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Special Populations > Urinary Incontinence > Flashcards

Urinary Incontinence Flashcards

1
Q

Why is UI higher is women than men?

A
  1. pregnancy/childbirth
  2. menopause
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2
Q

What type of UI is most common in men?

A

urge incontinence

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3
Q

What type of UI is most common in women?

A

stress incontinenece

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4
Q

What can UI lead to?

A
  1. rashes
  2. pressure ulcers
  3. UTIs
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5
Q

Where is urine made?

A

kidneys

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6
Q

Where is urine stored?

A

bladder

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7
Q

Which muscle surrounds the bladder and helps empty the bladder?

A

detrusor muscle

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8
Q

Where is the involuntary sphincter?

A

internal at the base of the bladder

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9
Q

Where is the voluntary sphincter?

A

external surrounds urethra

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10
Q

Which type of NT and receptor is responsible for detrusor muscle contraction?

A

NT- Ach
M3 receptor

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11
Q

At what volume does the detrusor muscle begin to contract and the internal sphincter begins to relax?

A

~200mL

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12
Q

At what volume does the detrusor muscle begin to force open the internal?

A

~500mL

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13
Q

What is the last thing that stops urination from occurring?

A

external sphincter

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14
Q

What are risk factors for UI?

A
  1. female
  2. > 40 y/o
  3. overweight
  4. smoking
  5. family history (urge)
  6. other comorbid conditions
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15
Q

What are the transient causes of UI?

A
  1. Delirium
  2. Infection (UTI)
  3. Atrophic urethritis/ vaginitis
  4. Pharmaceuticals
  5. Psychological (depression)
  6. Excessive urine output (HF/ hyperglycemia
  7. Restricted mobility
  8. Stool impaction
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16
Q

What foods/ drinks can contribute to UI?

A
  1. alcohol
  2. caffeine
  3. carbonated drinks
  4. artificial sweeteners
  5. chocolate
  6. spicy
  7. citrus/acidic food
  8. diuretics, sedatives,laxatives
  9. large doses of vit. C
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17
Q

What drugs can cause UI?

A
  1. diuretics
  2. psychotropics
  3. narcotics
  4. alpha blockers
  5. CCBs
  6. anticholinergics
  7. alpha agonist
  8. beta agonist
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18
Q

What can cause persistent UI?

A
  1. pregnancy
  2. childbirth
  3. menopause
  4. hysterectomy
  5. enlarged prostate
  6. obstruction
  7. neurologic disorder
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19
Q

What is urge incontinence?

A

“bladder overactivity” involuntary loss of urine

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20
Q

What is urge incontinence related to?

A

uninhibited detrusor muscle

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21
Q

What are the s/s of urge incontinence?

A
  1. urgency
  2. > 8 voids/day
  3. > 1 void/ night
  4. enuresis (bed wetting)
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22
Q

What are risk factors for urge incontinence?

A
  1. increased age
  2. neurologic disease
  3. diabetes
  4. smoking
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23
Q

What is stress incontinence?

A

urethral under activity; urethral/ external sphincter and/or bladder neck weakness; small amounts of urine loss during intra-abdominal pressure increases

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24
Q

What are risk factors for stress incontinence?

A
  1. pregnant/ childbirth
  2. menopause
  3. atrophic vaginities
  4. increased age
  5. obesity
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25
Q

What are s/s of stress incontinence?

A
  1. incontinence while sneezing, coughing, laughing, bending,etc
  2. NO incontinence while sleeping
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26
Q

What is overflow incontinence?

A

urethral overactivity and bladder underactivity; bladder becomes overly full but person has no urge to urinate

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27
Q

What are common causes of overflow incontinence?

A
  1. bladder outlet obstruction (BPH, neoplasm)
  2. diabetic neuropathy
  3. spinal cord injuries
  4. multiple sclerosis
  5. hysterectomy
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28
Q

What are s/s of overflow incontinence?

A
  1. lower abdominal fullness
  2. hesitancy, straining, decreased force of the stream
  3. incomplete bladder emptying
  4. frequency/urgency
  5. increased post-void residual
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29
Q

What is functional incontinence?

A

inability of a normally continent person to reach the toilet in time to avoid accident

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30
Q

What are s/s of functional incontinence?

A

accidents on the way to the toilet and early morning

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31
Q

What is the most common type of mixed incontinence in older women?

A

stress +urge

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32
Q

What are first-line therapies for UI?

A
  1. avoid trigger foods/ drinks
  2. weight reduction (stress/urge)
  3. smoking cessation
  4. avoid meds that exacerbate incontinence
  5. schedule voiding
    6, pelvic floor exercises (stress/urge)
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33
Q

What nonpharm therapies can be used for women with stress incontinence?

A
  1. vaginal weight training
  2. pessaries/ bladder neck support
34
Q

What pharm agents are used for stress incontinence (off-label)?

A
  1. intravaginal estrogens
  2. adrenergic agonists
  3. duloxetine
  4. vaginal pessary/ urethral insert
  5. surgery
35
Q

What is the MOA of vaginal estrogens?

A

treat atrophic vaginitis and increase urethral tone

36
Q

What are SEs with intravaginal estrogens?

A
  1. spotting
  2. breast tenderness
  3. nausea
37
Q

What role do adrenergic agonists have in stress UI?

A

situationally prn

38
Q

What adrenergic agonists are used for UI?

A
  1. pseudoephedrine
  2. phenylephrine
39
Q

What is the MOA of adrenergic agonists for UI?

