Overactive Bladder Flashcards

1
Q

Which muscarinic receptor is responsible for both emptying contractions as well as involuntary bladder contractions of incontinence?

A

M3 receptors

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2
Q

Which muscle is overactive in overactive bladder!

A

Detrusor muscle is hyperactive, causing the sx of freq micturitions, urgency, nocturia and/or incontinence

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3
Q

Risk factors for OAB?

A

Age > 40 yrs

DM

Restricted mobility

Obesity

Prior vaginal delivery

Neurologic conditions (eg stroke, Parkinson’s dx, dementia)

Hysterectomy

Drugs that can increase incontinence (ACE-I (due to cough), cholinesterase inh, diuretics)

Pelvic injury

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4
Q

Forms of urinary incontinence?

A

Functional

Overflow

Stress

Urge

Mixed

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5
Q

What’s Functional urinary incontinence?

A

No abnormality in the bladder, but pt may be cognitively, socially or physically impaired thus hindering him or her from access to a toilet (eg pts in wheelchair)

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6
Q

What’s Overflow urinary incontinence?

A

Leakage that occurs when quantity of urine stored in bladder exceeds its capacity, often occurring w/o the urge to urinate

BPH is the most common cause

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7
Q

What’s Stress urinary incontinence?

A

Urinary leaks out during any form of exertion (eg exercise, coughing, sneezing, laughing etc) as a result of pressure on bladder

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8
Q

What’s Urge urinary incontinence?

A

Pt can’t hold in urine long enough to reach the toilet and is associated with neuropathy

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9
Q

What’s Mixed urinary incontinence?

A

Combination of urge and stress incontinence

Approx 1/3 of incontinence is stress, 1/3 is urge, 1/3 is mixed

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10
Q

Non-pharmacologic therapy for OAB?

A

They are first-line tx

Pelvic floor muscle (Kegel) exercise

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11
Q

Pharmacologic therapy for OAB?

A

Anticholinergic drugs are 2nd line therapy (antagonists of muscarinic receptor and block acetylcholine this limiting contractions of detrusor muscle)

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12
Q

What type of anticholinergic formulation is preferred? Why?

A

Extended-release formulations

Due to lower rate of dry mouth

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13
Q

Effects of cholinergic drugs?

A

Act like acetylcholine and cause SLUD sx

Salivation
Lacrimation (tearing)
Urination
Diarrhea

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14
Q

What may be used to treat urinary retention?

A

Bethanecol (causes urination)

Pilocarpine (another cholinergic) used for dry mouth (to increase salivation)

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15
Q

Effect of anticholinergic?

A

Anti-SLUD

Peripheral sx of dry mouth, dry/blurry vision, urinary retention and constipation

Central anticholinergic effects - sedation and dizziness

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16
Q

Anticholinergic drugs used in OAB?

A

Oxybutynin

Oxybutynin XL (Ditropan XL)

Oxybutynin patch (Oxytrol)

Tolterodine (Detrol)

Tolterodine ER (Detrol LA)

Trospium (Sanctura, Sanctura XR)

Solifenacin (Vesicare)

Darifenacin (Enablex)

Fesoterodine (Toviaz)

17
Q

Which Anticholinergic drugs used in OAB must be taken on empty stomach?

A

Trospium (Sanctura, Sanctura XR)

18
Q

Brand name of Oxybutynin XL (anticholinergic drugs used in OAB)?

A

Ditropan XL

19
Q

Brand name of Oxybutynin patch (anticholinergic drugs used in OAB)?

A

Oxytrol

20
Q

Brand name of Solifenacin (anticholinergic drugs used in OAB)?

A

Vesicare

21
Q

SEs of anticholinergic drugs used in OAB?

A

Dizziness and drowsiness (greatest with Oxybutynin)

Xerostomia (dry mouth)

Constipation

Dry eyes/blurred vision

Urinary retention

22
Q

Which anticholinergic drugs used in OAB is available OTC?

A

Oxytrol patch (Oxybutynin) for women >= 18 yrs

Avoid reapplication to the same site within 7 days

23
Q

SE of Mirabegron (Myrbetriq) - Beta3 agonist?

A

HTN

24
Q

What’s 3rd line tx for pts with refractory OAB to 1st & 2nd line tx options?

A

Onabotulinimtoxin A (Botox)

25
Q

Look at pt counseling on pg 1012-1013

A

Look!

26
Q

Whats overactive bladder (OAB)?

A

Urinary urgency (a sudden, compelling desire to pass urine which is difficult to defer)
+
Urinary freq (voiding >= 8 times in a 24 ht period)
+
Nocturia (>= 2 awakenings to void per night)