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Pharmacotherapy 4271 > Urinary Incontinence (Final) > Flashcards

Urinary Incontinence (Final) Flashcards

1
Q

this is an involuntary loss of urine

A

urinary incontinence

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2
Q

what are the different types of UI

A
  • stress
  • urge
  • overflow
  • functional
  • mixed (stress & urge)
  • iatrogenic
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3
Q

is urinary continence more common in men or women?

A

women

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4
Q

in a patient who does NOT have urinary incontinence, is their intravesicular pressure smaller or bigger than the intraurethral pressure

A

smaller

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5
Q

in a patient who has urinary incontinence, is their intravesciular pressure smaller or bigger than the intraurethral pressure

A

bigger

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6
Q

what are the 2 main urological causes of urinary incontinence

A
  1. inability to store urine
    - bladder contracts too often
    - sphincter cannot contract sufficiently to allow the bladder to store urine therefore bladder never fills to capacity
  2. inability to void urine
    - bladder unable to contract appropriately
    - possible obstruction
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7
Q

what are some risk factors to developing urinary incontinence

A
  • caffeine/fluid intake
  • immobility
  • bowel problems (e.g. constipation)
  • smoking
  • menopause
  • medications
  • UTIs
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8
Q

this type of urinary incontinence is characterized by a transient loss of small amounts of urine with increased abdominal pressure.
- from coughing, bending, laughing

A

stress incontinence

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9
Q

besides increased abdominal pressure, what is the physiological cause of stress incontinence

A

urethral sphincter weakness

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10
Q

what are some risk factors specific to stress incontinence that may increase abdominal pressure

A
  • pregnancy
  • vaginal childbirth
  • obesity
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11
Q

this type of urinary incontinence is also caused overactive bladder, unstable bladder or spastic bladder. it is the most common type in the elderly

A

urge incontinence

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12
Q

what is the physiological cause of urge incontinence

A

abnormal bladder contractions because of overactive detrussor

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13
Q

which type of urinary incontinence can be caused by stroke, parkinsons, MS, diabates, or spinal cord damage

A

urge incontinence
- these can cause detrussor instability

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14
Q

this type of urinary incontinence occurs when the intravesicular pressure exceeds intraurethral pressure (only at HIGH volumes). this is common in males with BPH due to obstruction

A

overflow incontinence
O = obstruction & O = overflow

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15
Q

what are some causes of overflow incontinence

A
  • bladder outlet obstruction (BPH, prostate cancer)
  • diabetic neuopathy, spinal cord lesions below T-11
  • drugs (muscle relaxants, CCBs, anticholinergics, alpha-agonsits)
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16
Q

this type of urinary incontinence is known as the inability of a normally continent person to reach the toilet in time to avoid an accident. not caused by bladder or urethral specific factors

A

functional incontinence

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17
Q

what are some causes of functional incontinence

A
  • MSK limitations (joint pain, RA)
  • cognitive impairments
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18
Q

what are some causes of urinary incontinence that have no specific urogenital pathology

A

think DIAPERS
D - delirium
I - infection
A - atrophic urethritis / vaginitis
P - pharmaceuticals / psychiatric issues
E - excessive urinary output
R - restricted mobility
S - stool impaction

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19
Q

this urinary continence is known as incontinence related to medication use

A

Iatrogenic incontinence

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20
Q

what are some rx drugs that contribute to incontinence

A

think 3A’s, 2B’s & 1C, D & N
3 A’s
- alpha-agonsits
- alpha-blockers
- anticholinergics
2 B’s
- beta-agonsits
- beta-blockers
1 C, D & N
- CCBs
- diuretics
- narcotics

  • alcohol, antihistamines & caffeine are some other drugs that may also contribute to incontinence
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21
Q

select all that apply:
which urinary incontinence would present as the inability to store urine
a) stress
b) urge
c) overflow
d) functional

A

a and b

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22
Q

select all that apply:
which urinary incontinence would present as the inability to reach the toilet
a) stress
b) urge
c) overflow
d) functional

A

d

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23
Q

select all that apply:
which urinary incontinence would present as the inability to empty bladder
a) stress
b) urge
c) overflow
d) functional

A

c

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24
Q

what urinary incontinence is most likely if the patient is dry overnight

A

stress incontinence

25
Q

what urinary incontinence is most likely if the patients primary complaint is urgency, frequency (> 8 episodes/day) & nocturia

A

urge incontinence

26
Q

what urinary incontinence is most likely if the patients primary complaint is suprapubic tenderness with low urinary flow rates and the patients has a palpable or percussable bladder

A

overflow incontinence

27
Q

what urinary incontinence is most likely if the patient primary complaint is early morning incontinence or having an accident on the way to the toilet

A

functional incontinence

28
Q

what are some screening questions to ask patients who are possibly experiencing urinary incontinence

A
  • have you leaked urine in the past 3 months
  • do you ever lose urine when you dont want to
  • how often do you leak urine
  • when do you leak urine
  • do you ever leak urine when you cough, laugh or exercise
  • do you ever leak urine otw to the bathroom
  • do you ever use pads, tisse or cloth in your underwear to catch urine
  • do you ever feel that your unable to completely empty your bladder
29
Q

this is helpful when performing an assessment of symptom pattern and response to therapy. should be completed for at lease 3 days

