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pharmacology > Urinary Incontinence > Flashcards

Urinary Incontinence Flashcards

1
Q

Urge Incontinence

A

Urge Incontinence: Patient feels an urge and cannot hold urine back

Typically due to: MUSCLE
- detrusor hyperactivity/instability
- involuntary sphincter relaxation

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2
Q

mixed incontinence

A

Combo of urge + stress incontinence
- common in older women

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3
Q

overflow incontinence

A

Patient urinates incompletely = the residual urine leaks out

Typically due to: multiple issues (ex: drugs + fecal impaction) hypotonic or under active detrusor muscle secondary to:
- drugs
- obstructions: fecal impaction, urethral obstruction, or genital prolapse
- DM
- injury: lower spinal cord injury, disruption of the motor innervation of the detrusor muscle

Tx: alpha blockers to decrease sphincter tone (-azosins)

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4
Q

stress incontinence

A

Urine leaks out with physical activity (cough, sneeze, laugh)

Typically due to: SPHINCTER
- urethral sphincter failure secondary to anatomic anomalies
- intrinsic sphincter deficiency

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5
Q
A
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6
Q
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7
Q

drugs that cause polyuria resulting in urinary frequency + urgency incontinence

A
  • diuretics
  • alcohol
  • acetylcholinesterase inhibitors
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8
Q

drugs that can contribute to stress urinary incontinence symptoms

A
  • ACEi: cough
  • alpha receptor antagonists: urethral muscle relaxation and stress urinary incontinence
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9
Q

drugs that contribute to urinary retention

A

increases urethral muscle contraction (closure):
- alpha agonists
- TCAs

Reduced bladder contractility:
- CCBs:
- narcotic analgesics
- sedative hypnotics
- anticholinergics
- TCAs

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10
Q

drug that causes functional incontinence caused by delirium, immobility

A

Antipsychotics

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11
Q

Bladder overactivity vs urethral underactivity

A

Bladder overactivity:
- urgency
- frequency
- no leaking during physical activity (cough, sneeze)
- LARGE amounts of volume during incontinence
- cannot reach toilet in time
- usually has nocturnal incontinence and nocturia

Urethral Underactivity:
- LEAKING during physical activity: cough and sneeze**
- can make it to the toilet in time**
- no urgency or frequency
- SMALL volumes of urine leaked during incontinence episodes
- rare: nocturnal incontinence and nocturia

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12
Q

treatment of urinary incontinence

A

-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

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13
Q

Anticholinergics: drug names

A
  • Propantheline: prototype, not used now
  • oxybutynin: oxytrol and gelnique (M3 > M1)
  • tolterodine: M3/Mi
  • darifenacin: selective M3
  • solifenacin: selective M3 (M3 > M1)
  • tropsium chloride: M3/M1

Anticholinergics: block PNS effects -> stimulates SNS (cant pee while you run away from a bear)

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14
Q

Muscarinic receptors: role in treating incontinence

A

M3 is best to decrease contractility of BLADDER -> best target for drugs

M2: More cardiac

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15
Q

SNRI: drug name, MOA, indication, ADR

A

Duloxetine

MOA: Serotonin-Norepinephrine Reuptake Inhibitor

Indications: Stress Incontinence
- Not often used due to SE profile, but leads to 50% symptomatic relief

ADR: Increase BP (monitor in HTN pts)

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16
Q

α-Agonists : drug name, MOA, indication

A

Phenylpropanolamine

MOA: Stimulates urethral smooth muscle contraction = Prevent leakage

Indications: Stress Incontinence
- Not routinely used because of limited effectiveness

17
Q

Propantheline: description, MOA, indication

A

Original prototype for anticholinergic agents used for urologic conditions.

MOA: Muscarinic blocker:
- inhibits involuntary detrusor muscle contractions

Indication: Not as selective + ADRs -> not used clinically**

18
Q

Oxytrol & Gelnique

A

Subclass of Oxybutynin: urge incontinence tx (M3> M1)
- Applied topically for systemic effects = Avoid bypass first-effect = Less anticholinergic SE profile (dry mouth)
- more expensive

Oxytrol = Patch applied 2x week
- Do not apply a patch in same area consecutively
Gelnique = Gel applied daily

19
Q

Oxybutynin: Precaution and ADRs

A

Precaution: Narrow Angle Glaucoma (due to constriction of draining duct)

ADRs: Sedation, Altered Mental Status, Dry mouth, Dry Skin, Nausea, Constipation

DDIs: CYP3A4 Substrate & Inhibitor

20
Q

Oxybutynin: drug names and MOA and indication

A

drugs: Oxytrol, Gelnique

MOA: M3 > M1
- Inhibit involuntary detrusor muscle contractions = delays desire to void
- ↓ urgency & frequency *
- direct antispasmodic effect on smooth muscle