A

alpha-1 mediated smooth muscle contraction of the bladder neck and urethra to improve tone

40
Q

What are SEs to adrenergic agonists?

A
  1. dizziness
  2. increased BP
  3. insomnia
  4. headache
41
Q

What are CIs to adrenergic agonists?

A
  1. HTN
  2. Arrythmias
  3. coronary artery disease
  4. hyperthyroidism
  5. renal failure
42
Q

What is the MOA of Duloxetine for UI?

A

5HT/NE reuptake inhibitor increases urethral tone by NE

43
Q

What are SEs with Duloxetine?

A
  1. headache
  2. insomnia
  3. GI disturbances
  4. dry mouth
  5. dizziness
  6. fatigue
  7. increase BP
44
Q

What medications treat overflow UI due to obstruction from BPH?

A
  1. alpha-1 antagonists
  2. 5-alpha reductase inhibitors
45
Q

What medications treat overflow UI by stimulating detrusor muscle contractions?

A

Bethanechol (URECHOLINE)

46
Q

What is the MOA of Bethanechol (URECHOLINE)?

A

stimulates parasympathetic nervous system; increases bladder muscle tone, causing contractions to stimulate urination

47
Q

What are SEs with Bethanechol (URECHOLINE)?

A
  1. N/V/D
  2. flushing
  3. abdominal cramping
  4. salivation
48
Q

What are CIs with Bethanechol (URECHOLINE)?

A
  1. asthma/COPD
  2. PUD
  3. epilepsy
  4. coronary artery disease
49
Q

What is most commonly used to treat urge incontinence?

A

antimuscarinics

50
Q

What antimuscarinics are used to treat urge incontinence?

A
  1. oxybutynin
  2. Tolterodine
  3. Fesoterodine
  4. Tropium chloride
  5. Solifenacin
  6. Darifenacin
51
Q

What is the MOA of antimuscarinics for urge UI?

A

antagonist of M3 receptors in the detrusor muscle

52
Q

What are SEs with antimuscarinics?

A
  1. anticholinergic
  2. cognitive impairment (M1)
  3. dizziness
  4. vision changes
  5. headache
  6. thirst
53
Q

What patients should antimuscarinics be avoided in?

A
  1. delirium
  2. dementia
  3. chronic constipation
  4. cognitive impairment
54
Q

Oxybutynin ER

A

DITROPAN XL

55
Q

Oxybutynin gel

A

GELNIQUE

56
Q

OTC Oxybutynin patch

A

OXYTROL

57
Q

What population is OTC oxybutynin patch for?

A

women 18+ with 2+ sx

58
Q

How often should the OTC oxybutynin patch be changed?

A

every 3-4 days

59
Q

How long does it take to see the effectiveness of Oxybutynin? How long is a trial?

A
  1. a few weeks
  2. > /= 4 weeks to 12 weeks
60
Q

What dosage form of muscarinic are associated with less SEs?

A

ER forms

61
Q

Tolterodine

A

DERTROL; DETROL XL

62
Q

What CYP enzymes metabolize Tolterodine leading to drug interactions?

A
  1. CYP2D6
  2. CYP3A4
63
Q

What CrCl does Tolterodine require a dosage adjustment?

A

CrCl= 10-30

64
Q

Fesoterodine

A

TOVIAZ

65
Q

Why does Fesoterodine have have same drug interactions but fewer SEs than Tolterodine?

A

prodrug of Tolterodine

66
Q

What advantages does the quaternary ammonium give Trospium Chloride?

A

less transport across the BBB leading to less cognitive impairment

67
Q

Trospium Chloride

A

SANCTURA

68
Q

What drugs possibly compete for active tubular secretion with Trospium Chloride?

A
  1. digoxin
  2. morphine
  3. metformin
  4. vancomycin
  5. dofetilide
69
Q

What agents are selective antagonists for the M3 receptor?

A
  1. Solifenacin (VESICARE)
  2. Darifenacin (ENABLEX)
70
Q

What CYP enzyme metabolizes Solifenacin leading to drug interactions?

A

CYP3A4

71
Q

What CYP enzyme metabolizes Darifenacin leading to drug interactions?

A
  1. CYP2D6
  2. CYP3A4
72
Q

What is the MOA of Mirabegron?

A

beta-3 adrenergic activation relaxes the detrusor muscle during the storage phase to increase bladder capacity

73
Q

Mirabegron

A

MYRBETRIQ

74
Q

What drug interactions does Mirabegron have?

A
  1. moderate CYP2D6 inhibitor
  2. use lowest dose of digoxin
75
Q

What SEs does Mirabegron have?

A
  1. HTN
  2. UTI
  3. nasopharyngitis
  4. headache
76
Q

What is the MOA of Vibegron?

A

beta-3 adrenergic activation relaxes the detrusor muscle during the storage phase to increase bladder capacity and does not penetrate BBB

77
Q

What DIs does Vibegron have?

A

CYP2D6

78
Q

Vibegron

A

GEMTESA

79
Q

What are the indications for Onabotulinumtoxin A BOTOX?

A

treatment of overactive bladder with symptoms of urge incontinence, urgency, or frequency in adults who have inadequate response to anticholinergic

80
Q

What BBW doesOnabotulinumtoxin A BOTOX have?

A

spread of toxin effect

81
Q

What SEs does Onabotulinumtoxin A BOTOX have?

A
  1. UTI
  2. urinary retention
  3. dysuria

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