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Phar 508 > Urinary Incontinence > Flashcards

Urinary Incontinence Flashcards

1
Q

What is the stretchable smooth muscle of the bladder, what neurotransmitter is associated with it, which receptor types

A

Detrusor, acetylcholine, muscarinic (M2 and M3)

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2
Q

T/F: The internal sphincter and external sphincter are under voluntary control

A

False: The External sphincter is skeletal muscle under VOLUNTARY control while the internal sphincter is a continuation of smooth muscle of the bladder and not a true sphincter

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3
Q

What occurs in the bladder before urination in the parasympathetic pathway

A

Urine fills bladder and pressure increases -> bladder stretches -> bladder contraction and opening of internal sphincter/relation of external sphincter and “urge” sensation

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4
Q

What causes the holding of urine when the urge is present

A

Tightening of the external sphincter (overriding the parasympathetic stimulation) and the pelvic floor muscles

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5
Q

What exercises can strengthen the Pelvic floor muscles

A

Kegel

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6
Q

What type of nerve stimulation is associated with the internal sphincter, bladder relaxtion

A

alpha-1, beta-3

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7
Q

What are the four types of Urinary Incontinence

A

Functional, Urge, Stress, Overflow

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8
Q

T/F: A patient can have more than one type of urinary incontinence and stress incontinence is the most common

A

False: A patient CAN have more than one type of incontinence BUT the most common type of incontinence is urge UI

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9
Q

What is functional incontinence

A

Urine leakage due to inablility to reach the toilet due to physical and cognitive impairment

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10
Q

What are causes of functional incontinence

A

physical disability, dementia,MS, drowsiness or meds affect balance (diazepam etc.)

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11
Q

What is urge incontinence

A

Urine leakage due to inability to control bladder when feeling of fullness is perceived

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12
Q

What is the most common causes, other causes

A

Idiopathic (unknown)/ detrusor instability, CNS disorders (stroke)

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13
Q

What is the pathophysiology of Urge UI

A

OVER SIGNALING to the detrusor by acetylcholine (parasympathetic) -> increased bladder contractions -> more frequent urge to urinate

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14
Q

What is stress incontinence, how is it identified

A

Urine leakage due to increases in intraabdominal pressure along with weakness of internal/external sphincter, urine leakage due to coughing, laughing, exercise etc.

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15
Q

T/F: Losing weight is beneficial to controlling urge and stress UI

A

True

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16
Q

What is overflow UI

A

Leakage of urine (small amounts) from mechanical forces on an over stretched bladder or from urinary retention on bladder

17
Q

What are common causes of overflow UI

A

Obstruction by prostate (males), spinal cords injury, diabetes, atonic bladder, meds (opiates, anticholinergics)

18
Q

What is the first line therapy for types of UI except in cases of urinary obstruction

A

Behavioral approaches

19
Q

What are non pharmacological strategies

A

Kegel exercises, drinking up to two liters per day, avoid caffein smoking and alchohol, weight loss, diuretics early in the day

20
Q

T/F: Behavioral is more efficacious and there is less want to change therapy

A

True

21
Q

Which UI is most associated with drug therapy

A

Urge UI

22
Q

What classes of drugs are used in Urge UI, MOA

A

Antimuscarinics (muscarinic antagonists), relaxation of detrusor allowing greater volumes of urine before the urge of urination

23
Q

What is the beta-3 agonists used in Urge UI

A

Mirabegron (Myrbetriq)

24
Q

T/F: Meds for UI should only be used for up to 4 to 8 weeks then reevaluated at 3 month intervals, not for long term use

A

True

25
Q

What antimuscarinics should patinets NOT use for urinary incontinence

A

Propantheline, Dicyclomine, Imipramine, Flavoxate

26
Q

What are the antimuscarinics used in UI

A

Oxybutynin, tolterodine, festoterodine, solifenacin, darifenacin, trospium

27
Q

What are the adverse effects of anticholinergicsw

A

dry mouth, constipation, vision impariment, tachycardia, drowsiness

28
Q

What anticholinergic is the most reasonable first line

A

Tolterodine`

29
Q

What are drug-drug interactions to be concerned with when using anti-muscarinics

A

Fluoxetine, Sertraline, Fluvoxamine, erthymyocin/clarithryomycin, ketoconazole/fluconazole, grapefruit juice (ALL INTERACT WITH CYP 3A4)

30
Q

What drug should be avoided when using Tolteridine

A

Antacids by at least 4 hours

31
Q

Which antimuscarinic should be taken on an empty stomach

A

Trospium

32
Q

T/F: Topical Estrogens make stress UI worse

A

True

33
Q

What antidepressant is approved for Urge incontinence

A

Duloxetine

34
Q

How would overflow incontinence be treated

A

Catheterization or procedure

35
Q

T/F: Chronic diarrhea needs to be treated before overflow incontinence

A

False: Chronic CONSTIPATION needs to be treated before overflow incontinence

Phar 508 (21 decks)

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