A

bladder diary

30
Q

true or false: non-pharm tx is only used in adjunt to pharmacological treatment for urinary incontinence as the medications are very effective

A

false - first line is always 1st line because treatments are only modestly beneficial and have a/e

31
Q

what are some non-pharm recommendations for urinary incontinence

A
  • prompted voiding
  • bladder training
  • pelvic floor exercises
  • vaginal weight training
  • pessary
32
Q

true or false: any drug used to treat incontinence can make it worse if the diagnosis is wrong or if the patinet has more than one type of incontinence

A

true

33
Q

this is a treatment option for stress incontinence, but overall evidence supporting its use is weak - may offer some benefit in women who also have vaginal atrophy

A

vaginal estrogens
e.g. conjugated estrogen vaginal cream, vaginal ring, or vaginal tablet

34
Q

what are some a/e of vaginal estrogens

A
  • vaginal discharge
  • local irritation/pruritis
  • spotting
35
Q

this is a treatment option for stress incontinence. studies have demonstrated reduction in urinary incontinence and increased QoL - but does not have an indicaition for UI.

A

duloxetine

35
Q

what are some a/e of duloxetine

A
  • nausea
  • dizziness, insomenia, h/a
  • increased BP
  • constipation and dry mouth
  • risk of suicidal ideation
36
Q

this medicaation is not recommended for urinary incontinence therefore should only be used when all else fails. it wor,s by increasing intraurethral sphincter tone

A

pseudophedrine

37
Q

this is a class of treatment option for urge incontinence. it is the preferred treatment option if the patient fails non pharm. it may only reduce urination by 1 ep/day. it increases bladder capacity/storage

A

antimuscarinincs

38
Q

this antimuscarinic can cause a blockade of M1 receptors in the brain which can result in sleepiness and cognitive impairment

A

oxybutynin

39
Q

blockade of these receptors present in the detrusor muscle results in bladder relaxation and therefore less urinary incontinence

A

M3

40
Q

blockade of M3 receptors in other areas of the body besides the prostate can lead to what s/e?

A

constipation, dry mouth

41
Q

Darifenacin is the antimuscarinic with less CNS s/e. why?

A

its lipophilicity is low, it has a higher molecular weight and it has a postiive charge therefore it is less likely to cross the BBB and cause CNS s/e

42
Q

this antimuscarinic is the oldest agent with proven efficacy; considered the “gold standard” to which other therapies are compared to

A

oxybutynin

43
Q

what is an adequate trial of oxybutynin to see maximum benefit

A

4 weeks

44
Q

this antimuscarinic is a first line treatment for urinary incontinence. it is better tolerated with lower incidence of anticholinergic s/e compared to oxybutynin.

A

tolterodine

45
Q

true or false: dosage adjustment is reauired for renal/liver impairment in tolterodine

A

true

46
Q

what is an adequate trial of tolterodine to see maximum benefit

A

8 weeks

47
Q

this antimuscarinic is slightly more selective for M3 than M1. it is better tolerated than oxybutynin and tolterodine with regards to anticholinergic s/e

A

solifenacin

48
Q

this antimuscarinic is a prodrug with the same active ingredient as tolterodine. it should not be chewed or crushed b/c extended release and contains soya lecithin this should be avoided in patients with a soy or peanut allergy

A

fesoterodine

49
Q

true or false: fesoterodine requires dosage adjustment in renal and liver impariment

A

true

50
Q

this antimuscarninc may produce less anticholinergic s/e than others and should be taken on an empty stomach

A

trospium

51
Q

this antimuscarinic is the most M3 selective. can be taken with or without food. it is contraindicated in patients with urinary retention, gastric retention and uncontrolled narrow angle glaucoma

A

darifenacin

52
Q

what are some s/e of darifenacin since it is M3 selelctive

A

dry mouth and constipation
- least likely to cause CNS s/e!!!!!

53
Q

this is a treatment option for urinary incontinence that acts on beta-3 receptors therefore relaxes bladder and increases its capacity. it is an alternative to antimuscarinics if they are not tolerated or contraindicated.

A

mirabegron (myrbetriq)

54
Q

what are some a/e associated with mirabegron (myrbetriq)

A
  • hypertension
  • tachycardia
  • nasopharyngitis
  • UTIs
55
Q

this medication is a moderate inhibitor of CYP 2D6 and a weak inhbitor of p-gp. can increase digoxin and dabigitran levels and may be QT prolonging

A

mirabegron (myrbetriq)

56
Q

what is the therapy of choice in overflow incontinence who have chronic retention due to BPH

A

surgery
* treatment relates to BPH management (alpha-adrenergic antagonists and 5alpha-reducatse inhibitors)

57
Q

what is the best way to prevent urinary incontinence in pregnancy

A

pelvic floor muslce training

Pharmacotherapy 4271 (29 decks)

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