Pharm 40 Objectives Flashcards
(79 cards)
What are the 4 different types of urinary incontinence?
- Stress incontinence
- Urge incontinence/OAB
- Overflow incontinence
- Mixed incontinence: combination of stress and urge (MC)
What are the classes of mediations used to treat OAB?
- Antimuscarinics
- Beta-3 Agonist
- Local Estrogen
- Paralytic Agent
What is the MOA of antimuscarinics?
Relax/block excess detrusor activity
What is the efficacy/benefit of antimuscarinics?
Modest benefit, no improvement on the sphincter
What are the ASEs of antimuscarinics?
- Dry mouth
- Dry eyes
- Confusion
- Constipation
- Dizziness
- Blurred vision
What are the drug interactions that you need to note before giving an antimuscarinic?
- Alzheimer agents: Donepezil and Galantamine
- Antihistamines, Anti-Depression, B/P meds: cause addictive SEs
What are the drugs in the antimuscarinic class?
- Oxybutynin (Patch or PO)
- Tolterodine
- Fesoterodine
- Darifenacine
- Solifenacine
What is an advantage of the Oxybutynin patch?
- Avoids 1st pass effect
- Low steady drug levels
- Less antimuscarinic SEs
Are the new antimuscarinics more receptor sensitive or specific?
More receptor specific
What is the MOA of Beta-3 Agonist?
Relaxes the detrusor smooth muscle during urine storage phase thus increasing bladder capacity
What is the efficacy/benefit of Beta-3 Agonist?
- Modest benefit
- Full Effect takes up to 8 wks
What is the ASE of Beta-3 Agonist?
HTN
What are the drug interactions that you need to note before giving a Beta-3 Agonist?
Warfarin
- need to monitor INR
What drug is apart of the Beta-3 Agonist class?
Mirabegron
What is the MOA of local estrogen?
- Plumps up the tissue around the bladder sphincter
- Applied to vaginal/external urethra
What is the efficacy/benefit of local estrogen?
Benefit post menopausal women w/vaginal atrophy
What is the MOA of Paralytic agents?
- Prevents muscular contraction by inhibiting Ach release at the NM junction
What drug is apart of the Paralytic agents?
Botulinum Toxin A intravesical injection
What medication can contribute to or interfere with treatment of OAB?
- Diuretics: thiazides and loop diuretics
- Anticholinergic medications: use for nocturnal enuresis
- Cholinergic Medications: Bethanechol [use to wake the bladder], Aricept, Exelon, Pilocarpine
What drug is apart of the Cholinergic agonists?
Bethanechol
What is the MOA of Bethanechol?
Stimulates parasympathetic nervous system, increases bladder muscle tone causing contractions with initiate urinate.
What is the Bethanechol place in therapy?
- Neurogenic bladder
- Acute postoperative and postpartum NON-obstructive urinary retention
- Neurogenic atony of the bladder w/ urinary retention
What is the ASEs of Bethanechol?
Increase HR contractility
What are the 4 non-pharmacological treatments for OAB?
- Timed/prompted voiding
- Pelvic flood muscle strengthening exercises (Kegels)
- Biofeedback
- Eliminate suspected bladder irritants