Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Geriatrics > Urinary Incontinence > Flashcards

Urinary Incontinence Flashcards

(81 cards)

Start Studying
1
Q

What is UI?

A

Complaint of involuntary leakage of urine

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

How does UI affect QOL?

A 
Depression
Loss of independence
Lack of self-esteem
Decreased social engagement
Reason for older adults being institutionalized
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Is UI more common in men or women?

A

Women

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

What happens to the genitourinary system with age that may lead to UI?

A

Kidneys become less able to concentrate urine
Bladder has less capacity
Bladder may not empty completely

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

What is normal micturition?

A

Urethral sphincter maintains adequate tone to resist passage of urine from bladder until voluntary voiding is initiated
Bladders expand to accommodate increasing volumes of urine, w/o a significant increase in bladder pressure
Normal micturition occurs with a coordinated set of actions that leads to a rise in intravesicular pressure - decreased urethral resistance and bladder contraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is acetylcholine?

A

Primary neurotransmitter in the lower urinary tract

Mediates voluntary and involuntary contractions of the detrusor muscle

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

What are the main cholinergic muscarinic receptors responsible for micturition?

A

M2 and M3

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

What does M1 receptor affect?

A

Stomach and Brain

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

What does M2 affect?

A

Bladder and heart

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

What does M3 affect?

A

Bladder and salivary

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

What does M4 affect?

A

Areas of the brain

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

What are the reversible causes?

A 
DIAPPERS
Delirium
Infection
Atrophic vaginitis
Pharmaceuticals
Psychological condition
Excess urine output
Reduced mobility
Stool impaction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the mechanisms of persistent UI?

A 
Stress UI
Urge UI
Overflow incontinence
Mixed incontinence and other types
Functional Incontinence
Overactive Bladder (OAB)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is stress UI?

A

Urethral sphincter underactivity - results in involuntary loss of urine

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

What causes stress UI?

A

During exertion (cough, sneezing, exercise)
Volume lost is proportional to exertion
Most common in women during/post menopause, pregnancy, child birth, cognitive impairment and age
Men after urinary tract surgery or injury

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

What is urge UI?

A

Inability to delay voiding after sensation of bladder fullness is perceived

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is urge UI associated with?

A

Detrusor hyperactivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How do we define urge UI?

A

Frequency, urgency, and nocturia are commonly experienced as a result of involuntary bladder contractions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How is frequency defined?

A

Going more than 8 times a day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How is urgency defined?

A

A sudden, strong desire to urinate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is Overflow incontinence?

A

urethral overactivity and/or bladder underactivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the least common type of UI?

A

Overflow incontinence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

When does overflow incontinence happen?

A

When the bladder is filled to capacity but is unable to empty - causing urine leakage - lower ab fullness, weak urinary stream, interrupted stream, incomplete bladder emptying

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the most common causes of overflow incontinence?

