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Special Pops Exam 1 > Urinary Incontinence > Flashcards

Urinary Incontinence Flashcards

1
Q

What patient population is urinary incontinence the most prevalent in?

A

Women

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2
Q

Muscle that surrounds the bladder where contraction empties the bladder?

A

Detrusor muscle

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3
Q

Where is urine stored?

A

In the bladder

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4
Q

What muscle is at the base of the bladder?

A

Internal sphincter

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5
Q

What muscle is under involuntary control?

A

Internal sphincter

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6
Q

What muscle surrounds the urethra?

A

External sphincter

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7
Q

What muscle is controlled under voluntary control?

A

External sphincter

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8
Q

The process of emptying the bladder

A

Micturition

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9
Q

What mL of urine causes the detrusor muscle to contract?

A

200 mL

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10
Q

What mL of urine cause the detrusor muscle to force open the internal sphincter?

A

500 mL

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11
Q

What are the 6 risk factors of urinary incontinence?

A
  1. Gender (females»males)
  2. Age >40 yrs
  3. Smoking
  4. Family history
  5. Overweight
  6. Neurological disorders
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12
Q

What is the acronym for the transient causes of UI?

A

DIAPPERS

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13
Q

What does the acronym DIAPPERS stand for?

A

D- delirium
I- infection (UTI)
A- atrophic urethritis/vaginitis
P- pharmaceuticals
P- psychological (depression)
E- excessive urine output (HF or hyperglycemia)
R- restricted mobility
S- stool impaction

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14
Q

What are 9 drug classes that may cause UI?

A
  1. Diuretics
  2. Psychotropics
  3. Narcotics
  4. Alpha blockers
  5. CCBs
  6. Anticholinergic agents
  7. Alpha agonists
  8. Beta agonists
  9. Ethanol
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15
Q

What are the 5 types of UI?

A
  1. Urge
  2. Stress
  3. Overflow
  4. Functional
  5. Mixed
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16
Q

What is the most common type of UI?

A

Urge Incontinence

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17
Q

What are 4 risk factors or urge incontinence?

A
  1. Increased age
  2. Neurologic disease
  3. Diabetes
  4. Smoking
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18
Q

What are 4 clinical presentations of urge incontinence?

A
  1. Urgency
  2. Frequency (>8 voids/day)
  3. Nocturia (1> void/day)
  4. Enuresis (bed-wetting)
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19
Q

When urine leaks out of the bladder during any form of exertion as a result of pressure on the bladder

A

Stress incontinence

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20
Q

What are 8 risk factors for stress incontinence?

A
  1. Pregnancy
  2. Childbirth
  3. Menopause
  4. Atrophic vaginitis
  5. Cognitive impairment
  6. Obesity
  7. Increased age
  8. Lower UT surgery/injury (men)
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21
Q

When incontinence isn’t seen while sleeping?

A

Stress incontinence

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22
Q

Involuntary release of urine when the bladder becomes very full, even though the person feels no urges to urinate?

A

Overflow incontinence

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23
Q

What are 5 common causes of overflow incontinence?

A
  1. Bladder outlet obstruction
  2. Diabetic neuropathy
  3. Spinal cord injuries
  4. MS
  5. Pelvic surgeries
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24
Q

What type of incontinence does not usually occur when sleeping?

A

Stress incontinence

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25
Q

What are 5 clinical signs and symptoms for overflow incontinence?

A
  1. Lower abdominal fullness
  2. Hesitancy, straining, and decreased force of stream
  3. Incomplete bladder emptying
  4. Frequency/urgency
  5. Increased PVR
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26
Q

What type of incontinence: The inability of a normally continent person to reach the toilet in time to avoid accidents

A

Functional incontinence

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27
Q

What are 2 most common causes of functional incontinence?

A
  1. Musculoskeletal limitations
  2. Cognitive impairment
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28
Q

What are clinical signs and symptoms of functional incontinence?

A

Accidents on the way to the toilet and early morning incontinence

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29
Q

What two types of incontinence are involved in mixed incontinence?

A

Stress and Urge

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30
Q

What is considered first line to treat UI?

A

Non pharmacologic therapies

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31
Q

What 4 foods should you avoid for UI?

A
  1. Aspartame
  2. Spicy/citrus foods
  3. Caffeine
  4. Carbonated beverages
32
Q

True or false: drug treatment alone has minor benefit, especially in nursing homes

A

True

33
Q

When do the best results occur when using medication?

A

When used on combination with behavioral interventions

34
Q

What is the best treatment for functional incontinence?

