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Urinary Incontinence Flashcards

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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
What are s/s of stress incontinence?
1. incontinence while sneezing, coughing, laughing, bending,etc 2. NO incontinence while sleeping
26
What is overflow incontinence?
urethral overactivity and bladder underactivity; bladder becomes overly full but person has no urge to urinate
27
What are common causes of overflow incontinence?
1. bladder outlet obstruction (BPH, neoplasm) 2. diabetic neuropathy 3. spinal cord injuries 4. multiple sclerosis 5. hysterectomy
28
What are s/s of overflow incontinence?
1. lower abdominal fullness 2. hesitancy, straining, decreased force of the stream 3. incomplete bladder emptying 4. frequency/urgency 5. increased post-void residual
29
What is functional incontinence?
inability of a normally continent person to reach the toilet in time to avoid accident
30
What are s/s of functional incontinence?
accidents on the way to the toilet and early morning
31
What is the most common type of mixed incontinence in older women?
stress +urge
32
What are first-line therapies for UI?
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)
33
What nonpharm therapies can be used for women with stress incontinence?
1. vaginal weight training 2. pessaries/ bladder neck support
34
What pharm agents are used for stress incontinence (off-label)?
1. intravaginal estrogens 2. adrenergic agonists 3. duloxetine 4. vaginal pessary/ urethral insert 5. surgery
35
What is the MOA of vaginal estrogens?
treat atrophic vaginitis and increase urethral tone
36
What are SEs with intravaginal estrogens?
1. spotting 2. breast tenderness 3. nausea
37
What role do adrenergic agonists have in stress UI?
situationally prn
38
What adrenergic agonists are used for UI?
1. pseudoephedrine 2. phenylephrine
39
What is the MOA of adrenergic agonists for UI?
alpha-1 mediated smooth muscle contraction of the bladder neck and urethra to improve tone
40
What are SEs to adrenergic agonists?
1. dizziness 2. increased BP 3. insomnia 4. headache
41
What are CIs to adrenergic agonists?
1. HTN 2. Arrythmias 3. coronary artery disease 4. hyperthyroidism 5. renal failure
42
What is the MOA of Duloxetine for UI?
5HT/NE reuptake inhibitor increases urethral tone by NE
43
What are SEs with Duloxetine?
1. headache 2. insomnia 3. GI disturbances 4. dry mouth 5. dizziness 6. fatigue 7. increase BP
44
What medications treat overflow UI due to obstruction from BPH?
1. alpha-1 antagonists 2. 5-alpha reductase inhibitors
45
What medications treat overflow UI by stimulating detrusor muscle contractions?
Bethanechol (URECHOLINE)
46
What is the MOA of Bethanechol (URECHOLINE)?
stimulates parasympathetic nervous system; increases bladder muscle tone, causing contractions to stimulate urination
47
What are SEs with Bethanechol (URECHOLINE)?
1. N/V/D 2. flushing 3. abdominal cramping 4. salivation
48
What are CIs with Bethanechol (URECHOLINE)?
1. asthma/COPD 2. PUD 3. epilepsy 4. coronary artery disease
49
What is most commonly used to treat urge incontinence?
antimuscarinics
50
What antimuscarinics are used to treat urge incontinence?
1. oxybutynin 2. Tolterodine 3. Fesoterodine 4. Tropium chloride 5. Solifenacin 6. Darifenacin
51
What is the MOA of antimuscarinics for urge UI?
antagonist of M3 receptors in the detrusor muscle
52
What are SEs with antimuscarinics?
1. anticholinergic 2. cognitive impairment (M1) 3. dizziness 4. vision changes 5. headache 6. thirst
53
What patients should antimuscarinics be avoided in?
1. delirium 2. dementia 3. chronic constipation 4. cognitive impairment
54
Oxybutynin ER
DITROPAN XL
55
Oxybutynin gel
GELNIQUE
56
OTC Oxybutynin patch
OXYTROL
57
What population is OTC oxybutynin patch for?
women 18+ with 2+ sx
58
How often should the OTC oxybutynin patch be changed?
every 3-4 days
59
How long does it take to see the effectiveness of Oxybutynin? How long is a trial?
1. a few weeks 2. >/= 4 weeks to 12 weeks
60
What dosage form of muscarinic are associated with less SEs?
ER forms
61
Tolterodine
DERTROL; DETROL XL
62
What CYP enzymes metabolize Tolterodine leading to drug interactions?
1. CYP2D6 2. CYP3A4
63
What CrCl does Tolterodine require a dosage adjustment?
CrCl= 10-30
64
Fesoterodine
TOVIAZ
65
Why does Fesoterodine have have same drug interactions but fewer SEs than Tolterodine?
prodrug of Tolterodine
66
What advantages does the quaternary ammonium give Trospium Chloride?
less transport across the BBB leading to less cognitive impairment
67
Trospium Chloride
SANCTURA
68
What drugs possibly compete for active tubular secretion with Trospium Chloride?
1. digoxin 2. morphine 3. metformin 4. vancomycin 5. dofetilide
69
What agents are selective antagonists for the M3 receptor?
1. Solifenacin (VESICARE) 2. Darifenacin (ENABLEX)
70
What CYP enzyme metabolizes Solifenacin leading to drug interactions?
CYP3A4
71
What CYP enzyme metabolizes Darifenacin leading to drug interactions?
1. CYP2D6 2. CYP3A4
72
What is the MOA of Mirabegron?
beta-3 adrenergic activation relaxes the detrusor muscle during the storage phase to increase bladder capacity
73
Mirabegron
MYRBETRIQ
74
What drug interactions does Mirabegron have?
1. moderate CYP2D6 inhibitor 2. use lowest dose of digoxin
75
What SEs does Mirabegron have?
1. HTN 2. UTI 3. nasopharyngitis 4. headache
76
What is the MOA of Vibegron?
beta-3 adrenergic activation relaxes the detrusor muscle during the storage phase to increase bladder capacity and does not penetrate BBB
77
What DIs does Vibegron have?
CYP2D6
78
Vibegron
GEMTESA
79
What are the indications for Onabotulinumtoxin A BOTOX?
treatment of overactive bladder with symptoms of urge incontinence, urgency, or frequency in adults who have inadequate response to anticholinergic
80
What BBW doesOnabotulinumtoxin A BOTOX have?
spread of toxin effect
81
What SEs does Onabotulinumtoxin A BOTOX have?
1. UTI 2. urinary retention 3. dysuria

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