Bladder Function and Pharmacology Flashcards
(35 cards)
What anticholinergics are commonly used in in diseases of bladder function?
- Darifenacin
- Fesoterodine
- Oxybutynin
- Solifenacin
- Tolterodine
- Trospium
- Botulinum Toxin
What Sympathomimetics are commonly used in diseases of Bladder function?
- Mirabegron
- Pseudoephedrine
- Ephedra, Ma Huang
What Ancillary drugs are commonly used in disease of Bladder function?
- Methionine
* Bovine Collagen Implant
What drugs are used in the Management of Urinary Retention?
- Bethanechol
- Neostigmine
- Methylnaltrexone
- Naloxone
In what type of incontinence would you use antimuscarinic drugs?
• how do they work?
• Name them.
Use for:
• URGE incontinence
*these work by BLOCKING the M3 receptor that stimulates the bladder (detrussor) to contract
- Darifenacin
- Fesoterodine
- Oxybutynin
- Solifenacin
- Tolterodine
- Trospium
- Botulinum Toxin
In what type of incontinence would you use cholinomimetic drugs?
• how do they work?
• Name them.
Opiate Induced Urinary Retention is treated with Cholinoimetics
Bethanecol
In what type of incontinence would you used Alpha-agonist drugs?
• how do they work?
• Name them.
Use for:
• STRESS incontenence
*these work by AGONIZING ß3 causing relaxation of the detrussor and AGONIZING alpha-1 to stimulate internal urethral sphincter contraction
Drugs:
• Mirabegron
• Ephedra
• Pseudoephedra
Explain the mechanism of action of Botox.
Botox blocks SNAREs are prevents ACh release
Explain the mechanism of action of methionine.
Creates AMMONIA FREE urine by acidifying urine pH
Explain the mechanism of action of collagen.
Helps to support the external urethral sphincter
What is opiate-induced urinary retention and how is it treated clinically?
Opiate Induced Urinary Retention is treated with Cholinoimetics
Bethanecol
What is the action of the M3 receptor stimulation on the bladder?
• neurotransmitter used?
• Nerve that secretes it?
Pelvic n. uses Ach to stimulated M3 can cause BLADDER CONTRACTION
What is the action of ß3 receptor stimulation on the bladder?
• Neurotransmitter used?
• Nerve that secretes it?
Hypogastric n. releases NE to simulate SMOOTH MUSCLE RELAXATION
• Don’t want to have to pee while you’re trying to fight
What is the action of Alpha-1 receptors stimulation on the bladder?
• Neurotransmitter used?
• Nerve that secretes it?
Hyopgastric n. releases NE to simulate URETHRAL CONTRACTION
• again keeps you from peeing while fighting
What is the action of the nicotinic receptor stimulation on the urethra?
• Neurotransmitter used?
• Nerve that secretes it?
Pudendal n. acts at UG diaphragm to release Ach causing Contraction of the External Urethral Spincter
What are the most commonly prescribed drugs for urinary incontinence?
Antimuscarinic Drugs
• Tolterodine and Oxybutynin
What is the 1st line of care in people with urinary incontinence?
Behavioral Therapy, Pt. education, fluid management, bladder retraining, Pelvic floor exercises
Bottom line is there is a lot you want to do before starting someone on drugs because of side effects
Where do the following drugs act: • Darifenacin • Oxybutynin • Trospium • Tolterodine
- what receptor do they act on?
• Key feature of each?
Non-Selective Muscarinic Antagonists
Once daily Dosing:
• Darifenacin
• Oxybutyrin
Neglible CYP metabolism:
• Trospium
Extended release Availability:
• Tolterodine
• Oxybutyrin
What is the point of giving muscarinic drugs that are extendend release?
• which two have this availability?
Extended Release:
• Tolterodine
• Oxybutyrin
Reduces the MAJOR MUSCARINIC ANTAGONIST side effect of DRY MOUTH
What is the most common reason for people to stop using Muscarinic Receptor Therapy?
• Name the drugs used in this therapy?
DRY MOUTH
Drugs: • Darifenacin • Trospium • Oxybutynin • Tolterodine
What adverse effects should you monitor in someone taking muscarinic antagonists?
• Name Them.
- Urinary Retention
- CV effects - may include palpitations, tachycardia, prolonged QT interval
- GI effects - Mild constipation to severe obstruction
Drugs: • Darifenacin • Trospium • Oxybutynin • Tolterodine
In what patients should you Monitor Urinary Retention especially closely in?
• People with BPH
Drugs: • Darifenacin • Trospium • Oxybutynin • Tolterodine
What are the contraindications for Muscarinic Antagonist use?
- Angle Closure / Narrow Angle Glaucoma
- Urinary and Gastric Obstruction
- Need for mental alertness
- Alzheimer’s type Dementia
Why might someone want to use Botox to treat Urinary incontinence?
• who is it most effective in?
- Benefit is long lasting, lasts for several months
* Botox - most effective in patients who responded to anticholinergics but couldn’t tolerate the adverse effects
