storage phase to increase bladder capacity and does not penetrate BBB
What DIs does Vibegron have?
CYP2D6
Vibegron
GEMTESA
What are the indications for Onabotulinumtoxin A BOTOX?
treatment of overactive bladder with symptoms of urge incontinence, urgency, or frequency in adults who have inadequate response to anticholinergic
What BBW doesOnabotulinumtoxin A BOTOX have?
spread of toxin effect
What SEs does Onabotulinumtoxin A BOTOX have?
- UTI
- urinary retention
- dysuria
