Urinary Incontinence

Question 1

Muscarinic receptors have how many known subtypes? What kind is MC?

Answer 1

5

M2

Question 2

What is the ratio of M2/M3 receptors?

Answer 2

3:1

Question 3

What are M3 receptors responsible for?

Answer 3

• Emptying contractions

- Involuntary bladder contractions

Question 4

Most antimuscarinic therapy is primarily…

Answer 4

anti-M3 based

Question 5

What med class is 1st line for bladder overactivity (urge incontinence)?

Answer 5

Anticholinergic/antispasmodic

Question 6

What med classes are 1st line for urethral underactivity (stress incontinence)?

Answer 6

α-adrenergic receptor agonists & topical estrogens

Question 7

Overflow incontinence is caused by what?

Answer 7

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

Question 8

What is the goal of therapy for SUI?

Answer 8

Improve urethral closure by stimulating α-adrenergic receptors

Question 9

What are 2 sx seen w/ OAB (urge urinary incontinence)?

Answer 9

• Frequency: micturition > 8 times/day

- Urgency: sudden desire to urinate

Question 10

Anticholinergic/antispasmodic drugs have proved to be the most effective agents for…..

Answer 10

• suppressing premature detruser contractions, enhancing bladder storage
• relieving UUI sx

Question 11

Which type of incontinence most commonly experiences nocturia?

Answer 11

Bladder overactivity (Urge)

Question 12

What non-pharm options are recommended for management of UI?

Answer 12

• 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

Question 13

What are 2 examples of anti-incontinence devices?

Answer 13

• Alarms

- Pesaries

Question 14

What disease is associated with overflow incontinence?

Answer 14

BPH

Question 15

What medications can aggravate SUI?

Answer 15

meds w/ alpha-adrenergic blocking activity:
prazosin
terazosin
methyldopa
clonidine
labetalol

Question 16

What are risk factors for OAB?

Answer 16

• normal aging
• neurologic diseases (stroke, PD, MS)
• Bladder outlet obstruction (BPH, prostate CA)

Question 17

What is the difference between OAB and SUI in regards to patients being able to reach the toilet following an urge to void?

Answer 17

OAB= not able to or just barely make it to the toilet

SUI= able to make it to the toilet

Question 18

According to the AUA guidelines, what are the 2 first line treatment choices for OAB?

Answer 18

• behavioral therapies (bladder training, pelvic floor muscle training)
• behavioral therapy + antimuscarinic therapies

Question 19

What is used as first-line therapy in combination w/ meds in patients w/ stress, urgency, and mixed incontinence?

Answer 19

behavioral changes

Question 20

Physical therapy is useful in what kind of patient with urinary incontinence?

Answer 20

older patients w/ mobility impairments that have trouble reaching the toilet

Question 21

What kind of non pharmacological management is used for institutionalized or homebound patients w/ cognitive or physical impairments?

Answer 21

habit retraining

Question 22

What type of patient is bladder training most useful for?

Answer 22

stress and urgency incontinence in patients who are cognitively intact, able to toilet, and motivated to comply w/ training?

Question 23

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?

Answer 23

the patient seeking help for UI

• must be able to isolate muscles
• required cognitively intact and highly motivated pt

Question 24

What are some anticholinergic/antispasmodic meds used in UUI?

Answer 24

oxybutynin
tolteridine
trospium chloride
solfinacin
dandinacin

Question 25

What are some tricyclic antidepressants used for UUI?

Answer 25

Imipramine
Nortryptyline
Desimpramine
Doxepin

Question 26

If given the option to put your patient on an IR, LA, or topical anticholinergic med for UUI, which ones would you recommend and why?

Answer 26

ER, LA, topical-

associated w/ fewer ADEs (esp. dry mouth)

Question 27

What beta receptor predominantly mediates bladder smooth muscle relaxation?

Answer 27

beta-3

Question 28

What is the name of the medication used in OAB that acts on beta-3 receptors?

Answer 28

Mirabegron

Question 29

What ADE can Mirabegron cause?

Answer 29

can increase BP- don’t use in pts with severe uncontrolled HTN

caution in pts taking antimuscarinics for OAB- can cause urinary retention

Question 30

Who is Botulinum toxin A indicated for?

Answer 30

treatment of detrusor overactivity a/w neurologic condition and OAB

Question 31

What are examples of alpha-adrenergic meds used for stress incontinence?

Answer 31

Norfenefrine

Norephedrine

Question 32

What are ADEs of alpha adrenergic meds?

Answer 32

hypertension
HA
dry mouth
nausea
insomnia
restlessness
stroke risk w/ phenylpropanolamine (withdrawn)

Question 33

What type of med is used for overflow incontinences (atonic bladder)? ADEs?

Answer 33

Cholonomimetics (Bethanecol)

ADEs= sludge