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Pharm II- Exam 1 > Urinary incontinence > Flashcards

Urinary incontinence Flashcards

1
Q

What is the role of the PNS and Ach

A

primary motor input to the detrusor muscle

pelvic nerves coming from S2-S4

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2
Q

What is the primary neurotransmitter in the lower urinary tract?

A

Acetylcholine

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3
Q

Postsynaptic muscarinic receptors by acetylcholine control…

A

both volitional and involuntary contractions of the detrusor muscle

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4
Q

What is the ratio of M2/M3 receptors in humans?

A

3:1

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5
Q

which muscarinic receptor is responsible for both emptying contractions of normal micturition and involuntary bladder contractions?

A

M3

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6
Q

Most pharmacologic antimuscarinic therapy is primarily…

A

anti-M3 based

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7
Q

The majority of bladder smooth muscle cholinergic receptors are?

A

M2 variety

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8
Q

UI symptoms include…

A

over function or under function of the bladder and or urethra

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9
Q

What are causes of UI?

A

a combination of abnormalities in both

  • urethra (bladder outlet and urinary sphincter)
  • bladder
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10
Q

What is the TOC for urinary incontinence management?

A

nonpharmacologic, nonsurgical therapy

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11
Q

what is the TOC for bladder overactivity (urge incontinence)?

A

anticholinergic/antispasmodic agents

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12
Q

What is the TOC for urethral underactivity (stress incontinence)?

A

alpha-adrenergic receptor agonists and topical (vaginal) estrogens

(alone or together)

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13
Q

Which type of incontinence is rare but assoc. w/BPH?

A

overflow incontinence

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14
Q

What types of illnesses can result in UI? examples?

A

localized or systemic illnesses

ie. dementia/delirium, depression, UTI, DM, postmenopausal atrophic urethritis or vaginitis, constipation, pelvic malignancy

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15
Q

What medications influence the lower urinary tract function?

A

diuretics, acetylcholinesterase inhibitors (polyuria, freq, urgency)

a-receptor antagonists (urethral relaxation and stress urinary incontinence in women)

a-receptor agonists (urethral constriction and urinary retention in men)

antipsychotics (anticholinergic effects and urinary retention)

CCB (urinary retention)

anticholinergics (urinary retention)

ACEI’s (cough –> stress UI)

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16
Q

Overflow incontinence results when…

A

bladder is filled to capacity at all times but unable to empty causing –> urine to leak from a distended bladder past a normal or even overactive outlet and sphincter

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17
Q

Cause of secondary overflow incontinence?

A

benign or malignant prostatic hyperplasia

maybe pharacotharpy

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18
Q

Examples of when you might get urethral underactivity (stress urinary incontinence)?

A

during exertional activities

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19
Q

Risk factors for urethral underactivity (stress urinary incontinence)

A 
pregnancy
childbirth
menopause
cognitive impairment
obesity 
age

(uncommon in men)

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20
Q

What is the goal of therapy for urethral underactivity or SUI?

A

improve the urethral closure mechanism by stimulating alpha adrenergic receptors

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21
Q

When does bladder overactivitiy (OAB) occur?

A

during bladder filling and urine storage d/t involuntary (detrusor) contractions

from infx or neurologic disorders

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22
Q

what are symptoms of overactive bladder?

A

urinary frequency and urgency

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23
Q

Urgency

A

sudden compelling desire to urinate that is difficult to delay +/- urge incontinence

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24
Q

frequency

A

micturition more than 8 times per day

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25
Q

Risk factors of OAB (urge urinary incontinence)?

A 
normal aging
neurologic dz (stroke, parkinson's, MS, spinal cord injury)
bladder outlet obstruction (BPH, prostate CA)
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26
Q

which drugs are the most effective in tx’ing urge urinary incontinence (UUI) aka (bladder overactivity)?

A

anticholinergic/antispasmodic drugs

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27
Q

Examples of anticholinergic/antispasmodic drugs?

A

darifenacin, fesoterodine, oxybutynin, solifenancin, tolterodine
or
trospium (2nd line)

28
Q

Leaking during physical activity (ie. coughing, sneezing, lifting) is associated with UUI or SUI?

A

SUI stress

urethral underactivity

29
Q

Nocturnal incontinence and nocturia is more assoc.. w/ UUI or SUI?

A

UUI urge

bladder overactivity

30
Q

Urgency and frequency more assoc. w/ UUI or SUI?

A

UUI urge

bladder overactivity

31
Q

Amount of urinary leakage w/each episode of incontinence for UUI and SUI?

A

UUI urge — LARGE if present

SUI stess — usu. small

32
Q

Tx Goals

A

identify pt-specific tx that may change over time

choice of therapy influenced by pt age, comorbids, concurrent meds

if goals not achieved addition of second agent or alternative single agent

33
Q

What are first line tx’s for OAB?

A 
behavioral therapies (bladder training, control strategies)
BT combined w/antimuscarinic therapies
34
Q

What are 2nd line tx options for OAB?

A

oral muscarinic (darifenacin, festerodine, oxybutynin, solifenacin, tolterodine, or trospium)

if IR and ER formulations available choose ER

transdermal oxybutynin (patch or gel)

35
Q

What are 3rd line tx options for OAB?

A

sacral neuromodulation
peripheral tibial n. stimulation
intradetrusor onabotulinum toxin A

36
Q

Examples of bladder training?

A

pass urine every 2 hrs while awake
try to pass urine whether or not you have an urge
if strong urge –> stop, stand still, relax
keep schedule until 2 days w/out urine leakage

37
Q

Lifestyle modification examples for UI?

