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825 > Urinary Incontinence (Exam 1 Cut Off) > Flashcards

Urinary Incontinence (Exam 1 Cut Off) Flashcards

1
Q

Bladder Control

A
  • Inhibited by CNS, frontal lobe
  • Parasympathetic - detrusor muscle around bladder to contract
  • Sympathetic - internal sphincter (alpha stimulation causing contraction)
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2
Q

Mechanism of Stress UI

A
  • Stress UI: during exertion, urethral sphincter no longer able to resist flow, intra-abdominal pressure exerted
  • Risk factors: pregnancy, childbirth, menopause, obesity, age, cognitive impairment, TURP
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3
Q

Mechanism of Urge UI

A
  • Overactive detrusor muscle that contracts during filling, involuntary
  • Symptoms: >8 times per day, nocturnia, sudden urges
  • Risk factors: aging, neurological disease, bladder outlet obstruction
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4
Q

Overflow Incontinence

A
  • Bladder filled to capacity at all times and unable to empty
  • Urine leaks from distended bladder
  • Large volumes of residual urine
  • Urethral overactivity
  • More common in men
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5
Q

Bladder underactivity

A
  • Detrusor progressively weakened: unable to contact
  • Most common in long-term chronic bladder obstruction
  • Occurs in both sexes
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6
Q

Mixed/Other UI

A
  • Mixed: combinations can coexist

- Functional UI: dementia, cognitive or mobility impairment, UTI, constipation

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7
Q

Medications + UI

A
  • Diuretics
  • alpha antagonists and agonists
  • CCB
  • Narcotics
  • Sedative hypnotics
  • Antipsychotics/anticholinergics
  • Alcohol
  • ACE-I
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8
Q

Reversible Causes of UI

A 
DIAPPERS
D - Delirium
I - Infection
A - Atrophic vaginitis/urethritis
P - Psychiatric disorders
P - pharmacological treatments
E - Excessive urine output
R - Restricted mobility
S - Stool impaction
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9
Q

Nonpharm Treatment - UI

A
  • Behavioral interventions
  • Lifestyle modifications
  • Anti-incontinence device
  • Toileting substitutes
  • Absorbent products
  • Catheters
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10
Q

Prevention of Skin Breakdown

A
  • Skin protectants: petrolatum, butt paste, lanolin
  • Moisturizers
  • Cleansers
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11
Q

Pharmacologic Treatment - UI

A
  • Interfere with hyperactive detrusor muscle
  • Anticholingeric activity
  • Review AC drugs
  • Oxybutynin - best drug for UI, can be pull/patch
  • Major SE: dry mouth, dry eyes, constipation
  • Better selectivity for urinary bladder than tolterodine
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12
Q

Tolterodine

A
  • Detrol
  • Similar efficacy for ER/IR
  • Reduce dose for renal/hepatic insufficiency
  • SE: dry mouth
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13
Q

Solifenacin Succinate

A
  • Vesicare
  • More selective for M3 muscarinic receptors in bladder/GI tract
  • Less effective at lower doses than tolterodine
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14
Q

Darifenacin

A
  • Enablex

- More selective for M3 in bladder and GI tract

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15
Q

Trospium

A
  • Sanctura
  • Reduce for once a day for elderly
  • ADR: dry mouth
  • Take on empty stomach
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16
Q

Fesoterodine

A
  • Toviaz

- SE: Dry mouth

17
Q

TCA

A
  • Imipramine, nortriptyline, or desipramine

- If additional indication

18
Q

Mirabegron

A
  • Myrbetriq
  • Beta3 adrenoreceptor agonist
  • Approved for urge UI
  • Renal adjustments: CrCl between 15-29 mL/min: do not exceed 25 mg, <15 mL/minute not recommended
  • Common treatment, considered very safe
19
Q

UI Guidelines

A
  • Behavior therapy first
  • Anti-muscarinics first, preferably ER formulation (lower rates of dry mouth)
  • Unacceptable reactions should change doses or medications
  • Use SNS or PTNS to those who can’t use or are refractory to other treatments
20
Q

Anti-muscarinic CI

A
  • Narrow-angle glaucoma
  • Impaired gastric emptying/history of urinary retention (extreme caution)
  • Caution with multiple anticholinergics and frail OAB patients
  • Manage constipation/dry mouth before abandoning
21
Q

Stress/Mixed UI Pharmacologic Treatment

A
  • 1st line: pelvic floor muscle training
  • Consider contributing causes
  • Continence pessary/vaginal inserts
  • Surgery
  • Estrogens: modifies muscarinic receptors on detrusor, increases closing pressure on sphincter, do NOT use oral estrogen
22
Q

Overflow Incontinence: Secondary to BPH

A
  • Alpha antagonists: block NE on urinary sphincter

- 5alpha - reductase inhibitor: reduce prostate sie

23
Q

Overflow Incontinence: Secondary to hypotonic/atonic bladder

A
  • Catheterization

- Indwelling or intermittent

24
Q

Overflow Incontinence: Failure to Treatment

A
  • Surgery
  • Increase outlet resistance
  • Decreasing detrusor instability
  • Removing outlet obstruction
  • Electrical stimulation for refractory urge incontinence
25
Q

SNRI

A
  • Investigational Therapy
  • Duloxetine
  • Stimulate contraction urethral sphincter muscle
  • Approved for UI in Europe
  • Can cause QT prolongation, liver toxicity
26
Q

Other Investigational Therapies

A
  • Neurokinin-1 Receptor Antagonists: Aprepitant and Serlopitant
  • SMP-986: blocks sodium channels and muscarinic receptors, effects bladder contraction
  • Magnetic stimulation therapy
  • Tachykinins - may mediate bladder/spinal reflex signaling

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