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Reproductive > Urinary Incontinence or Retention > Flashcards

Urinary Incontinence or Retention Flashcards

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1
Q

beta 3 in the bladder

A

relaxes detrussor

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2
Q

alpha 1 in the internal sphincter

A

contracts urethral smooth muscle

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3
Q

sympathetic nerve int he micturation pathway

A

Hypogastric (t10-12)

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4
Q

external sphincter under control of

A

Pudendal nerve-ACH onto nicotinic receptors causes contraction

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5
Q

urine storage path

A

LOW level vesical firing–SNS outflow of Hypogastric (to IUS and Detrussor)–Somatic (pudendal) to EUS–GUARDING/ CONTINENCE reflexes–inhibits detrussor muscle contractility

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6
Q

Voiding Path

A

BLADDER FIRING INTENSELY in afferent pelvic nerve–activates spinobulbosal reflex arc–to Pontine MicCtr–PNS to bladder and sphincter-inhibits Pudendal (somatic) and SNS outflow

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7
Q

SNS and SOmatic inhibited

A

Voiding Phase

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8
Q

SNS (hypogastric) to IUS and Detrussor and Somatic (Pudendal) to EUS are very active

A

storage phase…this is continence

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9
Q

First line therapy usually after behavioral modification

A

Antimuscarinic meds, tolteridine, oxybutinin

*not without major adverse effects

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10
Q

problem with anticholinergics especially in elderly population

A

-drug drug interactions

>cognitive impairment

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11
Q

urge in continence seen in what patients

A

BPH with overflow
Alzheimers
parkinsons
Strokes

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12
Q

tx of urge incontinence

A

Anticholinergics
oxybutinin
tolterodine

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13
Q

urge incintinence will present how?

A

urgency and frequency, day and nocturia

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14
Q

stress incontinence will present how?

A

minimal urine loss with sneezing or laughing

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15
Q

tx of stress incontienence

A

topical E
Alpha agaonist
non-pharm methods

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16
Q

cause of atonic bladder

*complete loss of bladder control

A

severe DM neuro3pathy

stroke

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17
Q

Tx for atonic bladder

A

catheter

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18
Q

muscarinic rceptors on the bladder

A

m2 and m3

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19
Q

M2 in the bladder does what

A

opposes beta adrenergic receptors-indirect effect on bladder muscle

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20
Q

M3 in bladder does what

A

direct effect on contracting smooth detrussor muscle of bladder

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21
Q

blockade of M2/M3 results in

A

retnetion,
decreased contraction
(unopposed beta stimulation of IUS/detrussor

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22
Q

Colinergic excess

A 
Diarrhea (and Diaphoresis) and abdominal cramping
Urination
Miosis (pinpoint pupils)
Bradycardia (muscarinic) or 
Emesis (Nausea and Vomiting)
Lacrimation
Lethargy
Salivation
*therfore anticholinergics have the oposite effects of all these
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23
Q

quaternary amine that does not cross BBB

Study These Flashcards
A

Trospium-less central adverse effects

24
Q

only anti-cholinergic agent that does not undergo hepativ metabolism to less active drugs

25
drug with no urinary excretion-rapidly hydrolyzed to 5 hydroxymethyl-tolteridine
fesoterodine | parental drug not detectable in systemic circulation
26
drugs available in ER bc they have shitty duration of effect
oxybutinin and tolteridine
27
longest half life
solifenacin | vesicare
28
poorly bioavailable
Oxybutinin trospium darifenacin
29
contraindication for Anticholinergics
URINARY/GASTRIC OBSTRUCITON NEED FOR MENTAL ALERTNESS ALZHEIMERS DIMENTIA ANGLE CLOSURE OR NARROW ANGLE GLAUCOMA
30
ISSUE FOR PATIENT COMING OFF ANTIMUSCARINIC DRUGS IS
INTOLERABLE DRY MOUTH
31
BOTOX BETTER FOR..
PATIENTS WHO RESPONDED TO ANTICHOLINERGIC THERAPY BUT FOUND THE DRUGS SIDE EFFECTS INTOLERABLE
32
BOTOX MOA
inhibits vesicular release of escitatory NT's and axonal expression of the SNARE-complex dependent protiens or psinal reflexes thought to cause detrussor overactivity
33
inhibits expression of purinergic (P2X) and proposed SP receptors-thus changes the phenotype of urothelial cells
Botox
34
immediate effect is peripheral affarent desensitization
Botox
35
during urine storage, BOTOX....
blockes excitatotyr effect on sub-urothelial afferent and detrussor PNS nerve endings during storage phase
36
beta-3 receptor activation causes
relaxation of detrussor smooth muscle
37
alpha 1 activation causes
constriction of IUS smooth muscle
38
Beta 3 agonist
mirabegron | *increases baldder capacity by relaxing detrussor S.M.
39
direct and indirect alpha and beta agonist Alpha >beta effects (constrictive>relaxing)
Pseudoephedrine | *off label
40
Indirect non-selective alpha and beta
Ephedra, Ma-Huang
41
For Sympathomimetics--> longest half life, poorest oral bio availability, most CYP metabolism, least urinary excretion,
Mirabegron
42
elimination is accelerated in the presence of acidic urine
Pseudo ephedrine - Ma-Huang - Ephedra
43
issue with Mirabegron
HTN | tachycardia
44
issues is pseudo ephedrine
HTN, Tachycardia, A-fib insomnia anxiety, nervousness, restlessness
45
Ephedra issues
HTN, TAchyarrythmia, CHF, MI, Insomnia, CNC sitmulaiton symptoms
46
all sympathomimetics should be cautioned with
concurrent MAOI use
47
Reduces odor emanating from leaked urine | *and to counter dermatitis from leaked urine
methionine | *ammonia free urine by acidifying urine pH
48
used in patients with intrinsice sphincter dysfunction
bovine collagen
49
increases tissue bulk around uretheral lumen
bovine collagen
50
Drugs classes to treat urinary retention and overall goal
to increase cholinergic stimulation of detrusor muscle contraction 1. muscarinic agonist 2. acetylcholinesterase inhibitor
51
Muscarinic agonist to tx. urinary retention
Bethanechol | *does NOT cross BBB
52
acetlycholinesterase inhibitor for urinary retention
neostigimine
53
inactviated by cholinesterases and hepatic microsomal enzymes
neostigimine only
54
can increase ACH onto Nicotinic and Muscarinic receptors
Neostigimine | *Bethanecol only acts on stimulating Muscarinic receptors only
55
Urinary retention rug with major heart/hemodynamic/rhythm side effects
Neostigimine gives the acetylcholine excess picture AV block, Bradyarryhtmia, hypotension, tachycardia
56
bethanecol issue
lightheaded, syncope, urinary urgency, excess tears, dizziness
57
opiates and urinary control
detrussor relaxation

Reproductive (9 decks)

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