A

behavioral changes (fluid/caffeine modification, smoking cessation, weight loss, constipation prevention) for stress, urgency, and mixed UI

Physical therapy (gait strength) esp. older pt’s w/mobility issues

38
Q

Scheduling regimen examples?

A

timed voiding
habit retraining
bladder training
prompted voiding

39
Q

What is timed voiding and who is it used for?

A

toileting on a fixed schedule where interval does not change, typically every 2 hrs during waking hrs

pts w/cognitive or physical impairments

40
Q

What are pelvic floor muscle exercises?

A

kegel exercises - regular practice of pelvic floor muscle contractions for prevention of stress leakage and urge inhibition

41
Q

What are 3 interventions for pelvic floor muscle rehabilitation?

A

pelvic floor muscle exercises
biofeedback
vaginal weight training

42
Q

What are examples of external neuromodulation?

A

alternative med therapies - acupuncture
anti-incontinence devices - alarms, pesaries
supportive interventions - undergarments

43
Q

What 4 types of drugs can you rx to tx UUI?

A

anticholinergic/antispasmotics
tricyclic antidepressants
topical estrogens
Mirabegron

44
Q

What are anticholinergic/antispasmotics used for tx of UUI?

A 
oxybutynin (ditropan)
tolteridine
trospium chloride IR, ER (Sanctura)
solfinacin (VESIcare)
dandinacin
fesoterodine
45
Q

What are tricyclic antidepressants used for UUI?

A

imipramine
nortriptyline
desimpramine
doxepin

46
Q

What are topical estrogens used for UUI?

A

creams

vaginal insert/ring

47
Q

What are anticholinergic ADE’s?

A

dry mouth, constipation, ha, dyspepsia, dry eyes, blurred vision, cognitive impairment, tachycardia, sedation, orthostatic hypotension

application site (topical agents): pruritis, erythema

48
Q

What contraindications and precautions should you take with anticholinergic/antimuscarinic agents for UI?

A
  • urinary retention, gastric retention, severely decreased GI motility, angioedema, MG, uncontrolled narrow-angle glaucoma
  • renal/hepatic condition or concomitant drug therapy
  • mental status change or fall risk
49
Q

Which types of anticholinergic/antimuscarinics are assoc. w/fewer anticholinergic adverse effects, particularly dry mouth?

A

ER, LA, XL, and topical products

50
Q

What pt education should you give for anticholinergic/antimuscarinic alcohol-based gel?

A

avoid open fire or smoke until gel has dried

51
Q

Mirabegron MOA and what does it tx?

A

used for OAB

beta-3 subtype predominantly mediating bladder smooth muscle relaxation and improving urine storage

52
Q

What is important to know about dosing Mirabegron?

A

avoid in pt’s w/ESRD or severe hepatic impairment
25mg PO daily if Cr clearance is 15-29

swallow whole

53
Q

Mirabegron ADE’s and drug interactions

A

can increase BP - CI w/severe uncontrolled HTN

caution w/bladder outlet obstruction or if already on antimuscarinic meds for OAB

interacts w/ CYP2D6 substrates (tricylic antidepress, antipsychotics, SSRI, BB, type 1 antiarrythmics)

use w/caution in pt’s with cardiovascular dz

54
Q

How does Botulinum toxin A work and when is it indicated?

A

temporarily paralyzes smooth or striated muscle

indicated for tx of detrusor m. overactivity assoc. w/neuro condition or OAB

55
Q

How soon are therapeutic and adverse effects seen after receiving Botulinum toxin A injection? how long do they last?

A

3-7 days after and subside after 6 to 8 months

56
Q

ADE’s of botulinum toxin A?

A

dysuria, hematuria, UTI, urinary retention

57
Q

Urethral underactivity (stress incontinence) tx is aimed at…

A

improving urethral closure by stimulating a-adrenergic receptors in smooth muscle of bladder neck and proximal urethra

enhancing supportive structures underlying urethral epithelium

enhancing serotonin and norepi effects in micturition reflex pathways

58
Q

What medication can be used to tx Urethral underactivity (stress incontinence)?

A

alpha-adrenergics
estrogen-vaginal application
imipramine- peds bedwetting

59
Q

Which alpha adrenergics can be used to tx urethral underctivity (stress incontinence) and ADE’s?

A

agents: norfenefrine, norephedrine

ADE’s: HTN, HA, dry mouth, nausea, insomnia, restlessness

60
Q

Contraindications for alpha-adrenergics?

A

HTN, tachyarrhythmias, CAD, MI, corpulmonale, hyperthyoidism, renal failure, narrow angle glaucoma

61
Q

What medication can you use to tx overflow (atonic bladder)?

A

cholinomimetics (cholinergic) Bethanecol

62
Q

What are the 3 types of urinary incontinence?

A

Overflow
stress
urge

63
Q

Which type of UI: Urethral blockage with a bladder unable to empty properly?

A

overflow

64
Q

Which type of UI: bladder oversensitivity from infx and neurologic disorders?

A

urge

65
Q

Which type of UI: relaxed pelvic floor, increased abdominal pressure?

A

stress

66
Q

Which agents might aggravate Urethral underactivity or SUI?

A

alpha-adrenergic receptor blocking drugs

ie. -osin’s (prazosin, terazosin), methyldopa, clonidine, guanfacine, guanadrel, labetalol

Pharm II- Exam 1 (6 decks)

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