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Pharm II- Exam 1 > Urinary incontinence > Flashcards

Urinary incontinence Flashcards

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1
Q

What is the role of the PNS and Ach

A

primary motor input to the detrusor muscle

pelvic nerves coming from S2-S4

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2
Q

What is the primary neurotransmitter in the lower urinary tract?

A

Acetylcholine

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3
Q

Postsynaptic muscarinic receptors by acetylcholine control…

A

both volitional and involuntary contractions of the detrusor muscle

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4
Q

What is the ratio of M2/M3 receptors in humans?

A

3:1

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5
Q

which muscarinic receptor is responsible for both emptying contractions of normal micturition and involuntary bladder contractions?

A

M3

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6
Q

Most pharmacologic antimuscarinic therapy is primarily…

A

anti-M3 based

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7
Q

The majority of bladder smooth muscle cholinergic receptors are?

A

M2 variety

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8
Q

UI symptoms include…

A

over function or under function of the bladder and or urethra

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9
Q

What are causes of UI?

A

a combination of abnormalities in both

  • urethra (bladder outlet and urinary sphincter)
  • bladder
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10
Q

What is the TOC for urinary incontinence management?

A

nonpharmacologic, nonsurgical therapy

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11
Q

what is the TOC for bladder overactivity (urge incontinence)?

A

anticholinergic/antispasmodic agents

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12
Q

What is the TOC for urethral underactivity (stress incontinence)?

A

alpha-adrenergic receptor agonists and topical (vaginal) estrogens

(alone or together)

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13
Q

Which type of incontinence is rare but assoc. w/BPH?

A

overflow incontinence

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14
Q

What types of illnesses can result in UI? examples?

A

localized or systemic illnesses

ie. dementia/delirium, depression, UTI, DM, postmenopausal atrophic urethritis or vaginitis, constipation, pelvic malignancy

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15
Q

What medications influence the lower urinary tract function?

A

diuretics, acetylcholinesterase inhibitors (polyuria, freq, urgency)

a-receptor antagonists (urethral relaxation and stress urinary incontinence in women)

a-receptor agonists (urethral constriction and urinary retention in men)

antipsychotics (anticholinergic effects and urinary retention)

CCB (urinary retention)

anticholinergics (urinary retention)

ACEI’s (cough –> stress UI)

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16
Q

Overflow incontinence results when…

A

bladder is filled to capacity at all times but unable to empty causing –> urine to leak from a distended bladder past a normal or even overactive outlet and sphincter

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17
Q

Cause of secondary overflow incontinence?

A

benign or malignant prostatic hyperplasia

maybe pharacotharpy

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18
Q

Examples of when you might get urethral underactivity (stress urinary incontinence)?

A

during exertional activities

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19
Q

Risk factors for urethral underactivity (stress urinary incontinence)

A 
pregnancy
childbirth
menopause
cognitive impairment
obesity 
age

(uncommon in men)

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20
Q

What is the goal of therapy for urethral underactivity or SUI?

A

improve the urethral closure mechanism by stimulating alpha adrenergic receptors

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21
Q

When does bladder overactivitiy (OAB) occur?

A

during bladder filling and urine storage d/t involuntary (detrusor) contractions

from infx or neurologic disorders

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22
Q

what are symptoms of overactive bladder?

A

urinary frequency and urgency

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23
Q

Urgency

A

sudden compelling desire to urinate that is difficult to delay +/- urge incontinence

