Urinary Incontinence or Retention Flashcards Preview

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Flashcards in Urinary Incontinence or Retention Deck (57):
1

beta 3 in the bladder

relaxes detrussor

2

alpha 1 in the internal sphincter

contracts urethral smooth muscle

3

sympathetic nerve int he micturation pathway

Hypogastric (t10-12)

4

external sphincter under control of

Pudendal nerve-ACH onto nicotinic receptors causes contraction

5

urine storage path

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

6

Voiding Path

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

7

SNS and SOmatic inhibited

Voiding Phase

8

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

storage phase...this is continence

9

First line therapy usually after behavioral modification

Antimuscarinic meds, tolteridine, oxybutinin
*not without major adverse effects

10

problem with anticholinergics especially in elderly population

-drug drug interactions
>cognitive impairment

11

urge in continence seen in what patients

BPH with overflow
Alzheimers
parkinsons
Strokes

12

tx of urge incontinence

Anticholinergics
oxybutinin
tolterodine

13

urge incintinence will present how?

urgency and frequency, day and nocturia

14

stress incontinence will present how?

minimal urine loss with sneezing or laughing

15

tx of stress incontienence

topical E
Alpha agaonist
non-pharm methods

16

cause of atonic bladder
*complete loss of bladder control

severe DM neuro3pathy
stroke

17

Tx for atonic bladder

catheter

18

muscarinic rceptors on the bladder

m2 and m3

19

M2 in the bladder does what

opposes beta adrenergic receptors-indirect effect on bladder muscle

20

M3 in bladder does what

direct effect on contracting smooth detrussor muscle of bladder

21

blockade of M2/M3 results in

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

22

Colinergic excess

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

23

quaternary amine that does not cross BBB

Trospium-less central adverse effects

24

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

trospium

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