A

Removing the underlying cause

35
Q

What is the first line treatment for stress incontinence?

A

Pelvic floor exercises

36
Q

What are 5 pharmacologic treatments for stress incontinence?

A
  1. Intravaginal estrogens
  2. Adrenergic agonist
  3. Duloxetine
  4. Vaginal pessary and urethral insert
  5. Surgery to improve stability of the bladder neck
37
Q

What are the two Intravaginal estrogens that can be used?

A
  1. Conjugated estrogens vaginal cream
  2. Estradiol vaginal ring
38
Q

What are 3 adverse effects of the Intravaginal estrogens?

A
  1. Vaginal spotting
  2. Breast tenderness
  3. Nausea
39
Q

What are 2 adrenergic agonists that can be used in UI?

A
  1. Pseudoephedrine
  2. Phenylephrine
40
Q

What are 4 ADRs of the adrenergic agonists?

A
  1. Dizziness
  2. Increased blood pressure
  3. Insomnia
  4. Headache
41
Q

What is the purpose of surgery for stress incontinence?

A

To improve the closure of the sphincter to support the bladder neck

42
Q

What are 4 treatment options for overflow incontinence?

A
  1. Discontinue precipitating medications
  2. Treat BPH
  3. Cholinergic stimulation of the detrusor muscle
  4. Catheterization
43
Q

What is the MOA of Bethanechol?

A

Stimulates parasympathetic nervous system, which increases bladder muscle tone, causing contractions to initiate urination

44
Q

What are 4 ADRs of bethanechol?

A
  1. Diarrhea and N/V
  2. Flushing
  3. Abdominal cramping
  4. Salivation
45
Q

What does catheterization have an increased risk of?

A

UTIs

46
Q

What is the first line treatment for urge incontinence?

A

Antimuscarinics

47
Q

What receptor is responsible for normal micturition contractions?

A

M3

48
Q

How much do antimuscarinics reduce incontinence episodes by? Frequency?

A
  1. 50%
  2. 20%
49
Q

OXYBUTYNIN

A

DITROPAN XL; GELNIQUE; OXYTROL

50
Q

TOLTERODINE

A

DETROL LA

51
Q

Fesoterodine

A

TOVIAZ

52
Q

SOLIFENACIN

A

VESICARE

53
Q

DARIFENACIN

A

ENABLEX

54
Q

When should you avoid the use of antimuscarinics?

A

In older adults with delirium, dementia, cognitive impairment, or chronic constipation

55
Q

What brand of oxybutynin is highly potent and has high side effects?

A

DITROPAN

56
Q

What brand of oxybutynin is better tolerated?

A

Ditropan XL

57
Q

What should you avoid when using gelnique?

A

Bathing for 1 hour after application

58
Q

How often is the oxytrol patch replaced?

A

Every 3 to 4 days

59
Q

When should you change the oxytrol patch?

A

On the same 2 days each week

60
Q

What is important to know with oxytrol?

A

May not see effects until a few weeks of therapy

61
Q

True or false: Tolterodine is better tolerated than oxybutynin and is more effective

A

False (less effective)

62
Q

When should you adjust the dose with DETROL?

A

When the CrCl is 10-30 mL/min

63
Q

What is the prodrug of Tolterodine?

A

Fesoteradine

64
Q

What dose is used for toviaz?

A

4 mg QD

65
Q

What antimuscarinic agent has less cognitive impairment?

A

Trospium chloride

66
Q

What 2 animuscarinics are M3 selective receptor antagonists?

A
  1. SOLIFENACIN
  2. Darifenacin
67
Q

What are the 2 beta-3 adrenergic agonists?

A
  1. Mirabegron
  2. Vibegron
68
Q

What is the MOA for myrbetriq?

A

Relaxes the detrusor muscle during the storage phase to increase bladder capacity

69
Q

What does Myrbetriq have a drug interaction with?

A

Digoxin

70
Q

What does Vibegron not interact with but myrbetriq does?

A

CPY2D6 enzyme

71
Q

What drug has the worst anticholinergic side effect?

A

Oxybutynin

72
Q

MIRABEGRON

A

MYRBETRIQ

73
Q

VIBEGRON

A

GEMTESA

74
Q

What 3 antimuscarinics are better to use in terms of cognition?

A
  1. Solifenacin
  2. Darifenacin
  3. Trospium chloride
75
Q

When can Botox be used?

A

As a last line agent

76
Q

How long can an implantable device last?

A

15 years

Special Pops Exam 1 (5 decks)

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