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24
Q

frequency

A

micturition more than 8 times per day

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25
Risk factors of OAB (urge urinary incontinence)?
``` normal aging neurologic dz (stroke, parkinson's, MS, spinal cord injury) bladder outlet obstruction (BPH, prostate CA) ```
26
which drugs are the most effective in tx'ing urge urinary incontinence (UUI) aka (bladder overactivity)?
anticholinergic/antispasmodic drugs
27
Examples of anticholinergic/antispasmodic drugs?
darifenacin, fesoterodine, oxybutynin, solifenancin, tolterodine or trospium (2nd line)
28
Leaking during physical activity (ie. coughing, sneezing, lifting) is associated with UUI or SUI?
SUI stress | urethral underactivity
29
Nocturnal incontinence and nocturia is more assoc.. w/ UUI or SUI?
UUI urge | bladder overactivity
30
Urgency and frequency more assoc. w/ UUI or SUI?
UUI urge | bladder overactivity
31
Amount of urinary leakage w/each episode of incontinence for UUI and SUI?
UUI urge --- LARGE if present | SUI stess --- usu. small
32
Tx Goals
identify pt-specific tx that may change over time choice of therapy influenced by pt age, comorbids, concurrent meds if goals not achieved addition of second agent or alternative single agent
33
What are first line tx's for OAB?
``` behavioral therapies (bladder training, control strategies) BT combined w/antimuscarinic therapies ```
34
What are 2nd line tx options for OAB?
oral muscarinic (darifenacin, festerodine, oxybutynin, solifenacin, tolterodine, or trospium) if IR and ER formulations available choose ER transdermal oxybutynin (patch or gel)
35
What are 3rd line tx options for OAB?
sacral neuromodulation peripheral tibial n. stimulation intradetrusor onabotulinum toxin A
36
Examples of bladder training?
pass urine every 2 hrs while awake try to pass urine whether or not you have an urge if strong urge --> stop, stand still, relax keep schedule until 2 days w/out urine leakage
37
Lifestyle modification examples for UI?
behavioral changes (fluid/caffeine modification, smoking cessation, weight loss, constipation prevention) for stress, urgency, and mixed UI Physical therapy (gait strength) esp. older pt's w/mobility issues
38
Scheduling regimen examples?
timed voiding habit retraining bladder training prompted voiding
39
What is timed voiding and who is it used for?
toileting on a fixed schedule where interval does not change, typically every 2 hrs during waking hrs pts w/cognitive or physical impairments
40
What are pelvic floor muscle exercises?
kegel exercises - regular practice of pelvic floor muscle contractions for prevention of stress leakage and urge inhibition
41
What are 3 interventions for pelvic floor muscle rehabilitation?
pelvic floor muscle exercises biofeedback vaginal weight training
42
What are examples of external neuromodulation?
alternative med therapies - acupuncture anti-incontinence devices - alarms, pesaries supportive interventions - undergarments
43
What 4 types of drugs can you rx to tx UUI?
anticholinergic/antispasmotics tricyclic antidepressants topical estrogens Mirabegron
44
What are anticholinergic/antispasmotics used for tx of UUI?
``` oxybutynin (ditropan) tolteridine trospium chloride IR, ER (Sanctura) solfinacin (VESIcare) dandinacin fesoterodine ```
45
What are tricyclic antidepressants used for UUI?
imipramine nortriptyline desimpramine doxepin
46
What are topical estrogens used for UUI?
creams | vaginal insert/ring
47
What are anticholinergic ADE's?
dry mouth, constipation, ha, dyspepsia, dry eyes, blurred vision, cognitive impairment, tachycardia, sedation, orthostatic hypotension application site (topical agents): pruritis, erythema
48
What contraindications and precautions should you take with anticholinergic/antimuscarinic agents for UI?
- urinary retention, gastric retention, severely decreased GI motility, angioedema, MG, uncontrolled narrow-angle glaucoma - renal/hepatic condition or concomitant drug therapy - mental status change or fall risk
49
Which types of anticholinergic/antimuscarinics are assoc. w/fewer anticholinergic adverse effects, particularly dry mouth?
ER, LA, XL, and topical products
50
What pt education should you give for anticholinergic/antimuscarinic alcohol-based gel?
avoid open fire or smoke until gel has dried
51
Mirabegron MOA and what does it tx?
used for OAB beta-3 subtype predominantly mediating bladder smooth muscle relaxation and improving urine storage
52
What is important to know about dosing Mirabegron?
avoid in pt's w/ESRD or severe hepatic impairment 25mg PO daily if Cr clearance is 15-29 swallow whole
53
Mirabegron ADE's and drug interactions
can increase BP - CI w/severe uncontrolled HTN caution w/bladder outlet obstruction or if already on antimuscarinic meds for OAB interacts w/ CYP2D6 substrates (tricylic antidepress, antipsychotics, SSRI, BB, type 1 antiarrythmics) use w/caution in pt's with cardiovascular dz
54
How does Botulinum toxin A work and when is it indicated?
temporarily paralyzes smooth or striated muscle indicated for tx of detrusor m. overactivity assoc. w/neuro condition or OAB
55
How soon are therapeutic and adverse effects seen after receiving Botulinum toxin A injection? how long do they last?
3-7 days after and subside after 6 to 8 months
56
ADE's of botulinum toxin A?
dysuria, hematuria, UTI, urinary retention
57
Urethral underactivity (stress incontinence) tx is aimed at...
improving urethral closure by stimulating a-adrenergic receptors in smooth muscle of bladder neck and proximal urethra enhancing supportive structures underlying urethral epithelium enhancing serotonin and norepi effects in micturition reflex pathways
58
What medication can be used to tx Urethral underactivity (stress incontinence)?
alpha-adrenergics estrogen-vaginal application imipramine- peds bedwetting
59
Which alpha adrenergics can be used to tx urethral underctivity (stress incontinence) and ADE's?
agents: norfenefrine, norephedrine ADE's: HTN, HA, dry mouth, nausea, insomnia, restlessness
60
Contraindications for alpha-adrenergics?
HTN, tachyarrhythmias, CAD, MI, corpulmonale, hyperthyoidism, renal failure, narrow angle glaucoma
61
What medication can you use to tx overflow (atonic bladder)?
cholinomimetics (cholinergic) Bethanecol
62
What are the 3 types of urinary incontinence?
Overflow stress urge
63
Which type of UI: Urethral blockage with a bladder unable to empty properly?
overflow
64
Which type of UI: bladder oversensitivity from infx and neurologic disorders?
urge
65
Which type of UI: relaxed pelvic floor, increased abdominal pressure?
stress
66
Which agents might aggravate Urethral underactivity or SUI?
alpha-adrenergic receptor blocking drugs ie. -osin's (prazosin, terazosin), methyldopa, clonidine, guanfacine, guanadrel, labetalol

Pharm II- Exam 1 (6 decks)

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