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Summer Pharm Exam 1 > Urinary incontinence > Flashcards

Urinary incontinence Flashcards

1
Q

What is the role of the PNS and Ach in bladder physiology

A

PNS impulses travel to pelvic nerves (S2-S4) as primary motor control
Ach is the primary NT in the lower urinary tract- it activates post-synaptic muscarinic receptors causing volitional and involuntary contraction of detrusor muscle

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2
Q

What are the responsibilities of the muscarinic receptors in the bladder

A

MC in bladder: M2 (M2:M3 usually 3:1)
M3: emptying contractions and involuntary bladder contractions
*Pharm therapy is based mainly on M3 receptors

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3
Q

What abnormalities can cause UI

A

Urethral (bladder outlet and urinary sphincter)
bladder
combination

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4
Q

UI symptoms are

A

overfunction of bladder/urethra

underfunction of bladder/urethra

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5
Q

What are the types of urinary incontinence

A

Overflow: urethral block= bladder does not empty properly
Stress: relaxed pelvic floor/ high intra-abd pressure
Urge: bladder oversensitive 2/2 infection, or, neuro d/o

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6
Q

What is the Tx of choice for urge incontinence

A

Anti-cholinergics and anti-spasmodics; Oxybutynin, darifenacin, fesoterodine, tolterodine
(second line is trospium)
1. suppress premature detrusor contractions= better blader storage
2. relieve UUI Sx and complications

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7
Q

What is the Tx of choice for stress incontinence

A

Alpha agonists and topical vaginal estrogens
the urethra is underactive so we want to stimulate it
1. improve urethral closure
2. enhance supportive structures
enhance serotonin and NE effects in micturition pathway

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8
Q

What is overflow incontinence associated with

A

BPH

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9
Q

What disease states can lead to UI

A 
dementia/delerium 
depression 
Cystitis 
Post-menopause atrophic urethritis 
DM
Neuro (parkinsons, MS, SCI) 
pelvic malignancy 
constipation 
congenital malformation
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10
Q

What meds can affect the urinary tract

A 
diuretics 
alpha antagonits and agonists 
CCB 
Narcotics 
sedative hypnotics
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11
Q

What is overflow incontinence

A

Urethral overactivity + Bladder underactivity

Bladder is filled to capacity at all times and unable to empty= urine leaks from a distended bladder

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12
Q

What can secondarily cause overflow incontinence

A

BPH

Malignant prostatic hypertrophy

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13
Q

What is stress incontinence

A

UI during exertional activities
increased intra-abdominal pressure/ weak pelvic floor
2/2 pregnancy, childbirth, menopause, obesity, cognitive impairment, and age
(uncommon in men)

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14
Q

What is the goal of SUI therapy

A

improve urethral closure mechanism by stimulating alpha adrenergic receptors in smooth muscle of bladder neck

  • No role for med Tx to manage SUI s/p radical prostatectomy
  • Sx exacerbated if taking alpha blockers (prazosin)
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15
Q

What is urge incontinence

A

Involuntary detrusor bladder contractions during bladder filling and urine storage; overwhelming urge to urinate followed by loss of urine
*running to the bathroom is worse! try to sit still!

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16
Q

Symptoms of Urge incontinence are

A

urinary frequency (peeing >8xday) and urgency (sudden compelling desire to urinate)

17
Q

What are RF for urge incontinence

A 
normal aging 
neuro dz (stroke, parkinsons, MS, SCI) 
bladder outlet obstruction (BPH, prostate cancer)
18
Q

Big things to remember when choosing Tx for incontinence

A

Tx is not static, it can change over time
Tx choice depends on age, comorbidities, and other meds
If goals are not achieved, add a second agent!

19
Q

Tx for Overactive bladder

A
  1. Behavioral therapy, +/- antimuscarinics
  2. Oral antimuscarinics (oxybutynin, darifencin, solifencin, fesoterodine, tolterodine)
    - ER formulation better (less xerosis)
    - +/- transdermal oxybutynin
  3. Sacral neuromodulation; Peripheral tibial nerve stimulation; Intradetrusor botox
20
Q

Non-pharmacologic Tx choice for urinary incontinence

A

Behavior changes: fluid and caffeine intake, stop smoking, wt loss, prevent constipation
PT: gait/strength training
Timed voiding: Toilet every 2 hours while awake (good for pt with cognitive or physical impairment)
Bladder training: timed voiding, urgency suppression strategies, reinforcement
Pelvic floor muscle training: Kegals

21
Q

External neuromodulation (non-pharm) Tx choices for UI are

A 
Acupuncture 
Alarms, pesaries 
undergarments 
Radiofrequency heat (more collagen) 
Estrogen therapy
22
Q

What are the ADE of anti-cholinergics (Tx UUI)

A 
anticholinergic effects (dry, hot, blind, mad, red)
If topical: pruritis, erythema 
**Avoid open fire or smoke until alcohol based gel has dried
23
Q

CI to anticholinergics include

A 
urinary retention 
angioedema 
MG 
narrow angle glaucoma 
AMS or fall risk in elderly 
*Monitor renal or hepatic condition, esp if on concomitant medication
24
Q

What is Mirabegron

A

Stimulates B3 receptors in the bladder smooth muscle= bladder relaxes and can store more
Good Tx for overactive bladder, elderly (less ADE than anticholinergics)

25
Q

Who should not take Mirabegron

A

Those with ESRD or severe hepatic impairment
Caution is w/ bladder outlet obstruction or if on an antimuscarinic
Caution if with CVD

26
Q

ADE of Mirabegron are

A

High BP (do not use if w/ uncontrolled HTN >180/110)

27
Q

What are drug interactions of Mirabegron

A

It is a CYP2D6 inhibitor, so it interacts with CYP2D6 substrates (TCA, SSRI, BB, antipsychotics, type 1 anti-arrhythmics)
Does NOT interact with cholinergics

28
Q

How is botox used

A

It temp paralyzes smooth or striated uscle; AKA detrusor muscle in bladder
Takes 3-7 days, lasts 6-8 months

29
Q

ADE of botox as an OAB Tx are

A

dysuria
hematuria
UTI
urinary retention

30
Q

What is Duloxetine

A

Cymbalta! an SNRI that helps control ascending and descending urethral smooth muscle, and external urinary sphincter (increases sphincter muscle tone)

31
Q

What are ADE of Duloxetine

A 
nausea 
HA
constipation 
dry mouth 
insomnia
32
Q

What are the alpha agonists used to Tx SUI, and their ADE

A

Norfenefrine, norephedrine

ADE: HTN, HA, dry mouth, nausea, insomnia, restless`

33
Q

What are contraindications to using alpha agonits

A 
HTN 
tachyarrhythmia 
CAD 
MI 
cor pulmonale 
hyperthytoid 
renal failure 
narrow angle glaucoma
34
Q

What med is good for pediatric bedwetting

A

Imipramine

35
Q

What is a good med for overflow (atonic) bladder

A

Bethanecol, a Cholinomemitic (cholinergic); increases PNS= forceful contraction of bladder. good for post-op or to Tx BPH
ADE: cholinergic side effects (MUDPILES)

Summer Pharm Exam 1 (8 decks)

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