Urinary Incontinence Flashcards
Muscarinic receptors have how many known subtypes? What kind is MC?
5
M2
What is the ratio of M2/M3 receptors?
3:1
What are M3 receptors responsible for?
- Emptying contractions
- Involuntary bladder contractions
Most antimuscarinic therapy is primarily…
anti-M3 based
What med class is 1st line for bladder overactivity (urge incontinence)?
Anticholinergic/antispasmodic
What med classes are 1st line for urethral underactivity (stress incontinence)?
α-adrenergic receptor agonists & topical estrogens
Overflow incontinence is caused by what?
When the bladder is filled to capacity at all times but is unable to empty…
causing urine leaking from distended bladder past a normal or even overactive outlet and sphincter
What is the goal of therapy for SUI?
Improve urethral closure by stimulating α-adrenergic receptors
What are 2 sx seen w/ OAB (urge urinary incontinence)?
- Frequency: micturition > 8 times/day
- Urgency: sudden desire to urinate
Anticholinergic/antispasmodic drugs have proved to be the most effective agents for…..
- suppressing premature detruser contractions, enhancing bladder storage
- relieving UUI sx
Which type of incontinence most commonly experiences nocturia?
Bladder overactivity (Urge)
What non-pharm options are recommended for management of UI?
- behavioral changes (fluid modification, weight loss)
- PT
- Timed voiding: typically every 2 hrs (used for pts w/ cognitive or physical impairments)
- Habit retraining
- Bladder training
- Pelvic floor muscle exercises
- Acupuncture
- Undergarments
What are 2 examples of anti-incontinence devices?
- Alarms
- Pesaries
What disease is associated with overflow incontinence?
BPH
What medications can aggravate SUI?
meds w/ alpha-adrenergic blocking activity: prazosin terazosin methyldopa clonidine labetalol
What are risk factors for OAB?
- normal aging
- neurologic diseases (stroke, PD, MS)
- Bladder outlet obstruction (BPH, prostate CA)
What is the difference between OAB and SUI in regards to patients being able to reach the toilet following an urge to void?
OAB= not able to or just barely make it to the toilet
SUI= able to make it to the toilet
According to the AUA guidelines, what are the 2 first line treatment choices for OAB?
- behavioral therapies (bladder training, pelvic floor muscle training)
- behavioral therapy + antimuscarinic therapies
What is used as first-line therapy in combination w/ meds in patients w/ stress, urgency, and mixed incontinence?
behavioral changes
Physical therapy is useful in what kind of patient with urinary incontinence?
older patients w/ mobility impairments that have trouble reaching the toilet
What kind of non pharmacological management is used for institutionalized or homebound patients w/ cognitive or physical impairments?
habit retraining
What type of patient is bladder training most useful for?
stress and urgency incontinence in patients who are cognitively intact, able to toilet, and motivated to comply w/ training?
Two different patients with UI come in, one is cognitively impaired brought it by a loved one for UI and then other is seeking help for her UI. Which of the two patients would be best to recommend pelvic floor muscle exercises and why?
the patient seeking help for UI
- must be able to isolate muscles
- required cognitively intact and highly motivated pt
What are some anticholinergic/antispasmodic meds used in UUI?
oxybutynin tolteridine trospium chloride solfinacin dandinacin
