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350 again > Urinary Incontinence > Flashcards

Urinary Incontinence Flashcards

1
Q

What is urinary incontinence?

A

Involuntary loss of urine

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2
Q

Men vs. women. Who is urinary incontinence more prevalent in?

A

Women > men (30% vs. 5%)

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3
Q

What are the medical consequences of urinary incontinence? (4)

A
  1. Urinary tract infections (UTIs), urosepsis
  2. Skin irritation, breakdown, infection
  3. Disrupted sleep
  4. Falls
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4
Q

What are the psychosocial consequences of UI? (3)

A
  1. Embarrassment
  2. Isolation
  3. Depression
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5
Q

What are 2 myths about UI?

A
  1. Inevitable part of aging
  2. Nothing can be done
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6
Q

What relevant anatomy should we as pharmacists know for UI? (4)

A
  1. Detrusor muscle (muscarinic = contraction. B3 stimulation = relaxation)
  2. Internal sphincter (alpha-adrenergic stimulation = contraction)
  3. External sphincter
  4. Pelvic floor muscle
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7
Q

Transient/modifiable causes of incontinence can be remembered as DIAPPERS. What does that stand for?

A

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

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8
Q

What are some non-modifiable factors associated with UI? (7)

A
  1. Increased age
  2. Menopause
  3. Pregnancy/childbirth
  4. Diabetes
  5. Stroke
  6. Conditions affecting mobility
  7. Neurologic injury/disease
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9
Q

What are some modifiable factors associated with UI? (9)

A
  1. Certain medications
  2. Constipation/impaction
  3. UTI
  4. Smoking
  5. Caffeine intake
  6. Fluid intake
  7. High-impact physical activities
  8. Heavy lifting/straining
  9. Obesity
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10
Q

What are some investigations that can be done to check for UI? (5)

A
  1. History and physical
    - Type of incontinence
    - Reversible causes
  2. Lab tests
    - Urinalysis, urine culture
  3. Bladder diary
  4. Post-void urinary residual test
  5. Urodynamic tests
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11
Q

What are the different types of urinary incontinence? (5)

A
  1. Urgency
  2. Stress
  3. Mixed
  4. Overflow
  5. Functional
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12
Q

What is urgency urinary incontinence?

A

Leakage associated with a sudden, uncontrollable need to void

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13
Q

What % of pts with incontinence have urge UI?

A

14%

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14
Q

What are 2 causes of urge urinary incontinence?

A
  1. Overactive Bladder (OAB)
  2. Detrusor Overactivity
    - Urgency with or without actual incontinence (OAB-dry vs. OAB-wet)
    - Daytime frequency, nocturia
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15
Q

What is stress urinary incontinence?

A

Leakage with increased abdominal pressure (e.g., exercise, sneezing, coughing)

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16
Q

What % of UI pts have stress UI?
Women or men more likely?

A

50%
More common in women

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17
Q

What is mixed UI?

A

Both urgency and stress incontinence

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18
Q

What % of UI pts have mixed UI?
Men or women more likely?

A

32%
More common in women

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19
Q

What is overflow UI?

A

Leakage of urine from a full bladder

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20
Q

What are some common causes of overflow UI? (4)

A

Common with urinary retention
- Poor detrusor contractility or
- Bladder outlet obstruction (e.g., BPH)
- Elevated post-void residual (>100mL)

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21
Q

What is functional incontinence?

A

Inability to reach the toilet

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22
Q

What are some potential causes of functional incontinence? (4)

A
  1. Reduced mobility
  2. Constrictive clothing
  3. Inaccessible toilets or substitutes
  4. Dementia
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23
Q

What are some goals of treatment for UI? (5)

A
  1. Relieve distressing urinary symptoms
  2. Improve bladder function
  3. Prevent complications
  4. Avoid treatment side effects
  5. Improve QoL
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24
Q

Go through the stepwise approach to UI treatment (4)

A
  1. Lifestyle modifications
  2. Behaviour modifications
  3. Medications
  4. Minimally invasive procedures/surgery
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25
Q

What are some lifestyle factors that can be done to help with UI? (4)

A
  1. Decrease weight if BMI >30kg/m^2
    - Stress incontinence in middle-aged women
  2. Decrease alcohol and caffeine
  3. Restrict fluids in the evening if nocturia
    - Take diuretics in am
  4. Quit smoking
26
Q

What are some behaviour modifications that can be done to help with UI? (3)

A
  1. Pelvic floor muscle training
    - FIRST-LINE for urge, stress, and mixed UI
    - Adequate trial = 6-12 weeks
  2. Bladder training
    - Urge UI
    - Void regularly q1-2h, increased by 15 mins each week
    - Most effective in combination with drug tx
  3. Scheduled/prompted toileting
    - q2-3h
27
Q

What are 3 groups of pharmacological treatment for urge UI?

A
  1. Antimuscarinics
  2. Beta-3 adrenergic agonist
  3. Intravaginal estrogen
    - If associated with vaginal atrophy
    - Usually more for stress or mixed UI
28
Q

First-line pharmacotherapy for urge UI is?

