Urinary Incontinence Flashcards
(26 cards)
What are some of the bothersome urinary symptoms for overactive bladder?
- Urinary Urgency - sudden feeling to pee (normally with or without incontinence and accompanied by frquency & nocturia
- Urinary Frequency - > 8 times during the day
- Nocturia
- Urinary Incontience - leakage
What are the forms of urinary incontinence?
- Urge
- Stress
- Mixed
- Functinal
- Overflow
What is urge as it relates to urinary incontinence?
- A Sudden and unstopable urge to pee
- Associated with Neuropathy and is present in those with diabetes, strokes, dementia, parkinsons, or MS
What is stress as it relates to urinary incontinence?
- Urine leaks out during any form of exertion (cough, exercise, sneeze, laugh)
What is Mixed as it relates to urinary incontinence?
- Combo of urge and stress
What is funcitonal as it relates to urinary incontinence?
- no issues with Bladder but the patient may be hindered in some way where they cant access the bathroom
What is overflow as it relates to urinary incontinence?
- Leakage that happens because the bladder is too full (BPH is the most common cause)
What is the way that the bladder works in our body?
- Has detrusor muscle which helps coordinated to store and expel urine (gets innervated by the parasympathetic NS via acetylcholine on muscarnic receptors)
How does overactive bladder occur in the body?
- inappropriate stimulation of the muscarinic receptors on the detrusor muscle causing the involuntary contractions = URGENCY
- M3 receptor is responsible for both emptying contractions and involuntary contractions
What are some risk factors for overactive bladders?
- Age > 40
- Diabetes
- Prior Vaginal Delivery
- Obesity
- Neurologic Conditions (Parkinsons, Stroke, Dementia)
- Drugs that Increase incontinence
What are some non drug treatment options for overactive bladders?
- Behaviroal Therapies (bladder training, delayed or scheduled peeing, Pelvic floor muscle exercises [Kegel], urge control, fluid management,…) are 1st line
What are some of the drug treatments for someone with overactive bladder?
- Anticholinergic Medications
- Beta-3 Agonist
- Onabotulinumtoxin A (Botox A)
- Nerve Stimulation or Surgical Treatments
What is the MOA for the anticholinergic drugs?
- Also called antimuscarinic drugs; they bind to muscarinic receptors and block acetylcholine from binding = limits the detrusor muscle actions
What are some of the anticholinergic agents used for overactive bladder?
- Oxybutynin IR, ER (Ditropan XL), Patch
- Tolterodine (Detrol) & ER (Detrol LA)
- Trospium IR, XR
- Solifenacin (Vesicare) [M3 Selective]
- Darifenacin [M3 Selective]
- Fesoterodine (toviaz) [M3 selective]
M3 Selectives have fewer CNS side effects
What are some warnings for the anticholinergic agents used for overactive bladder?
- Agitation, Confusion, drowsiness, dizziness, blurred vision (caution in those that are doing task that required mental alertness)
What are some contraindications for the anticholinergic agents used for overactive bladder?
- Narrow angle glaucoma
What are some additional notes for the anticholinergic agents used for overactive bladder?
- Decreased dose with renal impairments
- Ditropan XL is an OROS form = Ghost Shells
- Oxy Patch & Gel cause less dry mouth
What are some anticholinergic effects?
- Dry eye/blurred Vision
- Urinary Retention
- Dry Mouth
- Constipation
- Tachycardia
- Sedation
- Dizziness
- Cognitive Impairment
Cant See, Cant Pee
Cant Spit, Cant Shit
What are some treatment options that could minimize the dry mouth side effects from the anticholinergic agents
The main reason why people stop using these medications
- Try the ER verisons
- Try Oxybutynin gel or patch
- Beta-3 Agonists have lower dry mouth risks
- NON-drug options
What is the MOA for the Beta-3 agonists used for overactive bladder?
- Relaxes the detrusor muscle and increases the bladder capacity by activating Beta-3 receptors
What are the beta-3 agonist that are used for overactive bladders?
- Murabegron (Mybetriq)
- Vibegron (Gemtesa)
What are some warnings for the beta-3 agonists used for overactive bladder?
- Urinary Retention in those with BPH and when used with anticholinergic drugs
- Mirabegron: increase BP
What is the MOA for OnabotulinumtoxinA (Botox)?
- For those that are refractory to the 1st and 2nd line treatments; affects the detrusor activity by inhibiting the release of acetylcholine
What drug is used for noctuira and what is the MOA
- Desmopression
- MOA: antidiuretic hormone analog that temporarily decreases urine production
