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Pharmacology-Exam #1 (Summer) > Urinary incontinence > Flashcards

Urinary incontinence Flashcards

1
Q

What is the MC/Majority muscarinic receptor subtype found in smooth muscle of the bladder?

A

M2

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2
Q

What are M3 receptors responsible for?

A

Emptying contractions of normal micturition AND

involuntary bladder contractions

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3
Q

What are most pharmacological antimuscarinic therapy aimed at?

A

Anti-M3

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4
Q

What are the pharmacological therapies of choice in urge incontinence (bladder overactivity)?

A

Anticholinergic/antispasmodic agents

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5
Q

What are the pharmacological therapies of choice in stress incontinence (urethral underactivity)

A
  1. α-adrenergic receptor AGONISTS
  2. Topical (vaginal) estrogens

*Alone or Both

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6
Q

Define Overflow Incontinence

A

Results of:

  1. Uretheral overactivity
  2. +/- Bladder under activity
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7
Q

Overflow incontinence etiology

A

BPH

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8
Q

Result of Overflow incontinence

A

urine leakage from a distended bladder past a normal or even overactive outlet and sphincter

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9
Q

What is the goal of treatment in stress urinary incontinence?

A

Improve urethral closure mechanism by stimulating α-adrenergic receptors in smooth muscle of: Bladder neck and Proximal Urethra

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10
Q

What medication aggravates SUI?

A

Alpha Blockers

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11
Q

Define Urge Urinary Incontinence

A
  1. Bladder overactivity

2. Involuntary bladder (detrusor) contraction

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12
Q

Define urinary frequency

A

Micturition >8x/day

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13
Q

Define urinary urge

A

Sudden compelling desire to urinate that is difficult to delay

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14
Q

According to the AUA Guidelines, What is FIRST LINE treatment in overactive bladder in adults (OAB)?

A

Behavioral therapies:

  1. Bladder training
  2. Bladder control strategies
  3. Pelvis floor muscle training
  4. Fluid management

*Behavioral therapies may be combined with antimuscarinic therapies

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15
Q

According to the AUA Guidelines, What is SECOND LINE treatment in overactive bladder in adults (OAB)?

A

Oral Antimuscarinics:

  1. Darifenacin
  2. Fesoterodine
  3. Oxybutynin
  4. Solifenacin
  5. Tolterodine
  6. Trospium
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16
Q

According to the AUA Guidelines, What is THIRD LINE treatment in overactive bladder in adults (OAB)?

A
  1. Sacral Neuromodulation: Severe refractory OAB sx’s, not candidate for 2nd line Tx
  2. Posterior Tibial Nerver Stimulation
  3. Intradetrusor Botox: Refractory to 1st/2nd line Tx
17
Q

Who is timed voiding used in? How often should they be voiding?

A

Pt’s with cognitive or physical impairments

Void every 2 hrs

18
Q

Define Habit retraining and what population it is recommended in

A
  • Scheduled toiling with adjustments of voiding intervals (longer or shorter) based on pt’s voiding pattern
  • Institutionalized or homebound patients w/ cognitive or physical impairments
19
Q

Who is bladder training recommended in?

A

Stress, Urgency, and mixed incontinence in pt’s who are:

  1. Cognitive
  2. Able to toilet
  3. Motivated to comply with training program
20
Q

Who is pelvic floor muscle rehab/exercises recommended in?

A

Stress, Urgency, and mixed incontinence in pt’s who:

  1. Can isolate and correctly contract pelvic floor muscles
  2. Cognitive
  3. Motivated
21
Q

What form of anticholinergics are associated with fewer anticholinergic ADE’s? What ADE in particular?

A
  1. Extended Release (ER)
  2. Long-Acting (LA)

*Dry Mouth

22
Q

anticholinergic CI?

A
  1. Urinary/Gastric retention
  2. Severely decreased GI motility
  3. Angioedema
  4. MG
  5. Uncontrolled narrow-angle glaucoma
  6. Elderly-Mental status change, risk of falls
23
Q

List the Beta-3 Agonist and MOA

A

Mirabegron*

Bladder smooth muscle relaxation–>Reduces frequency of rhythmic bladder contractions during filling phase–>increased bladder capacity–>improves OAB

24
Q

Mirabegron ADE

A

Increase BP: CI in pt’s with severe uncontrolled HTN (180/110)

25
Q

Mirabegron drug interaction

A 
CYP2D6 Inhibitor 
Dose adjustments in CYP2D6 substrates:
1. TCA's
2. Antipsychotics
3. SSRI's 
4. Beta Blockers
5. Type 1 antiarrhythmics
26
Q

What is an advantage of Mirabegron? Good alternative in what population?

A

Lack of anticholinergic ADE’s
Lack of adverse cognitive effects
Consider in elderly

27
Q

Botulinum Toxin A Clinical Indications

A

Detrusor overactivity assoc. w/ Neuro condition & OAB

28
Q

Botulinum Toxin ADE’s

A
  1. Dysuria
  2. Hematuria
  3. UTI
  4. Urinary retention
29
Q

Onset of Botulinum Toxin? Duration?

A

Onset=3-7 days post injection

Duration= 6-8 months

30
Q

List the dual inhibitor of Serotonin and NE Reuptake Inhibitor (SNRI) that is approved in Europe only. Clinical Application of this drug?

A

Duloxetine

Stress incontinence: Urethral Underactivity

31
Q

Duloxetine MOA

A

Facilitates bladder-to-sympathetic reflex pathway=

Increased urethral & external urethral sphincter tone

32
Q

Duloxetine ADE’s

A
  1. Nausea
  2. HA
  3. Constipation
  4. Dry Mouth
  5. Insomnia
33
Q

List the Alpha-Adrenergics. Clinical Application?

A
  1. Phenylpropanolamine (withdrawn)
  2. Norfenefrine
  3. Norephedrine

*Stress incontinence

34
Q

Alpha-Adrenergics ADE’s

A
  1. HTN
  2. HA
  3. Dry mouth
  4. Nausea
  5. Insomnia
  6. Restlessnees
35
Q

Why was Phenylpropanolamine withdrawn?

A

Risk of stroke

36
Q

Alpha-Adrenergics CI’s

A
  1. HTN
  2. Tachyarrhythmias
  3. CAD
  4. MI
  5. Narrow-angle glaucoma
  6. Cor Pulmonale
  7. Renal Failure
  8. Hyperthyroidism
37
Q

List the Cholinomimetic. Clinical application?

A

Bethanecol: Overflow (atonic Bladder)

  1. BPH
  2. Severe urinary retention
38
Q

Bethanecol ADE’s

A

SLUDGE

Pharmacology-Exam #1 (Summer) (6 decks)

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