Ch 74: Overactive Bladder Flashcards
OAB sx
urinary freq +/- incontinence (lack of control of urination), with inc freq and nocturia
Nocturia Tx
Desmopressin (Noctiva) nasal spray. BBW: hypoNa. Contraindications: risk pops with fluid retention (HF, uncontrolled HTN). Monitor Na
Onabotulinumtoxin A
Botox. 3rd line fo pts refractory to 1st and 2nd line tx. affects efferent path of detrusor activity by inhibiting the release of ACh. BBW: botulinum toxin effects possible. not interchangeable with other botox products. ppx abx tx (not aminoglycosides) should be admin 1-3 days prior to, during, and 1-3 days after botox admin.
Mirabegron
Myrbetriq. ADR of HTN. MOA: relaxes detrusor muscle and inc bladder capacity by activating beta 3 receptors. similar efficacy to antiACh but less dry mouth - consider in pts who cannot tolerate antiAch.
mgmt of dry mouth
choose ER form. try oxybutynin gel or patch. myrbetriq.
non drug tx
behavioral txs are 1st line to improve sx. include bldder training, delayed or sch voiding, pelvic floor muscle exercises (kegal), urge control techniques (distraction, self-assurance), fluid mgmt, diet changes, wt loss, lifestyle modifications.
surgical intervention
reserved for non-neurogenic pts who failed all other options and has intolerable sx
drug tx
2nd line option, sometimes used in combo with 1st line. antiACh usually tried first, then another or a beta3 receptor agonist before moving to 3rd line.
AntiACh ADRs
peripheral: dry mouth, dry eyes/blurred vision, urinary retention, constipation. central: sedation, dizziness, cognitive impairment.
urge incontinence
pt cannot hold urine long enough to reach toilet, assoc with neuropathy. found in pts with DM, strokes, dementia, PD, or MS
stress incontinence
urine leaks out during any form of exertions - exercise, coughing, sneezing, laughing, as result of pressure on bladder
mixed incontinence
combo of urge and stress
functional incontinence
no abnormality in bladder but pt may be cognitively, socially, or physically impaired - hindering them to be able to access a toilet. ie. wheelchair
overflow incontinence
leakage that occurs when quantity of urine stored in bladder excees capacity, occurring without urge to urinate (BPH is common cause)
pathophysiology
inappropriate stim of M2 and M3 receptors (via ACh) on detrusor muscle (outer muscular layer of bladder) causing involuntary contractions. M3 receptor is responsible for emptying contractions and involuntary bladder contractions.