A

Antimuscarinics

29
Q

What is the MOA of antimuscarinics in urge UI?

A

Relax detrusor muscle

30
Q

How efficacious are antimuscarinics in urge UI?

A

Cochrane review –> 4 less leaks and 5 less voids per week

31
Q

What are some contraindications of antimuscarinics in urge UI? (3)

A
  1. Urinary retention
  2. Angle-closure glaucoma
  3. Gastric retention
32
Q

What are the most common adverse effects of antimuscarinics? (6)

A
  1. Dry mouth
  2. Constipation
  3. Blurred vision
  4. Confusion
  5. Cognitive impairment
  6. Increased heart rate
33
Q

Antimuscarinics, use with caution in: (6)

A
  1. Frail older adults
  2. Cognitive impairment
  3. Dementia
  4. Parkinson’s disease
  5. DO NOT USE WITH CHOLINESTERASE INHIBITORS
  6. Caution with other drugs with anticholinergic effects
34
Q

True or False? Once started, anti-muscarinics don’t need to be evaluated often

A

False - re-evaluate often

35
Q

What are the 3 first-line antimuscarinic meds that are not EDS?

A
  1. Oxybutynin
  2. Tolterodine
  3. Solifenacin
36
Q

What is the main ADE of oxybutynin?

A

Dry mouth (dose-related)

37
Q

What dosage forms does oxybutynin come in? (3)

A
  1. IR tablet
  2. XL tablet
  3. Topicals
    - Transdermal patch
    - Transdermal gel
38
Q

What are the theoretical advantages of selective antimuscarinics? (3)

A
  1. Increased selectivity for bladder muscarinic (M3) receptors (solifenacin, darifenacin, trospium)
  2. Decreased lipophilicity –> decreased BBB penetration (tolterodine, trospium)
  3. Decreased ADEs - cognitive impairment, dry mouth, constipation
39
Q

True or False? Other than oxybutynin, solifenacin, or tolterodine, the rest of the antimuscarinics are EDS

A

True

40
Q

What are 3 second-line selective antimuscarinics?

A
  1. Trospium
  2. Darifenacin
  3. Fesoterodine
41
Q

A newer agent for urge UI is mirabegron. What is the MOA?

A

Beta-3 agonist
- Relaxes the detrusor smooth muscle and increased storage capacity

42
Q

Describe the efficacy of mirabegron

A

Similar (modest) efficacy as antimuscarinics
- No anticholinergic side effects
- Limited data in frail older adults

43
Q

Mirabegron is contraindicated when?

A

With uncontrolled HTN

44
Q

What are the ADEs of mirabegron? (5)

A
  1. Increased BP
  2. Tachycardia
  3. Headache
  4. Constipation
  5. UTIs
45
Q

Supratherapeutic doses of mirabegron were found to ________ ___

A

increase QTc

46
Q

What are the 2 drug therapies for stress UI?

A
  1. Vaginal estrogen
  2. Duloxetine (unlabelled use, not well-studied)
47
Q

True or False? Systemic estrogen is useful in stress UI

A

False - not recommended

48
Q

What is a special cause of UI in men?

A

Benign Prostate Hypertrophy (BPH)

49
Q

What to know about urge UI and BPH? (2)

A
  1. Commonly coexist in men
    - BPH should be treated first
  2. If still symptomatic, antimuscarinic therapy may be started
    - Provided there is no urinary retention
50
Q

What effect does alcohol have on continence?

A

Decreases awareness of need to void, polyuria

51
Q

What effect do alpha-agonists have on continence?

A

Increased urethral resistance –> decreased urine flow

52
Q

What effect do alpha-antagonists have on continence?

A

Decreased urethral resistance –> urine loss

53
Q

What effect do anticholinergics have on continence? (4)

A
  1. Decreased bladder emptying
  2. Sedation
  3. Delirium
  4. Constipation
54
Q

What effect do acetylcholinesterase inhibitors have on continence?

A

Stimulation of bladder contraction –> urine loss

55
Q

What effect do antipsychotics (typical) have on continence? (3)

A
  1. Anticholinergic
  2. Rigidity
  3. Sedation
56
Q

What effect do CCBs have on continence?

A

Pedal edema –> nighttime polyuria

57
Q

What effect do GABAergic agents have on continence? (3)

A
  1. Sedation
  2. Dizziness
  3. Pedal edema –> nighttime polyuria
58
Q

What effect do NSAIDs have on continence?

A

Pedal edema –> nighttime polyuria

59
Q

What effect do loop diuretics have on continence? (3)

A
  1. Polyuria
  2. Frequency
  3. Urgency
60
Q

What effect do narcotic analgesics have on continence? (4)

A
  1. Urinary retention
  2. Constipation
  3. Sedation
  4. Delirium
61
Q

What effect do sedative hypnotics have on continence? (3)

A
  1. Sedation
  2. Delirium
  3. Decreased mobility

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