Urinary Incontinence Flashcards
Defintion/Sx
Involuntary loss of urine
-Urgency, nocturia, increased frequency, leakage
Women, age, long-term care settings
Causes
-Delirium
-Infection
-Atrophic
-Pharm
-Psych
-Endocrine
-Restricted mobility
-Stool impaction
Meds That Influence LUT Function
-Diuretics
-Alpha anta/gonists
-CCBs
-Sedative hypnotics
-Antipsych
-Antichol
-Antidep
-ACEIs
-Alcohol
-Narcotics
Key Points
-Avoid antimuscarinic agents in pts with NA glaucoma, severe gastric emptying or severe urinary retention (PVR 250-300+) - GUG
-Caution in: frail, mild GE, mild UR, other AC meds (AGUF)
-Manage constipation and dry mouth before switching effective AM tx
Non-Pharm
-Lifestyle
-Scheduling regimens
-Pelvic rehab
-Anti-incontinence devices
-Supportive interventions
SLAPS
Tx Guideline
1st Line
-Behavioral therapies (bladder training and control, pelvic training, fluid management)
-Then combine with pharm
2nd Line
-Oral AM or B3 agents
-Prefer ER formulations
-Transdermal oxybutynin
-Combo tx with oral AM and B3 if refractory
3rd Line
-Botox in detrusor muscle for select pts
-Tibial nerve stimulation or sacral neuromodulation in select pts
Oxybutynin
IR, oldest/cheapest
XL lower conc of metabolite, but better tolerated
DDI with AC drugs and CYP3A4
Sugarless gum, candy, saliva sub for dry mouth
Transdermal system, bypasses first pass and better tolerated: rotate site to minimize irritation
oxyTAXC
Tolterodine
-Comp musc antagonist
-Equal to oxy but better tolerated
*LA formulation is QD and has < dm
-DDI with CYP3A4 and duloxetine
-8 weeks for max benefit
-AE: DM, dyspepsia, HA, constipation, dry eyes
-Monitor QTp with AADs
CHQDDDD
Fesoterodine Fumarate
Indicated for symptoms of urinary frequency, urgency, and urgency incontinence
More dry mouth than Tolterodine LA
AE: DM, dyspepsia, constipation, dry eyes
f is for more FUDI
Trospium Chloride
Caution in CrCl < 30 or 75+
= IR give 20 mg QD
= AVOID ER
*less dry mouth than oxy
*more AC AEs in 75+
DDI with procainamide, morphine, vancomycin, EtOH, antacid, metformin
(T37 MADE MVP)
Solifenacin Succinate
Indicated for neurogenic detrusor overactivity in children > 2 years old and adolescents
< dm than oxy
DDI with CYPs
OTcP at higher doses
Darifenacin
M3 affinity, improves urinary sx and QOL
DDI: CYP2D6
dari UQT
Mirabegron
B3 agonist
*efficacy in 4-8 weeks
AE: NUHH
-HTN, HA
-Nasopharyngitis
-UTI
PM of CYP2D6 can have increased conc of Mira
Vibegron
B3 agonist
low rates of AEs
3rd line: Botox
Paralysis of muscle
Indicated for tx of detrusor overactivity associated with neuro conditions and OAB
Lasts 4-8 months
AE: dysuria, hematuria, UTI, urinary retention
DONO DUUH
Underactivity, Stress Urinary Incontinence (SUI)
Aggravated by:
-Osins, dopa, clonidine, guanfacine, labetalol
Tx: ME DEV
-Topical estrogen
-Duloxetine
-Ephedrine/Midodrine
-Venlafaxine
