Urinary Incontinence Flashcards
What is Overflow Incontinence?
urethral overactivity and/or bladder underactivity
bladder is filled to capacity at all times – unable to empty
urethral blockage
presents w/ dribbling
What is Stress Incontinence?
urethral underactivity
relaxed pelvic floor
inc abdominal pressure
- associated w/ exertional activities
- MC in women
What is Urge Incontinence?
bladder overactivity
involuntary bladder contractions
*think about UTIs she says
Risk Factors for Stress Urinary Incontinence
pregnancy childbirth menopause cognitive impairment obesity age
There is NO role for medications in the management of stress urinary incontinence after what procedure?
radical prostatectomy
What group of medications can aggravate stress urinary tract incontinence?
alpha adrenergic antagonists
What are the symptoms of urge urinary incontinence?
frequency (>8x/d)
urgency
Risk Factors for Urge Urinary Incontinence
normal aging
neurologic disease
bladder outlet obstruction
What is first line treatment for urinary incontinence?
behavioral therapies
may be combined w/ antimuscarinics
What are the pharmacologic therapies of choice for urge incontinence?
anticholinergic/antispasmodic agents
- darifenacin
- fesoterodine
- oxybutynin
- solifenacin
- tolterodine
What are the pharmacologic therapies of choice for stress incontinence?
alpha adrenergic receptor agonists
and
topical (vaginal) estrogens
Which type of urinary incontinence involves leaking during physical activity?
stress incontinence
Which type of urinary incontinence involves leaking during physical activity?
stress incontinence
What are the nonpharmacologic treatments for urinary incontinence?
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
UUI: Anticholinergic/Antispasmotics: agents
oxybutynin tolteridine trospium chloride solfinacin dandinacin fesoterodine
UUI: Tricyclic Antidepressants: agents
imipramine
nortriptyline
desimpramine
doxepin
Anticholinergic: ADEs
DRY MOUTH constipation headache dyspepsia dry eyes blurred vision cognitive impairment tachycardia sedation orthostatic hypotension
*may have pruritus, erythema at application site
What classes of drugs are used in the treatment of urge incontinence?
anticholinergic/antispasmotics
tricyclic antidepressants
topical estrogens
mirabegron
What are the main concerns using anticholinergics in the elderly population?
mental status changes
risk of falls
With anticholinergics, what is a benefit of ER, LA, XL or topical formulations?
fewer ADEs - esp dry mouth
Mirabegron: MOA
stimulates beta 3 adrenoreceptors in the urothelium/bladder –> improved urine storage
Mirabegron: ADE
can inc BP
Mirabegron: contraindications
sev uncontrolled HTN
bladder outlet obstruction
w/ antimuscarinic medications
caution w/ CV disease
What is an advantage of Mirabegron?
lacks
- anticholinergic ADEs
- cognitive ADEs
does not interact w/ cholinergic agents
**good option for older pts
What is an advantage of Mirabegron?
lacks
- anticholinergic ADEs
- cognitive ADEs
does not interact w/ cholinergic agents
**good option for older pts
Botulinum Toxin A: action, indication, ADEs
temp paralyzes muscle
neurologic condition, overactive bladder
ADEs:
- dysuria
- hematuria
- UTI
- urinary retention
What are the targets of treatment in stress incontinence?
improving urethral closure by:
- stimulating alpha adrenergic receptors
- enhancing supportive structures
- enhancing effects of serotonin and NE in micturition pathway
Duloxetine:
what is it?
what does it do?
SNRI
inc sphincter tone during storage
What medications are used in the treatment of stress incontinence?
duloxetine
alpha adrenergics
Duloxetine: ADEs
nausea headache constipation dry mouth insomnia
Alpha Adrenergics: agents
phenylopropanolamine
norfenefrine
norephedrine
What medications are used in the treatment of stress incontinence?
duloxetine
alpha adrenergics
Alpha Adrenergics: contraindications
HTN tachyarrhythmias CAD MI cor pulmonale hyperthyroidism renal failure narrow angle glaucoma
What medication is used in the treatment of overflow incontinence (atonic bladder)?
cholinomimetics: bethanecol
Cholinomimetics: ADEs
salivation lacrimation urination defecation GI upset emesis cardiac respiratory
