Atropine and the bladder

Used pre-op. Post-op difficulty voiding d/t contract sphincter and relax detrussor. Can give bethanacol (parasym/cholinergic) relaxes sphincter and contracts detrussor.

Are anticholinergics given for urinary tract obstruction?

No-anticholin contract sphincter and relax detrussor-if person has obstr. wouldn't want to contract sphincter more.

Are cholinergics given for urinary tract obstruction?

No-contracts detruss/relax sphincter. why contract detruss that would clamp down on obstruction.

Are acetylcholinesterase inhibitor given for urinary tract obstruction?

Not a good idea. Inhibits esterase which breaks down acetylcholine - more free acetylcholinesterase and have cholinergic effects.

Not understood. As men grow older develop BPH. End product of testosterone is estrogen-feminization from steroids. As men age estrogen-studies show this maybe the cause.

Prostrate enlarges and can eventually obstruct outflow of urine from bladder. <force of stream; urgency; residual urine; pressure in abdomen.

BPH symptom index; urine flow study; test retention; CT; MRI; radionucleide scans; biopsy r/o prostatic ca. AUA score >7 candidate for meds.

Finesteride (Proscar) and doxazosin (Cardura)

67% reduction in risk of invasive therapy. Finesteride alone 64% reduction.

Finasteride- not to be handled by woman of childbearing age

5-alpha reductase inhibitor (enzyme that helps convert testosterone into dihydro testosterone. Help tone down testost effect on body. 5 mg/day

Alpha-1 inhibitor block alpha-adrenergic receptors-block alpha 1 constricton of the urethra and relaxes urinary sphincter. Alpha-1 no longer used for BP control->CHF

Alpha-1 receptor; Max 0.8 mg/day; SE: nasal congestion, ejacul disorder, drowsiness/fatigue, back pain, diarrhea, dizziness. Usual dose: 0.4 mg QD 1/2 hour after meal.

INCONTINENCE IN WOMEN

Structural difficulty or problem. Behavioral therapy including bladder training and prompted voiding improved symptoms of urge. Kegels-pelvic floor exercise for stress and mix incont. Oxybutnin and Tolterodine small beneficial effect w/ detrus overact.

Anticholinergic used for OAB. Max dose 20 mg/day or 30 mg if ER. SE: dry mouth and constipation. Recommended starting dose for ER: 5-10 mg/day; max 30 mg

Anticholinergic for OAB; Max dose 4 mg/day; SE: dry mouth/constipation. Initial dose 2 mg BID; may decrease to 1 mg based on response and tolerability.

TCA-increases the amount of serotonin and norepi in brain. Used for bed-wetting;

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Bladder

Pharmacology

Question	Answer
Atropine and the bladder	Used pre-op. Post-op difficulty voiding d/t contract sphincter and relax detrussor. Can give bethanacol (parasym/cholinergic) relaxes sphincter and contracts detrussor.
Are anticholinergics given for urinary tract obstruction?	No-anticholin contract sphincter and relax detrussor-if person has obstr. wouldn't want to contract sphincter more.
Are cholinergics given for urinary tract obstruction?	No-contracts detruss/relax sphincter. why contract detruss that would clamp down on obstruction.
Are acetylcholinesterase inhibitor given for urinary tract obstruction?	Not a good idea. Inhibits esterase which breaks down acetylcholine - more free acetylcholinesterase and have cholinergic effects.
BPH Causes	Not understood. As men grow older develop BPH. End product of testosterone is estrogen-feminization from steroids. As men age <testosterone and >estrogen-studies show this maybe the cause.
BPH	Prostrate enlarges and can eventually obstruct outflow of urine from bladder. <force of stream; urgency; residual urine; pressure in abdomen.
DIAGNOSIS OF BPH	BPH symptom index; urine flow study; test retention; CT; MRI; radionucleide scans; biopsy r/o prostatic ca. AUA score >7 candidate for meds.
Finesteride (Proscar) and doxazosin (Cardura)	67% reduction in risk of invasive therapy. Finesteride alone 64% reduction.
Finasteride- not to be handled by woman of childbearing age	5-alpha reductase inhibitor (enzyme that helps convert testosterone into dihydro testosterone. Help tone down testost effect on body. 5 mg/day
Doxazosin	Alpha-1 inhibitor block alpha-adrenergic receptors-block alpha 1 constricton of the urethra and relaxes urinary sphincter. Alpha-1 no longer used for BP control->CHF
	Obtain PSA r/o cancer prostate; AUA score 7 or above; other diagnostic tests; Flomax most commonly prescribed.
Flomax (Tamsulosin)	Alpha-1 receptor; Max 0.8 mg/day; SE: nasal congestion, ejacul disorder, drowsiness/fatigue, back pain, diarrhea, dizziness. Usual dose: 0.4 mg QD 1/2 hour after meal.
INCONTINENCE IN WOMEN	Structural difficulty or problem. Behavioral therapy including bladder training and prompted voiding improved symptoms of urge. Kegels-pelvic floor exercise for stress and mix incont. Oxybutnin and Tolterodine small beneficial effect w/ detrus overact.
Oxybutnin	Anticholinergic used for OAB. Max dose 20 mg/day or 30 mg if ER. SE: dry mouth and constipation. Recommended starting dose for ER: 5-10 mg/day; max 30 mg
Tolterodine	Anticholinergic for OAB; Max dose 4 mg/day; SE: dry mouth/constipation. Initial dose 2 mg BID; may decrease to 1 mg based on response and tolerability.
Imipramine	TCA-increases the amount of serotonin and norepi in brain. Used for bed-wetting;

Created by: jniebyls

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