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Geriatrics > Urinary Incontinence > Flashcards

Urinary Incontinence Flashcards

1
Q

Urinary incontinence (UI) is described as…

A

Involuntary loss of urine

A sufficient volume is whatever causes problems for the individual

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2
Q

Medical consequences of UI may include…

A

UTI’s, urosepsis
SKin irritation, breakdown, infection
Disrupted sleep
Falls

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3
Q

Psychological consequences of UI may include…

A

Embarassment
Isolation
Depression

Lower quality of life

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4
Q

Relevant bladder anatomy for us as pharmacists to know include…

A

Detrusor muscle
Internal sphincter
External sphincter
Pelvic floor muscle

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5
Q

The detrusor muscle contracts and relaxes in response to…

A

Contracts - muscarinic (cholinergic)
Relaxes - Beta3 stimulation

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6
Q

The internal sphincter contracts in response to…

A

Alpha-adrenergic stimulation

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7
Q

The external sphincter + pelvic floor muscle contracts and relaxes in response to…

A

Voluntary control

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8
Q

Transient/modifiable causes of incontinence may include…

DIAPPERS

A

Delirium
Infection
Atrophic vaginitis
Pharmaceuticals
Psychological
Excessive urine output
Reduced mobility
Stool impaction

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9
Q

Modifiable factors associated with UI may include…

A

Certain medications
Constipation/impaction
UTI
Smoking
Caffeine + fluid intake
High-impact physical activity
Heavy lifting/straining
Obesity

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10
Q

Investigations for UI may include…

A

History and physical (type of incontinence, reversible causes)
Lab tests (urinsalysis)
Bladder diary

Post-void urinary residual test
Urodynamic tests

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11
Q

Urge urinary incontinence is…

A

Leakage associated with a sudden, uncontrollable need to void

AKA overactive bladder (OAB), detrusor overactivity

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12
Q

Stress urinary incontinence is…

A

Leakage with increased abdominal pressure

(exercise, sneezing, coughing)

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13
Q

Mixed urinary incontinence is…

A

A combination of both urgency and stress incontinence

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14
Q

Overflow urinary incontinence is…

A

Leakage of urine from a full bladder

Common with urinary retention - poor detrusor contractility, bladder outlet obstruction, elevated post-void residual

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15
Q

Functional incontinence is…

A

Impaired ability to reach the toilet

Reduced mobility, constrictive clothing, inaccessible toilets/substitutes, dementia

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16
Q

Goals of treatment with UI involve…

A

Relieve distressing urinary symptoms
Improve bladder function
Prevent complications
Avoid treatment side effects
Improve quality of life

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17
Q

Lifestyle modifications for improving UI may include…

A

Weight loss, if BMI is greater than 30
Decrease consumption of alcohol + caffeine
Restrict fluids in evening if nocturia, take diuretics in AM
Quit smoking

18
Q

Behaviour modifications for UI may involve…

A

Pelvic floor muscle training
Bladder training
Scheduled/prompted toileting

19
Q

Pelvic floor muscle training can be used first line for…

A

Urge, stress, and mixed UI

20
Q

Adequate trial of pelvic floor muscle training is…

A

6-12 weeks

Does require a good level of commitment

21
Q

Bladder training is primarily used for ____, and involves…

A

Urge UI - build up bladder storage capacity, & let the body adjust (void regularly q1-2h, increased by 15 minutes each week)

Most effective in combination with drug treatment

22
Q

Pharmacological treatment for urge UI may include…

A

Antimuscarinics (1st line) + Beta-3 adrenergic agonist

Intravaginal estrogen if associated with vaginal atrophy

Estrogen is usually more for stress/mixed UI

23
Q

Antimuscarinics for urge UI work by…

A

Relaxing the detrusor muscle

24
Q

Efficacy of antimuscarinics for urge UI is…

A

Modest - 4 less leaks and 5 less voids per week

Not everyone finds them to be beneficial

25
Q

Contraindications to using antimuscarinics for urge UI may include…

A

Urinary retention
Angle-closure glaucoma
Gastric retention

26
Q

Most common AE’s of antimuscarinics involve…

A

Dry mouth
Constipation
Blurred vision
Confusion, cognitive impairment
Increased heart rate

27
Q

Antimuscarinics with urge UI are cautioned in these patients…

A

Frail older adults +/- cognitive impairment, dementia, Parkinson’s
Other drugs with anticholinergic effects

Should NOT be used with cholinesterase inhibitors; re-evaluate often

28
Q

A common antimuscarinic used for urge UI includes…

A

Oxybutynin - IR/XL tablet, topicals

29
Q

The different selective antimuscarinics for urge UI have ____ efficacy

A

Equal efficacy across the board

30
Q

Theoretical advantage of selective antimuscarinics include…

A

Increased selectivity for bladder muscarinic (M3) receptors
Decreased lipophilicity
Decreased adverse effects

Lower rates of cognitiive impairment, dry mouth, constipation

31
Q

First-line selective antimuscarinics for urge UI include…

A

Tolterodine
Solifenacin

32
Q

Second-line selective antimuscarinics for urge UI includes…

A

Trospium
Darifenacin
Fesoterodine

EDS is required for all of these

33
Q

The beta-3 agonist used for urge UI is ____ and works via…

A

Mirabegron - relaxes detrusor smooth muscle and increases storage capacity

34
Q

Efficacy of mirabegron to the antimuscarinics is…

A

Similar - modest efficacy

35
Q

Advantages of mirabegron to the muscarinics include…

A

No anticholinergic side effects

36
Q

AE’s with mirabegron include…

A

Increased BP
Tachycardia
Headache
Constipation
UTI’s

Larger doses may increase QTc

CI with uncontrolled hypertension

Generally well tolerated

37
Q

Drug therapy for stress UI may include…

A

Vaginal estrogen (NOT systemic)
Duloxetine

38
Q

Efficacy of vaginal estrogen for UI is…

A

Beneficial for UI if urogenital atrophy is present - mixed results in studies

39
Q

Efficacy of duloxetine for stress UI is…

A

Not well-studied - unlabelled use

40
Q

For UI in men, we should…

A

Consider BPH and treat this first before UI - if still symptomatic, antimuscarinic therapy may be started provided there is NO urinary retention

41
Q

Drug-related causes of UI may include…

A

Anything that can cause:
Constipation
Excess urine output/retention
Lower extremity edema
Anything that may cause functional impairment

Alpha stimulants/antagonists
Anticholinergics
Diuretics
Sedating agents

Geriatrics (8 decks)

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