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Stack #197133
Urinary Antispasmodics (1.10)
| Question | Answer |
|---|---|
| What type of incontinence is it when you have an underactive urethra? | Stress Urinary Incontinence (SUI) |
| What type of incontinence is it when you have an overactive bladder? | Urge Urinary Incontinence (UUI) |
| What are the symptoms of stress urinary incontinence? | Loss of small volume of urine, urinary urgency and frequency. |
| Describe stress urinary incontinence. | This is when the bladder is compressed by increased intra-abdominal pressure (lifting, running, sneeze, cough). Urine is forced thru a weak internal sphincter. Urethra and internal sphincter are weak due to risk factors. |
| What are the risk factors of stress urinary incontinence? | Pregnancy, multiple childbirths, age, menopause, prostatectomy, A1 receptor antagonists. |
| Describe Urge Urinary Incontinence (UUI). | UUI is when you have an overactive bladder during filling and then a involuntary bladder contraction. |
| What are the risk factors of urge urinary incontinence (UUI)? | Stroke, Parkinson's, spinal cord injury. Also an outlet obstruction (benign prostatic hypertrophy) which leads to increase thickness and irritability of bladder wall, which leads to excessive contraction of the detrusor wall. |
| What are the Sxs of urge urinary incontinence (UUI)? | Sudden strong urge to urinate (> 8 times/day); enuresis (> or = 2 times/night) |
| What type of incontinence is it when you have bladder underactivity and/or outlet obstruction? | Overflow incontinence. |
| Describe overflow incontinence. | This is when your bladder is filled to capacity but is unable to empty. |
| What are the risk factors of underactive bladder? | This is due to neurological deficit (diabetes mellitus, hysterectomy, alcoholism, Parkinson's, B12 deficiency, spinal cord injury). |
| What are the risk factors of outlet obstruction? | This is due to benign prostatic hypertrophy (BPH) or prostate cancer in men or cystocele in women. |
| What are the Sxs of bladder underactivity and/or outlet obstruction? | You have lrg volume of residual urine, urine leak from a distended bladder past a normal or overactive sphincter, decreased flow of stream, strain to void, urinary frequency and urgency, dribbling after voiding. |
| What is functional incontinence? | This is when you have a normal detrusor, sphincter and neurological functions. |
| What are the risk factors of functional incontinence? | This is when an Alzheimer's pt does not plan timely travel to toilet or when wheelchair-bound pt is unable to get to bathroom. |
| What is transient incontinence? | This is when you have normal bladder, sphincters, and urethra. |
| What are the risk factors of transient incontinence? | UTI, constipation, alcohol, anticholinergics, sedatives/hypnotics, a receptor antagonists |
| What med(s) can you take for SUI? | Duloxetine (Cymbalta), phenylephrine, pseudoephedrine, TCA's such as imipramine, doxepin, nortripyline. Females with urethritis can also take topical estrogen. |
| What is the MOA for Duloxetine (Cymbalta)? | Inhibits 5-HT and NE uptake in Onuf's nucleus. It stimulates pudendal nerve which contracts the external sphincter. |
| What is the MOA for phenyephrine and pseudoephedrine? | These are a-receptor agonists. They contract the internal sphincter. |
| What is the MOA for the TCA's: imipramine, doxepin, nortriptyline? | These are anti-Ach PLUS a-receptor agonists. They contract the internal sphincter. |
| What is the MOA for topical estrogen (combined Rx)? | These increase # of a1-receptors and their sensitivity to a1-agonists. |
| What meds can you take for bladder underactivity and/or outlet obstruction? | You can take cholinergics such as Bethanechol (Urecholine) or a1-receptor antagonists such as Prazosin (Minipress), Terazosin (Hytrin) or Doxazosin (Cardura). |
| What's the MOA for Bethanechol (Urecholine)? | This cholinergic drug increases bladder contractility + relaxes the internal sphincter. |
| What is the MOA for Prazosin (Minipress), Terazosin (Hytrin) or Doxazosin (Cardura)? | These a1-receptor antagonists (used for BPH or prostate cancer) relax the internal sphincter. |
