Urinary Incontinence Flashcards
Most prevalent bladder smooth muscle cholinergic receptors
M2
Which muscarinic receptor is responsible for eptying contractions and involuntary bladder contractions
M3
Most pharmacologic antimuscarinic therapy is aimed at what receptor?
M3
Overflow incontinence
- urethral blockage (typically BPH)
- bladder unable to empty properly
Stress incontinence
- relaxed pelvic floor
- Increased abdominal pressure
Urge incontinence
- bladder oversensitivity due to infection
- neurologic disorders
What type of medication is best for urge incontinence/overactive bladder?
anticholinergic agents
What are the best therapies for stress incontinence?
alpha-adrenergic receptor agonists
+/-
- Topical (vaginal) estrogens
Drugs that can cause urinary retention
- alpha-receptor agonists
- CCBs
- Narcotics
- Antipsychotic
- Anticholinergics
Is there a role for medications in the management of stress urinary incontinence after radical prostatectomy?
NO
Overactive bladder first line therapy
behavioral therapy
- Go pee every 2 hours
ex. fluid and caffeine modifications, smoking cessation, weight loss, constipation prevention
Overactive bladder 2nd line therapy
oral antimuscarinics (ex. darifenacin, festoerodine, oxybutynin*, solifenacin, tolteridine, trospium)
Overactive bladder 3rd line therapy
- sacral neuromodulation (if severe and refractory)
- Tibial nerve stimulation
- Intradetrusor botulinum toxin
Adverse effect of anticholinergic medications
- dry mouth
- constipation
- headache
- dyspepsia
- dry eyes
- cognitive impairment
- tachycardia
(in general, ER and XL are associated with fewer adverse effects)
Anticholinergic contraindications
- urinary retention
- decreased GI motility
- angioedema
- Myasthenia gravis
- Narrow-angle glaucoma
