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
Mirabegron
- stimulates beta-3 adrenoceptors in the bladder, allowing for bladder relaxation
- No adverse cognitive effects
(avoid in ESRD, or severe hepatic impairment)
What is the most important ADE to be aware of when using Mirabegron?
can increase BP (so, don’t use if uncontrolled HTN)
Botulinum toxin A
ADEs: dysuria, hematuria, UTI, urinary retention*
Indication: detrusor overactivity with neurologic condition + overactive bladder
How long after injection will you see either therapeutic benefit or adverse effect of botulinum toxin?
3-7 days after injection
What SNRI is approved in Europe for stress incontinence?
Duloxetine (Cymbalta)
-inhibits serotonin and norepinehrine
What alpha-adrenergic is used for pediatric bedwetting?
Imipramine
Cholinomimetics (cholinergic) medication to help you pee?
Bethanecol
Bethanecol ADE
SLUDGE! (cause it’s a cholinergic)
