Urinary Incontinence

Question 1

What is Overflow Incontinence?

Answer 1

urethral overactivity and/or bladder underactivity

bladder is filled to capacity at all times – unable to empty

urethral blockage

presents w/ dribbling

Question 2

What is Stress Incontinence?

Answer 2

urethral underactivity

relaxed pelvic floor
inc abdominal pressure

• associated w/ exertional activities
• MC in women

Question 3

What is Urge Incontinence?

Answer 3

bladder overactivity

involuntary bladder contractions

*think about UTIs she says

Question 4

Risk Factors for Stress Urinary Incontinence

Answer 4

pregnancy
childbirth
menopause
cognitive impairment
obesity
age

Question 5

There is NO role for medications in the management of stress urinary incontinence after what procedure?

Answer 5

radical prostatectomy

Question 6

What group of medications can aggravate stress urinary tract incontinence?

Answer 6

alpha adrenergic antagonists

Question 7

What are the symptoms of urge urinary incontinence?

Answer 7

frequency (>8x/d)

urgency

Question 8

Risk Factors for Urge Urinary Incontinence

Answer 8

normal aging
neurologic disease
bladder outlet obstruction

Question 9

What is first line treatment for urinary incontinence?

Answer 9

behavioral therapies

may be combined w/ antimuscarinics

Question 10

What are the pharmacologic therapies of choice for urge incontinence?

Answer 10

anticholinergic/antispasmodic agents

• darifenacin
• fesoterodine
• oxybutynin
• solifenacin
• tolterodine

Question 11

What are the pharmacologic therapies of choice for stress incontinence?

Answer 11

alpha adrenergic receptor agonists
and
topical (vaginal) estrogens

Question 12

Which type of urinary incontinence involves leaking during physical activity?

Answer 12

stress incontinence

Question 13

Which type of urinary incontinence involves leaking during physical activity?

Answer 13

stress incontinence

Question 14

What are the nonpharmacologic treatments for urinary incontinence?

Answer 14

behavioral changes
physical therapy
timed voiding 
habit retraining 
prompted voiding
bladder training
pelvic floor muscle exercises 
biofeedback
vaginal weight training 
acupuncture
alarms, pesaries
supportive undergarments

Question 15

UUI: Anticholinergic/Antispasmotics: agents

Answer 15

oxybutynin
tolteridine
trospium chloride
solfinacin
dandinacin
fesoterodine

Question 16

UUI: Tricyclic Antidepressants: agents

Answer 16

imipramine
nortriptyline
desimpramine
doxepin

Question 17

Anticholinergic: ADEs

Answer 17

DRY MOUTH
constipation
headache
dyspepsia
dry eyes
blurred vision
cognitive impairment
tachycardia
sedation
orthostatic hypotension

*may have pruritus, erythema at application site

Question 18

What classes of drugs are used in the treatment of urge incontinence?

Answer 18

anticholinergic/antispasmotics
tricyclic antidepressants
topical estrogens

mirabegron

Question 19

What are the main concerns using anticholinergics in the elderly population?

Answer 19

mental status changes

risk of falls

Question 20

With anticholinergics, what is a benefit of ER, LA, XL or topical formulations?

Answer 20

fewer ADEs - esp dry mouth

Question 21

Mirabegron: MOA

Answer 21

stimulates beta 3 adrenoreceptors in the urothelium/bladder –> improved urine storage

Question 22

Mirabegron: ADE

Answer 22

can inc BP

Question 23

Mirabegron: contraindications

Answer 23

sev uncontrolled HTN

bladder outlet obstruction

w/ antimuscarinic medications

caution w/ CV disease

Question 24

What is an advantage of Mirabegron?

Answer 24

lacks

• anticholinergic ADEs
• cognitive ADEs

does not interact w/ cholinergic agents

**good option for older pts

Question 25

What is an advantage of Mirabegron?

Answer 25

lacks - anticholinergic ADEs - cognitive ADEs does not interact w/ cholinergic agents **good option for older pts

Question 26

Botulinum Toxin A: action, indication, ADEs

Answer 26

temp paralyzes muscle neurologic condition, overactive bladder ADEs: - dysuria - hematuria - UTI - urinary retention

Question 27

What are the targets of treatment in stress incontinence?

Answer 27

improving urethral closure by: - stimulating alpha adrenergic receptors - enhancing supportive structures - enhancing effects of serotonin and NE in micturition pathway

Question 28

Duloxetine: what is it? what does it do?

Answer 28

SNRI inc sphincter tone during storage

Question 29

What medications are used in the treatment of stress incontinence?

Answer 29

duloxetine | alpha adrenergics

Question 30

Duloxetine: ADEs

Answer 30

``` nausea headache constipation dry mouth insomnia ```

Question 31

Alpha Adrenergics: agents

Answer 31

phenylopropanolamine norfenefrine norephedrine

Question 32

What medications are used in the treatment of stress incontinence?

Answer 32

duloxetine | alpha adrenergics

Question 33

Alpha Adrenergics: contraindications

Answer 33

``` HTN tachyarrhythmias CAD MI cor pulmonale hyperthyroidism renal failure narrow angle glaucoma ```

Question 34

What medication is used in the treatment of overflow incontinence (atonic bladder)?

Answer 34

cholinomimetics: bethanecol

Question 35

Cholinomimetics: ADEs

Answer 35

``` salivation lacrimation urination defecation GI upset emesis cardiac respiratory ```