Urinary Incontinence Flashcards
What is urinary urgency
sudden feeling of needing to urinate
Primary symptoms of OAB
Can present with or without incontinence and is accompanied by urinary frequency and nocturia
What is urinary frequency
Voiding 8 or more times during waking hours
What is nocturia
2 or more awakenings in the night to urinate
What is urinary incontinence
involuntary leakage of urine
What are the forms of urinary incontinence
Urge - associated with neuropathy Stress - leaks during exertion Mixed Functional Overflow - BPH is most common cause
Risk factors for overactive bladder
Age > 40 Diabetes Prior vaginal delivery Obesity Neurologic conditions Restricted mobility Hysterectomy Pelvic injury
What drugs increase incontinence?
Alcohol
Cholinesterase inhibitors
Diuretics
Sedatives
Non pharm therapies for OAB
Behavioral therpies (bladder training, pelvic floor muscle exercises, fluid management)
Drug therapies for urge/mixed incontinence
Anticholinergics (oxybutynin ER, tolterodine, solifenacin)
Beta-3 receptor agonist (mirabegron)
OnabotulinumtoxinA (Botox) has high efficacy but is not first line d/t administration route and cost
Drug therapies for stress incontinence
None FDA approved and minimally effective
pseudoephedrine
Duloxetine
Anticholinergic medications used for OAB
Oxybutinin XL (ditropan XL) or IR
Tolterodine (Detrol)
Solifenacin (Vesicare)
Long acting preferred t/d lower risk of dry mouth
Anticholinergic medication MOA
block acetylcholine from binding, preventing contraction of detrusor muscle
Which anticholinergics have fewer CNS side effects? Why?
Solifenacin, darifenacin, fesoterodine
More selective for M3
Anticholinergics CI, warnings, SE
CI: narrow angle glaucoma
Warnings: agitation, confusion, drowsiness, dizziness, blurred vision
SE: dizziness, drowsiness, dry mouth, constipation
Which anticholinergic can leave a ghost shell in the stool
Oxybutinin XL (Ditropan XL)
