Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PHRM 844 Module #2 > Geriatrics Part II > Flashcards

Geriatrics Part II Flashcards

1
Q

Urinary Incontinence

A

involuntary leakage of urine
overactive bladder (most common type of urinary incontinence)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Patients with UI may experience

A

loss of independence: loss of physical, social activity, social isolation
lack of self-esteem: depression, anxiety
additional medical complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Frequency of UI types in women

A

urge (63%)
stress (21%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Frequency of UI types in men

A

urge (59%)
overflow (29%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Normal bladder function

A
  1. stretch receptors notify brain that bladder is full and needs to empty - beta3 receptors support detrusor relaxation/filling
  2. neurologic stimulation initiates contraction - Ach receptors in the dome, alpha-adrenergic receptors in the base and proximal urethra (modulate sphincter muscles around the outlet)
  3. sphincter relaxes allowing release of urine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

beta vs cholinergic receptors

A

beta receptors - relaxation
cholinergic receptors - focus on squeezing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Age-related changes to the bladder and urethra

A

decrease bladder capacity/elasticity
increase spontaneous detrusor contractions
decrease sphincter compliance
may result in: incomplete bladder emptying and decrease ability to postpone urination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Types of Incontinence

A

overflow
stress
urge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Overflow

A

urethral blockage
bladder unable to empty properly (inappropriate sphincter relaxation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Stress

A

relaxed pelvic floor
increased abdominal pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Urge

A

bladder oversensitivity from infection
neurologic disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Urge urinary incontinence

A

aka: overactive bladder
hyperactivity of detrusor muscle causes sudden & poorly predictable voiding
may cause large or small volume accidents
symptoms include: urgency (unpredictable or unable to control), frequency (excessive feelings of urination)
causes can be neurologic or medications (acetylcholinesterase inhibitors for Alzheimer’s disease)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Prescribing cascade

A

need for more meds in order to treat the side effects experienced from another med

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Stress urinary incontinence

A

outlet incompetence (external urethral sphincter) with abdominal pressure
women > men ( due to estrogen deficiency/lifetime experience of childbirth)
most often small volume of accidents
risk factors include: multiple births, estrogen deficiency
can be exacerbated or caused by alpha-antagonists

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Stress urinary incontinence symptoms classically associated with

A

laughter
alcohol
caffeine
cough

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Overflow incontinence

A

results from outlet obstruction or inability to or uncoordinated detrusor constriction
most commonly from BPH or prostatic blockage of urethra

17
Q

Overflow incontinence symptoms

A

abdominal discomfort or pain
frequency
feeling the need to void shortly after voiding

18
Q

Neurogenic bladder

A

disruption in neurologic innervation of the bladder
inability or uncoordinated detrusor constriction
may also be atony of bladder muscle - stroke, neuropathy (including sever uncontrolled diabetes), spinal cord injury

19
Q

Neurogenic bladder symptoms

A

small urine volume during voiding, small volume accidents
loss of feeling that bladder is full
dribbling of urine
frequency, urgency
increases risks of UTI
increases risks of kidney stones

20
Q

Functional incontinence

A

inability to get to the bathroom in a timely fashion
causes: physical impairment (mobility), change in mental status (dementia), UTI, medications (sedating)

21
Q

Medication causes for incontinence

A

frequency: diuretics, alpha antagonists
urgency: acetylcholinesterase inhibitors
overflow: alpha antagonists, antihistamines

22
Q

UI treatments: non-pharmacological

A

should be provided for all types of urinary incontinence
1. scheduled/timed voiding
2. pelvic floor muscle strengthening (Kegel): 30-60x/day
3. avoiding irritants: coffee, alcohol, caffeine, avoid water before bed
4. absorbent products (pads, shields, adult diapers)
5. catheters

23
Q

UI pharmacologic treatment for overflow

A

alpha-antagonists
injections or surgery

24
Q

UI pharmacologic treatment for stress

A

estrogen
alpha-agonists
SNRI
injections or surgery

25
Q

UI pharmacologic treatment for urge

A

anticholinergic/antimuscarinic
beta3 agonist
injections or surgery

26
Q

UI pharmacologic treatment for neurogenic

A

injections or surgery

27
Q

Goal of pharmacologic treatment for urge UI

A

reduce detrusor contraction frequency

28
Q

Anticholinergic/antimuscarinic medications

A

oxybutynin
tolterodine
solifenacin
darifenacin
trospium
fesoterodine

29
Q

Anticholinergic/antimuscarinic adverse events

A

dry mouth
constipation
fatigue
confusion
tachycardia

30
Q

B3 agonist medications

A

mirabegron
vibegron

31
Q

B3 agonist adverse events

A

mirabegron: minor increase in BP, UTI
vibegron: minor, UTI

32
Q

Max benefit of these meds (for urge UI)

A

takes at least 4 weeks to achieve
taper down over course of 2-4 weeks when stopping med

33
Q

Stress UI management

A
  1. non-pharmacologic management –> kegel
  2. duloxetine 40 mg BID, increased sphincter tone to prevent leaks
  3. topical estrogen (vaginal atrophy) - estrogen vaginal cream, intravaginal cream inserted via applicator, 21 days on, 7 days off
  4. alpha-agonists
  5. vaginal pessaries or surgery
34
Q

Overflow UI management

A
  1. address the obstruction
  2. alpha-adrenergic blockers (if BPH) - doxazosin, tamsulosin (less hypotension)
  3. catheterization
35
Q

Neurogenic UI management

A

no pharmacologic managment routinely effective - focused on non-pharmacologic management
intermittent catherterization
botulism A toxin (botox) injections (bladder or urinary sphincter)
surgery - augmentation cystoplasty, bladder walls and intestinal walls connected to improve storage capacity

36
Q

Catheters

A

intermittent straight
indwelling
condom
suprapubic

37
Q

Monitoring

A

review efficacy after 4-8 weeks
monitor consistently for adverse events

38
Q

Pharmacists role in UI

A

assess for contributing factors
educate and support non-pharmacologic management
modify dosage forms as needed
redognize treatment-related ADR
prevent complications, support QOL
support deprescribing when appropriate

PHRM 844 Module #2 (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions