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Pharm 835 > Urinary Incontinence > Flashcards

Urinary Incontinence Flashcards

1
Q

External sphincter controls voluntary or involuntary control?

A

-Voluntary

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2
Q

Role of estrogen in urinary incontinence

A
  • Decreased estrogen

- Decreased competence of internal/external sphincter

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3
Q

Stress Urinary Incontinence (UI)

A
  • During exertion (Sneezing, exercising, etc)
  • Sphincter no longer is able to resist flow
  • Risk factors; pregnancy, menopause, obesity, age
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4
Q

Urge Urinary Incontinence (UI)

A
  • Over active detrusor muscle
  • Involuntary bladder contractions
  • Risk factors; aging, neurological diseases, bladder outlet obstruction
  • Symptoms; frequency, urgency, nocturia, bed wetting (Enuresis)
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5
Q

Overflow UI

A
  • Full bladder that is unable to empty completely
  • Urine leaks from bladder
  • Large residual volume
  • Urethral overactivity
  • Bladder under activity
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6
Q

Mixed/Other UI

A
  • Combos can coexist
  • Functional incontinence
  • Drug related incontinence
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7
Q

Functional Incontinence

A
  • Dementia
  • Mental or mobility impairment
  • UTI
  • Constipation
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8
Q

Drug induced incontinence (Diuretics)

A
  • Alpha receptor agonist/antagonist
  • ACEIs
  • CCBs
  • Narcotics
  • Sedatives
  • Alcohol
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9
Q

Drugs/ disease states that induce polyuria

A
  • Stress UI
  • Urinary Retention
  • Functional UI
  • Anticholinergics
  • Stress UI (when you cough)
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10
Q

Reversible causes of UI “DIAPPERS”

A
  • Delirium
  • Infection
  • Atrophic vaginitis/urethritis
  • Psychiatric disorder
  • Pharmacological treatments
  • Excessive urine output
  • Restricted mobility
  • Stool impaction (think narcotics and such)
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11
Q

Nonpharm treatment of UI

A
  • Behavioral; pelvic floor exercises, peeing schedule
  • Antiincontinence devices
  • Catheters
  • Absorbents
  • Tolieting substitutes
  • Skin protectants
  • Moisturizers
  • Cleansers
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12
Q

Pharmacological treatment of UI

A
  • Oxybutynin (Ditropan)
  • Tolterodine (Detrol)
  • Solifenacin succinate (Vesicare)
  • Darifenacin (Enablex)
  • Trespium (Sanctura)
  • Fesoterodine (Toviaz)
  • Botox injection
  • Mirabegron (Myrbetriq)
  • Use ER/patches over regular release
  • Common side effect is dry mouth
  • TCAs need additional indication
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13
Q

1st line treatment of UI

A
  • Behavioral therapies
  • Can combine with anticholinergic therapies
  • For Urge UI and over active bladder
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14
Q

2nd line treatment of UI

A
  • Offer antimuscarinic
  • ER>IR
  • Don’t use in pts with glaucoma
  • Use caution if history of urinary retention, impaired gastric emptying
  • Manage dry mouth and constipation
  • Be careful in older populations
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15
Q

3rd line treatment of UI

A
  • SNS
  • PTNS
  • Intradetursor Botox
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16
Q

Treatment for Stress or mixed UI

A
  • Pelvic floor exercises
  • Contributing factors?
  • Vaginal inserts
  • Estrogens; vaginal cream (do not use oral estrogen)
  • Surgery
17
Q

Treatment of overflow UI

A

a) Secondary to BPH treat with
- Alpha one adrenergic antagonists
- 5 alpha reductase inhibitors
b) secondary to hypotonic/atonic bladder
- Catheterization
c) Failure with all other treatment?
- Surgery!
- SNRIs are still investigational

18
Q

How to treat over active bladder

A
  • Anticholinergics

- Mirabegon (antimuscarinic)

19
Q

How to treat stress or mixed UIs

A
  • Pelvic floor exercises

- Pessary

20
Q

How to treat overflow UI

A
  • BPH treatment

- Catheterization

Pharm 835 (4 decks)

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