UI

Question 1

OAB Sxs

Answer 1

• Urinary urgency: suddenly needing to urinate with or without incontinence
• Urinary frequency: voiding >= 8x/d
• Nocturia: >= 2 awakening in the night to urinate
• UI: involuntary leakage of urine

Question 2

Urge Incontinence

Answer 2

• Sudden and unstoppable urge to urinate

- Associated with neuropathy

Question 3

Stress Incontinence

Answer 3

• Urine leaks out during any form of exertion

- Includes exercise, coughing, sneezing, laughing, etc.

Question 4

Mixed Incontinence

Answer 4

-Mixture of stress and urge

Question 5

Functional Incontinence

Answer 5

• No abnormality in bladder

- Cognitively, socially, or physically impaired that is inhibiting access to toilet

Question 6

Overflow Incontinence

Answer 6

• Quantity of urine stored in bladder exceeds capacity
• Often occurs without urge to urinate
• EX: BPH

Question 7

OAB Risk Factors

Answer 7

• Age > 40 yo
• Diabetes
• Prior vaginal delivery
• Obesity
• Neurologic conditions
• Drugs that increase incontinence (alcohol, diuretics, sedatives, cholinesterase inhibitors)

Question 8

Non-Rx Treatment

Answer 8

• Behavioral therapies are considered first-line
• Includes bladder training, delayed/scheduled voiding, pelvic floor muscle, urge control technique, fluid management, dietary changes, weight loss
• Therefore, ALL drugs are 2nd line

Question 9

Urge/Mixed Incontinence Tx

Answer 9

• First-line: anticholinergics, beta-3 receptor agonists
• Botox second/third line (higher efficacy but high cost/inconvenient)
• Last line: nerve stimulation or surgery

Question 10

Anticholinergic Drugs

Answer 10

• AKA antimuscarinic drugs
• Block ACh from binding
• ER formulations preferred due to lower risk of dry mouth
• Drugs that are more selective for M3 receptors have fewer CNS side effects
• Avoid in pts >= 65 yo (Beers Criteria)

Question 11

Ditropan XL

Answer 11

• Anticholinergic Agent
• Oxybutynin ER - OROS formulation, can leave ghost shell
• IR formula available too
• Oxytrol - OTC patch (>= 18 yo) applied twice a week
• Gel formulation also on the market
• Topical options cause less dry mouth
• Older, less selective

Question 12

Detrol

Answer 12

• Anticholinergic agent
• Tolterodine
• ER formulation = Detrol LA

Question 13

Tropsium

Answer 13

• Anticholinergic agent

- Take on empty stomach

Question 14

Vesicare

Answer 14

• Anticholinergic agent
• Solifenacin
• More selective for M3 and less CNS SE

Question 15

Anticholinergic Agent Info

Answer 15

• CI: uncontrolled narrow angle glaucoma
• Warning: agitation, confusion, drowsiness, dizziness, blurred vision (caution in tasks needing mental alertness) - anti-SLUDD
• SE: dizzy/drowsy (worst with oxybutynin), xerostomia, constipation

Question 16

Central Anticholinergic SE

Answer 16

• Sedation
• Dizziness
• Cognitive impairment

Question 17

Peripheral Anticholinergic SE

Answer 17

• Dry mouth
• Dry eyes/blurred vision
• Urinary retention
• Constipation

Question 18

Beta-3 Agonists

Answer 18

• Relax detrusor muscle by activating B3 receptors
• Similar side effects to anticholinergics but less dry mouth
• Warning: urinary retention in BPH/anticholinergic agent users, increase BP
• SE: HTN

Question 19

B3 Agonist Examples

Answer 19

• Myrbetriq (Mirabegron)

- Gemtesa (Vibegron)

Question 20

Nocturia Tx

Answer 20

• Only approved medication is desmopressin (DDAVP), ADH analog that temporarily decreases urine production
• Formulations: tablet, injection, NS
• Given at bedtime
• Box warning: hyponatremia (monitor Na!)
• CI: fluid retention

Question 21

Stress Incontinence Tx

Answer 21

• None are FDA-approved and have minimal efficacy
• Pseudoephedrine - can cause tachycardia and palpitations
• Duloxetine - could be a good option for UI and depression

Question 22

Botox

Answer 22

• Onabotulism toxin
• 3rd line but most effective option but limited due to cost/route
• Inhibits ACh to detrusor muscle
• Can spread to other areas and cause UTI/urinary retention