Urinary Incontinence and BPH (Final Exam)

Question 1

this is also known as “over active” bladder. it is caused by involuntary contractions of the detrusor muscle in the bladder wall. symptoms include
- urinary urgency
- urinary frequency (> 8x/day)
- nocturia
- urge incontinence (involuntary leakage)

Answer 1

urge incontinence

Question 2

this is also known as leaky bladder. it is caused by a pressure gradient imbalance between the bladder and urethra. expulsion of urine may occur due to sneezing, coughing, laughing.

Answer 2

stress incontinence

Question 3

where would the pressure be higher for stress incontinence, urethra or bladder?

Answer 3

bladder

to prevent urine from being expelled, the pressure in the urethra should be higher than the bladder

Question 4

is urinary incontinence more common in women or men

Answer 4

women - because their urethra is shorter therefore physcally harder to hold in urine

Question 5

what is the first line tx for urinary incontinence

Answer 5

non pharm!
- scheduled voiding
- timing fluid intake
- kegel exercises

Question 6

name the class of medications used for overactive bladder and explain their MOA

Answer 6

anticholinergics!! (muscarinic receptor antagonists)

MOA: block muscarinic receptors in the detrusor muscle and therefore inhibit bladder contractions and the urge to void.

Question 7

what are the three types of muscarinic receptors and which one is the intended target in order to treat over active baldder

Answer 7

M1, 2 and 3. M# is located in the detrusor muscle therefore we want to target M3 selectively to reduce any other heart or CNS s/e

Question 8

this medication is used for overactive bladder and is highly anticholinergic. it is slightly M3 selective and is highly lipid soluble thus it crosses the BBB and causes CNS s/e <- nasty for elderly people!!

Answer 8

oxybutynin

Question 9

this medication for overactive bladder is very M3 selective

Answer 9

darifenacin

Question 10

this medications for overactive bladder is similar to Darifenacin but is less selective. it has a long half life of 50 hours therefore only OD dosing

Answer 10

Solifenacin

Question 11

this medication for overactive bladder is non selective but does not cross the BBB

Answer 11

Tolterodine

Question 12

this medication is used for overactive bladder. it is a selective beta03 agonist that relaxes baller smooth muscle and reduces voiding frequency. S/e include hypertension and tachycardia

Answer 12

Mybetriq (mirabegron)`

Question 13

this medication is used for nocturnal enuresis. it is an antidiuretic hormone analogue. it reduces urine output the given before sleeping and used when a rapid response is required

Answer 13

Desmopressin

Question 14

this medication is used for urinary retention (can’t pee). it is a muscarinic agonist, therefore it binds to and activates muscarinic receptors. s/e = increased urination, diarrhea, increased saliva

Answer 14

bethanechol (Duvoid)

Question 15

these medications are used for BPH. they are most appropriate for very large prostate as they cause the prostate to shrink. onset is 6-12 months. they inhibit the conversion of testosterone to it’s active form 5 alpha dihydrotestosterone

Answer 15

finasteride, duasteride (anti-androgens)

Question 16

this class of medications used for BPH block alpha-1a receptors leading to relaxation of smooth muscle of bladder neck, prostate capsule and urethrea. does not shrink the prostate. works within weeks.

selective=tamsulosin (Flomax) [s/e retrograde ejaculation]
nonselective = terazosin, doxazosin [hypotension, fainting, nasal congestion]

Answer 16

alpha-1 blockers