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Spring 15 - Pharm Unit III > Urinary Incontinence > Flashcards

Urinary Incontinence Flashcards

1
Q

Physiology of Urination and Bladder Control

A
  • detrusor muscle control (parasympathetic, beta adrenergic)
  • internal urethral sphincter (alpha adrenergic)
  • external urethral sphincter (voluntary, somatic)
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2
Q

How are incontinence and aging related?

A
  • incontinence is NOT a normal part of aging

- age predisposes to incontinence, but does not cause it

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3
Q

Urge Incontinence Pathophysiology

A
  • overactive bladder

- detrusor muscle hyperactivity

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4
Q

Stress Incontinence Pathophysiology

A
  • urethral underactivity

- sphincter incompetence

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5
Q

Overflow Incontinence Pathophysiology

A
  • urethral overactivity and/or bladder underactivity
  • detrusor hypoactivity (d/t stroke, MS, neuro problem)
  • urethral sphincter obstruction (eg BPH)
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6
Q

Functional Incontinence

A

not caused by bladder or urethra-specific factors

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7
Q

Causes/Risk Factors for UI

A
  • delirium
  • infection
  • atrophic urethritis or vaginitis
  • pharmaceuticals (anticholinergics, diuretics, sedatives, opioids)
  • psychological
  • excessive urine output
  • restricted mobility
  • stool impaction
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8
Q

What are some medications the influence lower urinary tract function?

A
  • diuretics
  • alpha receptor agonists and antagonists
  • CCBs and ACE-Is
  • narcotic analgesics
  • sedative hypnotics, antipsychotics, TCAs
  • anticholinergics
  • alcohol
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9
Q

General Management Strategies for UI

A
  • accessible toilets: higher toilets, well lit area, bedside commode
  • wear clothes that are easily removed
  • moderation in fluid intake
  • lose weight if obese
  • smoking cessation, avoid EtOH and caffeine
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10
Q

Nonpharm Treatment of UI

A
  • mainstay of UI management
  • bladder training
  • bladder control strategies
  • pelvic floor muscle training
  • fluid management
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11
Q

What drug classes can be used with urge incontinence?

A
  • anticholinergics/antispasmodics
  • TCAs
  • topical estrogen (women w/ urethritis, vaginitis)
  • beta-3 agonist
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12
Q

How do anticholinergics work in UI?

A

-decreases bladder contractility

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13
Q

Give 2 examples of anticholinergics used for UI.

A
  • oxybutynin 2.5-5 mg bid, tid or qid

- tolterodine 1-2 mg bid

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14
Q

Which TCAs can be used for UI?

A
  • imipramine, doxepin, nortriptyline, desipramine

- dosed at bedtime

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15
Q

What topical estrogen options are available for UI?

A
  • estradiol vaginal tablets

- estradiol vaginal ring

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16
Q

MOA of Beta-3 Agonist in UI

A

-relax bladder smooth muscle

17
Q

Do beta-3 agonists work for UI? What are the AEs?

A
  • modestly effective at decreasing frequency and incontinence episodes
  • may increase BP, HR
18
Q

What drug classes can be used with stress incontinence?

A
  • duloxetine (SNRI)
  • alpha adrenergic agonists (pseudoephedrine)
  • topical estrogen
  • imipramine (TCA)
19
Q

MOA of Duloxetine in UI

A

-involved in smooth muscle and external urethral sphincter control

20
Q

What drug can be used for overflow UI?

A

-cholinomimetics (bethanechol)

21
Q

What is the treatment plan for functional UI?

A

scheduled bathroom breaks

22
Q

What is first line drug therapy for urge UI?

A

-anticholinergics (oxybutynin or tolterodine is preferred)

23
Q

In what pts should TCAs be used?

A

-UI with additional indication like depression or neuropathic pain

24
Q

What is first line drug therapy for stress UI?

A

-duloxetine (even though not approved for stress UI)

25
Q

AEs of Duloxetine

A
  • nausea, constipation, decreased appetite
  • dry mouth
  • fatigue, somnolence
  • increased sweating
  • sexual dysfunction
  • increased BP
26
Q

AEs of Alpha Adrenergic Agonists (Pseudoephedrine)

A
  • tachycardia
  • palpitations
  • insomnia
  • use with caution in pts with HTN, DM, CHD
27
Q

What pts should receive alpha adrenergic agonists (pseudoephedrine)?

A

-alternative first line therapy for women with no CI

28
Q

AEs of Cholinomimetics (Bethanecol)

A
  • HoTN
  • tachycardia
  • flushing
  • HA
  • malaise
29
Q

What is important to remember when giving a pt a cholinomimetic like bethanecol?

A
  • short term use only

- never give IV or IM b/c of life-threatening cardiovascular and severe GI reactions

Spring 15 - Pharm Unit III (12 decks)

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