| What meds are used to treat UUI? | Oxybutynin (Ditropan, Oxytrol), Tolterodine (Detrol), Trospium (Sanctura), Solifenacin (Vesicare), Darifenacin (Enablex), Propantheline (Pro-Banthine), imipramine, doxepin, nortripyline, Terbutaline (Brethine), and Botox. |
| What are the 6 anticholinergic drugs that treat UUI? | Oxybutynin (Ditropan, Oxytrol), Tolterodine (Detrol), Trospium (Sanctura), Solifenacin (Vesicare), Darifenacin (Enablex), Propantheline (Pro-Banthine). |
| What is the MOA of anticholinergics drugs that treat UUI? | They block M3 receptors + presynaptic M1 receptors (decreases Ach release). This decreases bladder contractility + relaxes the internal sphincter. |
| Which of the 6 anticholinergics drugs that treat UUI has the least amount of ADRs? Why? | Trospium (Sanctura) has the least amount of CNS ADRs because it is a quatenary amine and therefore does not cross the BBB. |
| Which 3 of the 6 anticholinergics drugs that treat UUI are considered antispasmodic? | Oxybutynin (Ditropan, Oxytrol), Tolterodine (Detrol), and Trospium (Sanctura). |
| What is the MOA for Terbutaline (Brethine)? | It relaxes the bladder / increases contractility of the external sphincter. |
| What is the MOA for Botulinum toxin type A (Botox)? | It decreases the release of Ach from cholinergic nerve terminals. |
| What are the indications for Botox? | Bladder overactivity (UUI) and also it is used as an alternative to surgery in spinal cord injured pts with neurogenic detrusor overactivity who do not respond to std drug therapy (under investigation). |
| What are the indications for Desmopressin (DDAVP, Stimate)? | Enuresis and nocturia. |
| What is the MOA for Desmopressin? | It is a synthetic analogue of ADH. It is an agonist of the V2 receptor which prolongs the time to fill the bladder. |
| What is the sympathetic response of the PMC? | The hypogastric nerve releases NE and stimulates B2/B3 receptors which relax the detrusor and also stimulates A1 receptors which contracts the internal sphincter. |
| What is the parasympathetic response of the PMC? | The pelvic nerve releases Ach and stimulates M3 receptors which contract the detrusor and relax the internal sphincter. |
| What happens when the PMC stimulates Onuf's nucleus? | The pudendal nerve (a spinal nerve) releases Ach and stimulates Nm receptors. This contracts the external sphincter (which is a skeletal muscle which has Nm receptors). |
| How does the CNS regulate storage and urination? | The pons contains the PSC and the PMC. Combined, these receive input fr the cerebral cortex, limbic system, other brain areas, plus afferent nerves which ascend fr the spinal cord. They can +/- activity of SNS and PNS or +/- activity of the pudendal nerve |
| What nerves descend from the PSC to stimulate Onuf's nucleus? What happens? | NE, 5-HT and glutamate nerves descend fr the PSC to stimulate Onuf's nucleus of the pudendal nerve. This releases Ach to contract the ext sphincter. |
| Why is glutamate so important in terms of onuf's nucleus? | The action of NE and 5-HT require glutamate from the glutamate nerve. You must have glutamate otherwise cholinergic nerves are NOT stimulated. |
| Urine storage is accomplished by what 3 things? | Guarding reflex, bladder to SNS reflex, and PSC. |
| Describe urine storage in terms of the guarding reflex + PSC. | Bladder filling activates afferent pelvic n fibers. This leads to sacral spinal cord and stimulates Onuf's which stimulates the pudendal n. Ach released fr the pudendal n contracts the external sphincter (Nm). |
| Describe urine storage in terms of the bladder to SNS reflex. | Bladder filling activates afferent fibers of pelvic n which enter the sacral cord segments & ascend to thoraco-lumbar segments where they activate the SNS hypogastric n. NE released fr postgangl n relaxes detrusor (B2, B3) & contracts int sphincter (A1) |
| Describe urination in terms of the spinal-bulbo-spinal reflex + PMC. | Affer fibers of pelvic n ascend to PMC - integrates this info (for voluntary urination) w/info fr other brain areas. Stimulates PNS = contracts bladder + relax int sphincter). Inhibits SNS = relax int sphincter. Inhibits pudendal n = relax ext sphincter. |
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hcp1227
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