Indication: urge incontinence

21
Q

Propantheline: ADRs and precaution

A

ADRs: Urinary retention, blurred vision, dry mouth, nausea, constipation, tachycardia, drowsiness, and confusion

Precaution: narrow angle glaucoma, elderly -> beers list

22
Q

Trospium Cl

A

MOA: M3/M1 receptor blocker (similar to tolterodine)

ADRs: Sedation, Altered Mental Status, Dry mouth, Dry Skin, Nausea, Constipation

Renally excreted = No CYP450 DDIs -> best for ppl with multiple drugs**

23
Q

tolterodine MOA and precaution

A

MOA: M1/M3 receptor blocker
- Has greater affinity for muscarinic receptors in bladder than saliva

Precaution: Narrow Angle Glaucoma (due to constriction of draining duct); elderly

24
Q

fesoterodine description

A

Subclass of Tolterodine
-new ER agent of Tolterodine
- Has same active metabolite as tolterodine
- MAY be more effective in higher doses, but will also have more ADRs

25
Q

Tolterodine: ADRs and DDis

A

ADRs: Urinary retention, Blurred vision, Dry mouth, Nausea, Constipation, Headache, Drowsiness, Confusion

DDIs: CYP2D6 & CYP3A4 substrate

26
Q

Darifenacin vs Solifenacin

A

Darifenacin MOA: M3 receptor blocker

Solifenacin MOA: M3 > M1 receptor blocker
- Less CNS effects b/c does not cross blood brain barrier (esp. solifenacin)

27
Q

darifenacin and solifenacin: ADR + DDIs

A

ADRs
- same as others, but less severe
- Less CNS effects b/c does not cross blood brain barrier (esp. solifenacin)
-best agents right now

DDIs - CYP450 substrate

28
Q

Beta-3 Agonist : MOA, indication, ADRs, DDIs

A

drug: Mirabegron (new drug)
-no data yet to combine with anticholinergics

Second-line Therapy**, after anticholinergics (ADRs + expensive )

MOA: β3 Agonist = Relaxes smooth muscle in bladder and increases storage + volume of urine

ADRs:
- HTN**
- Tachycardia, Headache, Constipation, Diarrhea

DDIs: CYP2D6 Inhibitor

29
Q

tricyclic antidepressants: drug names, MOA, indication

A

Example:
- Imipramine
- Amitriptyline
- Doxepin

Have anticholinergic properties but SIGNIFICANT CNS ADRs **
- Not yet FDA-approved for incontinence

Indications: Nocturnal Enuresis (bedwetting)

30
Q

when would you consider estrogen therapy?

A
  • adjunctive pharmacologic agent for postmenopausal women with STRESS incontinence or MIXED incontinence
  • Conflicting data - some trials suggest Estrogen = ↑ Incontinence
    -Conjugated estrogens and medroxyprogesterone may be used
    -used for pts with atrophic vaginitis
31
Q

calcium channel blockers: drug example and MOA

A

Example: Nifedipine (MC CCB for urinary incontience)

MOA: Blocking of Calcium = Inhibits urinary muscle contractions (causes smooth muscle relaxation)
- Not FDA-Approved
-May be useful b/c calcium is involved in urinary muscle contractions
-less spasms

32
Q

Alpha-1 Antagonist: indication and MOA

A

MOA: Decreases sphincter tone

Indicated for Overflow Incontinence
-BPH man gets newer azosins
-women would get an older azosin

33
Q

Desmopressin MOA

A

MOA: Enhances reabsorption of water by increasing cellular permeability of the collecting ducts
= Less urine output
- PO = less hyponatremia

Tx for pediatric nocturnal enuresis

34
Q

Nocturnal Enuresis: adults vs kids tx

A

adults: tricyclic antidepressants

Tx for pediatrics (MC): Desmopressin PO/Nasal Spray
- PO = Less Hyponatremia

MOA: Enhances reabsorption of water by increasing cellular permeability of the collecting ducts
= Less urine output

35
Q

DDIs of Drugs: cyp450, cyp2d6, none, cyp3a4

A

CYP3A4
- oxybutynin
- tolterodine (+CYP2D6)

CYP 450: DS = 450
- darifenacin
- solifenacin

CYP2D6: 2D = TM
- tolterodine (+CYP3A4)
- mirabegron

NONE:
- Trospium Cl**- best for elderly pts on multiple drugs

pharmacology (15 decks)

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