A

BPH and prostate cancer

Neurologic less common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is mixed incontinence and other types?
Combination of bladder overactivity and urethral underactivity
26
What is functional incontinence?
Incontinence that is not related to bladder or urethral factors, but rather another primary disease state
27
What is OAB?
Urinary urgency w/ or w/o urge incontinence, frequency, nocturia
28
What is the cornerstone of UI treatment?
Nonpharmacologic therapy
29
What are the nonpharmacologic therapies for UI?
Behavior modification Pelvic floor muscle exercises +/- biofeedback Environmental changes
30
What are pharmacologic therapies for UI?
``` Anticholinergic/antispasmodic (first line) Beta-3 receptor agonist TCAs Botox Sacral nerve stimulation ```
31
How does anticholinergic/antispasmodics work in UI?
Suppresses premature detrusor contractions, enhancing bladder storage, relieves urge sx
32
What are the efficacy considerations for anticholinergic/antispasmodics?
Modest reduction in UI Similar efficacy demonstrated in all agents Full continence achieved in 9-13%
33
What are the ADRs for anticholinergics?
``` Use caution with cognitive impairment Drowsiness Dry mouth Decreased sweating Urinary hesitancy and/or retention Hot flashes Fever Vasodilation Amblyopia Transient blurred vision Mydriasis Cyclopegia Decreased lacrimation and increased ocular tension Decreased GI mobility Constipation ```
34
What drugs are selective for M3?
Solifenacin and darifenacin - theoretically less ADRs
35
What is our only beta-3 adrenergic receptor antagonist?
Myrbertiq
36
What is the MOA of Myrbetriq?
Activates beta-3 receptors causing relaxation of the detrusor muscle, increasing the urinary storage capacity of the bladder
37
What is the indication for Myrbetriq?
Overactive bladder with sx of urge UI, urgency, and frequency
38
What are the ADRs for Myrbetriq?
N/D, HA, HTN, constipation, dizziness, tachycardia, nasopharyngitis and UTI
39
What drugs are anticholinergic/antispasmodics for UI?
``` Oxybutynin (Ditropan XL) Tolterodine (Detrol LA) Fesoterodine (Toviaz) Trospium (Sanctura XR) Darifenacin (Enablex) Solifenacin (Vesicare) ```
40
What is Ditropan XL's dosing strategies?
``` IR tabs/Liquid 5mg/5mL -5mg PO BID-TID -Max 20mg/day ER tabs -5-10 mg QD -Max30 mg/day Transdermal patch -3.9 mg/day patch twice weekly Topical gel -10% = 1 packet daily -3% = 3 pumps QD ```
41
What is Detrol LA's dosing strategy?
IR tablets - 1-2 mg PO BID ER Capsules - 2-4 mg PO QD
42
What drugs require renal and hepatic dose adjustments?
Detrol LA Darifenacin Solifenacin Myrbetriq
43
What is a SE of Detrol LA?
Potential for QTc prolongation
44
What should be avoided with most anticholinergic/antispasmodic agents? Which one does not need to worry?
Grapefruit juice | Sanctura XR
45
What is the dosing strategy for Toviaz?
ER tabs | - 4-8 mg PO daily
46
What is the dosing strategy for Sanctura XR?
IR tabs - 20mg BID ER caps - 60mg QD
47
What is the dosing strategy for Enablex?
ER tabs | - 7.5-15 mg QD
48
What anticholinergic/antispasmodic agent only requires hepatic dose adjustments?
Derifenacin
49
What DDI does Enablex have?
Metoprolol (2D6)
50
Which agents cause the worst constipation?
Enablex/vesicare
51
What are nonpharmacologic treatments of stress incontinence?
``` 1st line: pelvic floor exercises Absorptive pads Behavioral modifications (weight loss) Devices Surgery Urethral injection with bulking agents ```
52
What are the pharmacologic treatments of stress incontinence?
Alpha-adrenergic agonists (pseudoephedrine, phenylephrine) 1st line Estrogens Duloxetine
53
What is the efficacy of duloxetine in stress incontinence?
Benefits in incontinence episodes, number of micturitions per day and QOL
54
People with what disease should be discouraged to use duloxetine?
Chronic liver disease
55
What is the guiding principle for the treatment of mixed incontinence?
Treat the predominate sx first
56
How do we treat overflow incontinence?
Alpha blockers (tamsulosin, alfuzosin, doxazosin, terazosin, silodosin), 5-alpha reductase inhibitors (finasteride, dutasteride) and surgery
57
What is fecal incontinence?
The involuntary voiding of feces into clothing or bedclothing
58
How is continence maintained?
The external and internal sphincters and the puborectalis muscle
59
What are the RFs for fecal incontinence?
``` H/o UI Presence of neurologic dz Presence of psychiatric dz Poor mobility Age greater than 70 years Dementia ```
60
What are the causes of fecal incontinence?
``` Fecal impaction Loss of normal continence mechanism Problems overwhelming normal continence mechanism Psychologic and behavioral problems Neoplasms ```
61
What is the most common cause of fecal incontinence?
Fecal impaction
62
What are the causes of loss of normal continence mechanism?
Local neuronal continence mechanism Impaired neurologic control Anorectal trauma/sphincter disruption
63
What are problems that overwhelm normal incontinence mechanism?
Diarrhea colitis Laxative Radiation Poor access to toilet
64
What are psychologic and behavioral problems that may cause fecal incontinence?
Severe depression Dementia Cerebrovascular dz
65
What is sarcopenia?
Loss of muscle mass and strength that occurs with aging - associated with functional impairment
66
What are the factors affecting nutrition?
``` Finances Social (living alone) Functional (ability to shop, cook, etc) Cognition Dysphagia Chewing problems Anorexia associated with medications of disorders Delayed gastric emptying leading to early satiety ```
67
How does overnutrition occur in elderly?
Overweight and obesity are not associated with increased mortality in older adults as it is in younger adults, except at extreme levels
68
What nutrients are supposed to be included when weight loss is necessary in elderly?
``` Protein Vit D Vit B12 Calcium Fiber Fluids ```
69
How do we treat undernutrition?
Use of high calorie, nutrient dense meals and snacks should be encouraged May need meal supplementation Encourage use of MVT Appetite stimulant therapy
70
What are the appetite stimulants?
Mirtazapine Dronabinol Megestrol
71
What is the MOA of mirtazapine?
Affects leptin levels (a hormone produced by adipose cells - affect satiety) and TNF alpha
72
What is the starting dose of mirtazapine?
7.4 mg QHS d/t sedation; can titrate in 1-2 weeks
73
Which patients do we use mirtazapine in?
Concomitant depression and/or insomnia
74
What is dronabinol's MOA?
Appetite stimulation occurs in he lateral hypothalamus. Also affects feeding behaviors, decrease nausea, and reward mechanisms
75
What is the dronabinol dosing?
2.5 mg BID before lunch and dinner; may increase to a max dose of 20 mg per day. Also available in an oral solution; dosing is slightly different
76
What is the MOA of megestrol?
Appetite stimulant effects thought to be separate from primary pharmacology as a glucocorticoid May interfere with cachexin
77
What is cachexin?
Hormone which inhibits lipogenic enzymes
78
What is dronabinol approved for?
AIDs cachexia
79
What is the dose for megestrol?
200-400 mg QD | Usually need to use suspension as tablets come in 20-40 mg
80
How long until megestrol beings to work?
3 weeks
81
Why is megestrol on the Beers list?
Risk of VTE

Geriatrics (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions