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PHA 551 > Urinary Incontinence > Flashcards

Urinary Incontinence Flashcards

1
Q

What is Overflow Incontinence?

A

urethral overactivity and/or bladder underactivity

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

urethral blockage

presents w/ dribbling

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2
Q

What is Stress Incontinence?

A

urethral underactivity

relaxed pelvic floor
inc abdominal pressure

  • associated w/ exertional activities
  • MC in women
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3
Q

What is Urge Incontinence?

A

bladder overactivity

involuntary bladder contractions

*think about UTIs she says

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4
Q

Risk Factors for Stress Urinary Incontinence

A 
pregnancy
childbirth
menopause
cognitive impairment
obesity
age
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5
Q

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

A

radical prostatectomy

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6
Q

What group of medications can aggravate stress urinary tract incontinence?

A

alpha adrenergic antagonists

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7
Q

What are the symptoms of urge urinary incontinence?

A

frequency (>8x/d)

urgency

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8
Q

Risk Factors for Urge Urinary Incontinence

A

normal aging
neurologic disease
bladder outlet obstruction

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9
Q

What is first line treatment for urinary incontinence?

A

behavioral therapies

may be combined w/ antimuscarinics

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10
Q

What are the pharmacologic therapies of choice for urge incontinence?

A

anticholinergic/antispasmodic agents

  • darifenacin
  • fesoterodine
  • oxybutynin
  • solifenacin
  • tolterodine
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11
Q

What are the pharmacologic therapies of choice for stress incontinence?

A

alpha adrenergic receptor agonists
and
topical (vaginal) estrogens

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12
Q

Which type of urinary incontinence involves leaking during physical activity?

A

stress incontinence

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13
Q

Which type of urinary incontinence involves leaking during physical activity?

A

stress incontinence

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14
Q

What are the nonpharmacologic treatments for urinary incontinence?

A 
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
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15
Q

UUI: Anticholinergic/Antispasmotics: agents

A 
oxybutynin
tolteridine
trospium chloride
solfinacin
dandinacin
fesoterodine
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16
Q

UUI: Tricyclic Antidepressants: agents

A

imipramine
nortriptyline
desimpramine
doxepin

17
Q

Anticholinergic: ADEs

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

*may have pruritus, erythema at application site

18
Q

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

A

anticholinergic/antispasmotics
tricyclic antidepressants
topical estrogens

mirabegron

19
Q

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

A

mental status changes

risk of falls

20
Q

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

A

fewer ADEs - esp dry mouth

21
Q

Mirabegron: MOA

A

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

22
Q

Mirabegron: ADE

A

can inc BP

23
Q

Mirabegron: contraindications

A

sev uncontrolled HTN

bladder outlet obstruction

w/ antimuscarinic medications

caution w/ CV disease

24
Q

What is an advantage of Mirabegron?

A

lacks

  • anticholinergic ADEs
  • cognitive ADEs

does not interact w/ cholinergic agents

**good option for older pts

25
Q

What is an advantage of Mirabegron?

A

lacks

  • anticholinergic ADEs
  • cognitive ADEs

does not interact w/ cholinergic agents

**good option for older pts

26
Q

Botulinum Toxin A: action, indication, ADEs

A

temp paralyzes muscle

neurologic condition, overactive bladder

ADEs:

  • dysuria
  • hematuria
  • UTI
  • urinary retention
27
Q

What are the targets of treatment in stress incontinence?

A

improving urethral closure by:

  • stimulating alpha adrenergic receptors
  • enhancing supportive structures
  • enhancing effects of serotonin and NE in micturition pathway
28
Q

Duloxetine:
what is it?
what does it do?

A

SNRI

inc sphincter tone during storage

29
Q

What medications are used in the treatment of stress incontinence?

A

duloxetine

alpha adrenergics

30
Q

Duloxetine: ADEs

A 
nausea
headache
constipation
dry mouth
insomnia
31
Q

Alpha Adrenergics: agents

A

phenylopropanolamine
norfenefrine
norephedrine

32
Q

What medications are used in the treatment of stress incontinence?

A

duloxetine

alpha adrenergics

33
Q

Alpha Adrenergics: contraindications

A 
HTN
tachyarrhythmias
CAD
MI
cor pulmonale
hyperthyroidism
renal failure
narrow angle glaucoma
34
Q

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

A

cholinomimetics: bethanecol

35
Q

Cholinomimetics: ADEs

A 
salivation
lacrimation
urination
defecation
GI upset
emesis
cardiac 
respiratory

PHA 551 (9 decks)

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