Urinary Incontinence Flashcards
What are the types of urinary incontinence?
Urge Incontinence
Stress Incontinence
Mixed Urge & Stress Incontinence
Unspecified Incontinence
Name the Genitourinary Disorders (7)
Urge incontinence—sudden need to void
Urinary incontinence: the sudden need to void with leakage
Frequency: frequent urination
Hesitancy: difficulties in initiating or straining to initiate
Dribbling: leakage of small amount of urine after voiding
Nocturia: waking to void
Overactive bladder: includes urgency, frequency, and nocturia to void
What are two common antimuscarinic medications used to treat urge incontinence or overactive bladder?
Oxybutinin (Ditropan)
Tolterodine (Detrol)
Antimuscarinic are anticholinergics.
What are the signs of anticholinergic side effects?
dry mouth, constipation, urinary retention, bowel obstruction, dilated pupils, blurred vision, increased heart rate, and decreased sweating
Antimuscarinic medications interact with drugs that induce CYP2D6, such as…
Dexamethasone, rifampin
True or False: Antimuscarinics should be avoided in clients with dementia or cognitive impairment.
True
Name the only Beta-3 Agonist to treat Urge Incontinence and OAB.
mirabegron (Myrbetriq)
What are the side effects associated with mirabegron (Myrbetriq)?
Increased heart rate & interactions with CYP2D6 inducers
What are some co-morbidities that may cause or contribute to urinary incontinence?
Sleep Apnea
Diabetes
Medications
What are some lifestyle interventions that could help alleviate symptoms of urinary incontinence?
Weight loss
Decrease caffeine consumption
Decrease alcohol consumption
Decrease fluid intake before bed
Quit smoking
Behavioral therapies to treat urinary incontinence include:
Bladder training
Pelvic Muscle Exercises
- Which of the following is true about tolterodine?
a. It should be avoided in men with prostatic hypertrophy.
b. It increases the risk of constipation compared with oral oxybutynin.
c. It acts by ablating detrusor spasms.
d. It has a greater risk of adverse effects with its twice-daily formulation.
d. It has a greater risk of adverse effects with its twice-daily formulation.
An 82-year-old man, Mr. A, complains of worsening nocturia, occurring four times per night. His other lower urinary tract symptoms are slow stream, occasional urgency, and urgency-related leakage once weekly. Medical problems include poorly controlled hypertension, diastolic heart failure, hyperlipidemia, osteoarthritis, and prediabetes. His medications include lisinopril 20 mg daily, metoprolol succinate 75 mg daily, atorvastatin
10 mg daily, metformin 500 mg twice daily, hydrocodone-acetaminophen as needed, and aspirin 81 mg daily. Amlodipine 5 mg daily was recently added by his cardiologist. On
review of systems, Mr. A complains that nocturia is causing daytime fatigue, and he is more constipated.
Physical examination is notable for blood pressure 162/83 mmHg,
heart rate 60 beats per minute, clear lungs, soft abdomen, enlarged prostate, and 21 pretibial edema. Your next step in management should be:
a. Stop hydrocodone-acetaminophen and add naproxen.
b. Stop amlodipine and increase lisinopril.
c. Add afternoon furosemide.
d. Add tamsulosin.
b. Stop amlodipine and increase lisinopril.
The daughter of a 79-year-old woman notes that her mother, who has dementia and lives with her, is wetting herself when she attends her new day program. Program staff
have requested that “something be done” as she is requiring a clothes change nearly every time she is there. She cannot describe the circumstances of leakage, saying “it just comes.” Leakage is uncommon at home. Her medications include donepezil and acetaminophen. Physical examination is normal. Initial treatment approach will require intervention by which of the following?
a. Mrs. A’s physician
b. Mrs. A’s daughter
c. Day program staff
d. Physical therapist through a home care agency
c. Day program staff
Ms. J, who is 82 years old, complains of urine leakage while playing golf. This has gotten worse over the past year, and she rarely makes it through nine holes without feeling like she needs to “run into the bushes and go.” Leakage is usually small volume, but causes her extreme embarrassment because she is afraid she will smell of urine. She has tried limiting caffeine in the morning before she golfs and avoiding drinking water while playing, to no effect. She also tried “those Kegler” exercises in the past without success. Which of the following is the most appropriate recommendation for Ms. J?
a. Bladder training
b. Referral for biofeedback training in pelvic muscle exercise
c. Trial of solifenacin
d. Trial of topical estrogen
a. Bladder training
