Block 4 Unit 2 Nephro_Urology - TX Bladder.pdf

Name Types of Incontinence Functional Incontinence URGE: 1st Line: Anticholinergics Examples Transient (temporary) Functional (can't go when u wanna go) Urge (peeing when u don't wanna pee) Stress (skill issue) Overflow (obstructive) Habit training Scheduled voiding Environmental adjustment Undergar...

Name Types of Incontinence Functional Incontinence URGE: 1st Line: Anticholinergics Examples Transient (temporary) Functional (can't go when u wanna go) Urge (peeing when u don't wanna pee) Stress (skill issue) Overflow (obstructive) Habit training Scheduled voiding Environmental adjustment Undergarments External collection devices Oxybutynin IR (Ditropan IR; PO) Oxybutynin XL (Ditropan XL; PO) Oxybutynin Patch (Oxytrol; TD) Oxybutynin Gel 10% (Gelnique; TD) MOA Indications SEs Contraindications Overall Pharmacology can also cause incontinence Drug therapy is not helpful for these patients Inhibit the action of acetylcholine in synapses thereby inhibiting parasympathetic activation Treatment of: - Urge incontinence - Dry mouth/skin - Constipation - Blurred vision - Confusion - Tachycardia - Cognitive dysfuntion - Orthostatic hypotxn OTC: Oxytrol Patch "For Women"??? - Gastric retention - Uncontrolled narrow-angle glaucoma - Caution: CYP34A inhibitors Pregnancy category: C BEER'S LIST: Caution in elderly patients IR medications have higher incidence of side effects than XL Maximum benefit may not be seen until >4 weeks Patch: - Pruritis/erythema URGE: 1st Line: β-3 Agonists Mirabegron XR (Myrbetriq; PO) Vibegron (Gemtesa; PO) Selectively binds to B3 adrenergic receptors thereby relaxing the detrusor muscle Moderate CYP2D6 inhibition Treatment of: - Urge incontinence - UTI - HTN - Headache - Severe HTN - Pregnancy Renal dosing: - CrCl < 30 = 25mg - CrCl < 15 = just don't, dude Renal dosing adjustments! Vibegron: - Does not inhibit 2D6 pathway Maximum benefit may not be seen until >8 weeks Treatment of: - Urge incontinence - Urinary retention - Existing urinary retention Outpatient procedure Caution: - Cardiac disease - Tachyarrhythmias - Hyperthyroidism - Renal failure - Narrow-angle glaucoma Similar efficacy to anticholinergic class URGE: 2nd/3rd Line: Botulinum A Botox C. botulinum toxin creates diffuse muscle relaxation via cholinergic inhibition Pseudoephedrin (Sudafed; PO) Stimulate smooth muscle receptors in bladder neck and proximal urethra Treatment of: - Stress incontinence - HTN - Tachycardia - Restlessness - Insomnia - Dry mouth - Headache Duloxetine (Cymbalta) Inhibits reuptake of serotonin and norepinepherine in the synpase Treatment of: - Stress incontinence - Depression - HTN - Withdrawal syndrome Don't use estrogens to treat UI, I guess Why was this information here Treatment of: - Symptomatic treatment of overflow incontinence - HTN - Hypotxn - Weakness - Tachycardia STRESS: 1st Line: Alpha adrenergic agonists STRESS: 1st Line: SNRI STRESS: Estrogen Oral Topical Estradiol (Estring; vaginal) OVERFLOW: 5-α-reductase inhibitor Finasteride (Proscar; PO) Dutasteride (Avodart; PO) OVERFLOW: α1-adrenergic antagonist Nonselective: Prazosin Terazosin Doxazosin Alfuzosin Caution: - Renal failure Avoid in: - Narrow-angle glaucoma - Alcoholics Orals will worsen UI Topicals may still be able to be used without effect on UI Hit the α-1 receptor thereby inhibiting smooth muscle constriction at the bladder neck This is literally useless Thanks for nothing - Hypotxn BEER'S LIST: Caution in elderly patients! Caution: - Elderly Selective: Tamsulosin (Flomax) OVERFLOW: Cholinergics Bethanechol Activates acetylcholine receptors in the Treatment of: synapse thereby inducing parasympathetic - Symptomatic treatment of overflow response incontinence SLUDGEM-like - Cramping - Hypersalivation - Diarrhea - Bradycardia - Bronchospasm - Bronchial asthma - Existing orthostatic hypotxn - CAD - Parkinson's FYI: → ↑ ↓← → ° ± β α 1. Discuss the mechanism of action, indications, therapeutic course, contraindications,drug interactions, side effects and monitoring parameters of pharmacotherapeuticagents commonly used in the treatment of urinary incontinence. 2. Identify patient factors that guide specific drug selection. 3. Describe indications for and use of combination therapies in adults with urinaryincontinence. 4. Develop an evidence-based treatment plan for a patient presenting with urinaryincontinence with consideration for patient specific factors and patient safety. 5. Describe key components of patient education and counseling when prescribing therapyfor adult patients with urinary incontinence. 6. Discuss non-pharmacologic treatment options for urinary incontinence. Incontinence Type Urge Stress (When you're stressed, you don't want to be antagonized) Overflow Palliate Anticholinergics β-3 Agonists α-adrenergic agonists * GOLD: Nonpharm!* α-adrenergic antagonists ("-osin") Cholinergics (bethanechol) Exacerbate Cholinergics α-adrenergic antagonists (blockers; "-osin") Nonspecific α-adrenergic antagonists (labetaolol, methyldopa, clonidine) Estogen α-adrenergic agonists TRT (Testosterone replacement therapy) Anticholinergics Diuretics