incontinence Flashcards
urge incontinence
-usually a result of detrusor instability, detrusor hyperactivity with impaired bladder contractility, or involuntary sphincter relaxation
-MUSCLE
stress incontinence
resulting from urethral sphincter failure - due to either anatomic changes or intrinsic sphincter deficiency (ISD)
-SPHINCTER
overflow incontinence
results from hypotonic or underactive detrusor secondary to drugs, fecal impaction, diabetes, lower spinal cord injury, disruption of the motor innervation of the detrusor muscle, urethral obstruction, or genital prolapse
mixed incontinence
refers to a combination of urge and stress incontinence, especially common in older women
treatment of urinary incontinence
-Pharmacological
-Behavioral- Weight loss, dietary changes, smoking cessation!, exercise (kegel)
-Surgical
-In general, the first choice should be the least invasive treatment with the fewest potential adverse complications for the patient.
-Before treatment, a complete evaluation (including a review of medication profile) and appropriate urodynamic testing should be completed
medication and effect chart
symptoms chart
muscarinic receptors- role in tx of incontinence
target M3 mostly
SNRI: duloxetine
-MOA – serotonin-norepinephrine reuptake inhibitor
-Use: Stress incontinence
-Not used often due to side effects, though there is a 50% improvement of symptoms
-can cause a slight increase in BP -> monitor in a HTN pt
alpha adrenergic agonists: phenylpropanolamine
-MOA: stimulates the urethal smooth muscle contraction
-Uses: Stress incontinence
-Not used routinely because only mildly efficacious
anticholinergics- propantheline
-Original prototype for anticholinergic agents used for urologic conditions.
-MOA – Muscarinic blocker - inhibits involuntary detrusor muscle contractions. Not as selective as other agents for incontinence so not used clinically
-Precautions – narrow angle glaucoma, elderly
-ADRs - urinary retention, blurred vision, dry mouth, nausea, constipation, tachycardia, drowsiness, and confusion
-not commonly used for elderly bc SE is consistent with elderly syndromes (glaucoma, constipation, etc.) -> beers list
-not used as much bc of SE
anticholinergics: muscarinic receptor antagonists- oxybutynin
-MOA - inhibit involuntary detrusor muscle contractions, delays desire to void, urgency & frequency, direct antispasmodic effect on smooth muscle. (M3 > M1)
-Precautions – narrow angle glaucoma, elderly
-Active metabolite - N-desethyloxybutynin
-ADRs - dry mouth, dry skin, blurred vision, sedation, change in mental status, nausea, constipation. (Severity of ADRs increases with dosage)
-DDI – CYP3A4 substrate & inhibitor- many
oxytrol and gelnique
-Both applied topically for systemic effects
-Both bypass first-pass effect so less anticholinergic side effects
-Significantly less dry mouth
-Both – much more costly
-Oxytrol – patch. Apply twice weekly
-Gelnique – Gel. Apply daily
anticholinergics: tolterodine
-fesoterodine -new ER agent. Has same active metabolite as tolterodine. MAY be more effective in higher doses, but will also have more ADRs
-MOA –M3/M1 blocker. Has greater affinity for muscarinic receptors in bladder than saliva
-Precautions – narrow angle glaucoma, elderly
-ADRs - urinary retention, blurred vision, dry mouth, nausea, constipation, headache, drowsiness, and confusion
-DDI – CYP2D6 & CYP3A4 substrate
anticholinergics: darifenacin and solifenacin
-Darifenacin (Enablex); Selective M3 blocker
-Solifenacin (Vesicare): M3 > M1
-Same precautions as other anticholinerigics
-ADRs - same as others, but less severe. Less CNS effects b/c does not cross blood brain barrier (esp. solifenacin)
-less drowsey, less sx, not perfect
-DDIs - CYP450 substrate
-best agents right now
antimuscarinic / beta 3 adrenergic agonist chart
