Bladder Function and Pharmacology Flashcards Preview

Renal Week 3 > Bladder Function and Pharmacology > Flashcards

Flashcards in Bladder Function and Pharmacology Deck (35):
1

What anticholinergics are commonly used in in diseases of bladder function?

• Darifenacin
• Fesoterodine
• Oxybutynin
• Solifenacin
• Tolterodine
• Trospium
• Botulinum Toxin

2

What Sympathomimetics are commonly used in diseases of Bladder function?

• Mirabegron
• Pseudoephedrine
• Ephedra, Ma Huang

3

What Ancillary drugs are commonly used in disease of Bladder function?

• Methionine
• Bovine Collagen Implant

4

What drugs are used in the Management of Urinary Retention?

• Bethanechol
• Neostigmine
• Methylnaltrexone
• Naloxone

5

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


6

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

7

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

8

Explain the mechanism of action of Botox.

Botox blocks SNAREs are prevents ACh release

9

Explain the mechanism of action of methionine.

Creates AMMONIA FREE urine by acidifying urine pH

10

Explain the mechanism of action of collagen.

Helps to support the external urethral sphincter

11

What is opiate-induced urinary retention and how is it treated clinically?

Opiate Induced Urinary Retention is treated with Cholinoimetics

Bethanecol

12

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

13

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

14

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

15

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

16

What are the most commonly prescribed drugs for urinary incontinence?

Antimuscarinic Drugs
• Tolterodine and Oxybutynin

17

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**

18

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

19

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**

20

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

21

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

22

In what patients should you Monitor Urinary Retention especially closely in?

• People with BPH

Drugs:
• Darifenacin
• Trospium
• Oxybutynin
• Tolterodine

23

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

24

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

25

Botox
• MOA

• Inhibits Afferent Cholinergic Impulses by inhibiting SNARE-complex-dependent proteins

• Phenotypic change in SUBurothelial tissue to ablate the excitatory effect of local chemical mediators

26

Where do the following drugs act?
• Mirabegron
• Pseudoephedrine
• Ephedra, Ma Huang

*how does mirabegron differ from the others?

These drugs agonize ß3 and alpha 1 receptors to relax bladder and contract internal urethral sphincter respectively

How is Mirabegron different?
• long acting drug that undergoes extensive hepatic metabolism
• others are minimally broken down and are shorter acting

27

What is a common side effect to all of the sympathomimetic drugs used in urinary incontinence?
• name the drugs.

Drugs:
• Mirabegron
• Ephedra
• Pseudoephedra

Side Effect:
SYMPATHETIC STIMULATION
• HTN
• Tachycardia-Tachyarrythmia
• Anxiety - Restlessness - nervousness - insomnia

28

Methionine
• MOA
• Administration
• use in urinary incontence

Makes yo Piss Stank-less
• Controls odor, dermatitis, and ulceration

• Take with Food, Milk, or other liquid

MOA:
• Creates Ammonia-Free urine by acidifying urine pH

29

Bovine Collagen
• MOA
• Who is it used for?
• Interactions?

MOA:
• Injected into the submucosal tissue of urethra and/or bladder neck
• Forms a soft cohesive network of Fibers around Urethral Lumen

Interactions:
• Don't give with IMMUNOSUPPRESIVE therapy or CORTICOSTEROIDS

30

Bovine Collagen
What are some adverse rxns?

• Urinary Retention
• Hematuria
• Injection Site Rxn
• Worsening Incontinence
• Erythema
• Urticaria
• Abscess formation

31

What drugs are used to MAKE YOU PEE MORE?
(in urinary retention)
• what do these drugs act on?
• Administration frequency?

Bethanechol - MUSCARNIC agonist

Neostigmine - Acetylcholinesterase inhibitor

**Both of these drugs must be administered several times per day

32

Bethanechol
• MOA
• Adverse Effects

MOA:
• CHOLINESTERASE-RESISTANT muscarinic agonist

ADVERSE EFFECTS:
CV - lightheadedness, syncope
GI - Diarrhea, stomach cramps
Neurologic - dizziness
Opthalmic - Excessive tear production, miosis

33

Neostigmine
• MOA
• Adverse Effects

MOA:
• Acetylcholinesterase Inhibitor

Adverse Effects:
• AV block, Brady-arrhythmia
• Cardiac Arrest, Cardiac Dysrythmia
• HypOtension, Syncope
• Tachycardia

34

Opiate Adverse Effects on Urination
• how do we manage these problems in people who need to take opiates chronically?

Opiate Effects:
• Mu (µ) and Delta (∆) receptors are acted on in sacral cord inhibiting parasympathetic OUTFLOW
• DETRUSSOR doesn't get activated

Management:
• Opiate Antagonists
• Bethanechol

35

Which of the anticholenergic drugs are M3 specific?

• M3 specific = Darifenacin --> no obvious benefit to this specificity