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Therapeutics Other Ruscin
Final Urinary Incontinence
18
Accounting
12th Grade
04/26/2011

Additional Accounting Flashcards

 


 

Cards

Term
Stress Incontinence
Definition
  • Dysfunction of bladder outlet (urethral sphincter weakness) leading to transient loss of small amounts of urine when intra-abdominal pressure increases
  • Coughing, laughing, sneezing, bending, lifting
  • Posterior urethrovesicular angle changes (parity, surgery)
  • Strength or responsiveness of urethral sphincter
  • Patients often dry at night
Term
Detrusor Instability/Overactive Bladder and Urge Incontinence
Definition
  • CNS dysregulation, stroke, PD, AD, neoplasm, NPH
  • Hyperreflexia of afferent pathways
  • Deconditioned voiding reflexes
  • Clinical feautres: urgency, frequency, nocturia, frequent small volume voiding
  • No characteristic features on physical exam, although CNS dysfunction may be apparent
Term
Overflow Incontinence
Definition
  • Occurs when intravesicular pressure exceed intraurethral pressures -- ONLY at HIGH volumes
  • Bladder outlet obstruction (BPH, neoplasm)
  • Impaired afferent sensation
  • Diabetic neuropathy, spinal cord below T-11
  • Muscle relaxants, calcium channel blockers, anticholinergics
  • Clinical features: palpable or percussable bladder, suprapubic tenderness, low urinary flow rates, post-void residual urine
Term
Functional Incontinence
Definition
  • The inability of a normally continent person to reach the toilet in time to avoid an accident
  • Musculoskeletal limitations -- joint pain, arthritis, muscle weakness
  • Unfamiliar setting, lack of conventional toilet facilities
  • Clinical features: accidents on the way to the toilet and early morning incontinence are suggestive of this type
Term
Iatrogenic Incontinence
Definition

The following may aggravate or unmask other causes:

  • Potent fast acting diuretics (lasix)
  • Sedative hypnotics, neuroleptics
  • Muscle relaxants
  • Alpha1 agonists -- PPA, pseudoephedrine
  • Alpha 1 antagonists -- terazosin, prazosin
  • Anticholinergics
  • Calcium channel blockers
Term
Non-Pharm Treatments for Urinary Incontinence
Definition
  • Scheduling regimens/timed voiding
  • Prompted voiding
  • Bladder training
  • Pelvic floor exercise/Kegel exercises
  • Vaginal weight training
  • Biofeedback
  • Pessaries/bladder neck support prostheses
Term
Treatments for Stress Incontinence
Definition
  • Kegel exercises
  • Topical estrogens/estring -- atrophic vaginitis
  • Pseudoephedrine
  • Duloxetine (not FDA approved but has shown improvement in symptoms)
Term
Treatments for Overflow Incontinence
Definition
  • Prazosin
  • Terazosin
  • Doxazosin
  • Phenoxybenzamine
  • Bethanechol
  • 5-alpha reductase inhibitors (finasteride, dutasteride)
Term
Treatments for Detrusor Instability (OAB)
Definition
  • Anticholinergics
  • Oxybutynin
  • Oxybutynin XL
  • Oxybutynin patch
  • Tolterodine
  • Tolerodine LA
  • Trospium chloride
  • Solifenacin
  • Darifenacin
  • Fesoterodine
Term
DEO is a metabolite of _________
Definition
Oxybutynin
Term
DEO concentration is highest with _________ and lowest with _________
Definition

DEO highest with oxybutynin IR

DEO lowest with patch/gel

Term
How is transdermal oxybutynin administered?
Definition
  • 1 patch every 3-4 days
  • Replace the patch the same 2 days every week (pref. Sun and Wed)
  • Rotate site application
Term
Trospium Chloride: MOA, Side Effects, CI
Definition

MOA

Antimuscarinic

 

Side Effects

Dry mouth, constipation, dyspepsia, headache

 

CI

Urinary retention, gastric retention, narrow-angle glaucoma

Term
Solifenacin: MOA, Side Effects, CI
Definition

MOA

Antimuscarinic (M3 selective)

 

Side Effects

Dry mouth, constipation, blurred vision, urinary retention, dry eyes

 

CI

Urinary retention, gastric retention, narrow angle glaucoma

Term
Darifenacin: MOA, Side Effects, CI
Definition

MOA

Antimuscarinic (M3 selective)

 

Side Effects

Dry mouth, constipation, blurred vision, dyspepsia, abdominal pain

 

CI

Urinary retention, gastric retention, narrow angle glaucoma

Term
Fesoterodine: MOA, Side Effects
Definition

MOA

Antimuscarinic (non-selective)

 

Side Effects

Dry mouth, constipation, blurred vision, dyspepsia, abdominal pain

Term
Effects of Anticholinergic Treatments for OAB
Definition
  • Reduce incontinence episodes
  • Reduce frequency episodes
  • Increase bladder storage (volume voided)
  • Decrease urgency episodes
  • May decrease nocturia
Term
Treatment for Functional Incontinence
Definition
  • Avoid sedative hypnotic drugs
  • Scheduled bathroom visits
  • Bedside commode
  • Assist with functional disabilities
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