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49 Cards in this Set
- Front
- Back
Normal physiology for bladder to fill
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1)detrusor muscle relaxation (b-receptor stimulation)
2)urethral pressure increased (alpha-receptor stimulation) 3)detrusor muscle relaxation (inhibition of parasympathetic system cholinergic receptors) |
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normal physiology for bladder to empty
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1)detrusor muscle contraction
-stimulation of cholinergic receptors 2)urethral pressure decreased -inhibition of alpha-receptor stimulation |
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Consequances of urinary incontinence
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1)physical
-skin breakdown, infections 2)psychological -depression, sleep disturbance 3)social -avoidance of sexual activity 4)economic |
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Transient or Reversible causes of urinary incontinence
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"DIAPPERS"
(delirium/dementia, infections, atrophic vaginitis or alcohol ingestion, pharmacologic agents, psychologic causes, endocrine d/o (hyperglycemia, hypercalcemia), restricted mobility (physcial restraints), stool impaction (chronic constipation and fecal incontinence) |
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drugs which reduce bladder wall contractility leading to overflow -> urinary retention w/ resultant frequency
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1)TCA
2)antipsychotics 3)antihistamines 4)opiod analgesics 5)CCBs |
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drugs which increase urethral sphincter pressure leading to retention -> urinary retention w/ resultant frequency
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1)ephedrine
2)pseudoephedrine |
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drugs which increase urine production leading to leakage -> potential to cause frequency and urgency
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1)alcohol
2)caffeine 3)diuretics |
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What is urge incontinence?
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1)overactivity due to involuntary detrusor muscle contractions
2)leakage w/ sudden, strong desire to void 3)urine frequency and nocturia |
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What is stress incontinence?
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1)weakness of pelvic floor musculature and/or urethral sphincter malfunction
2)hormonal deficiency following menopause allows atrophy of genitoruinary tissues 3)minimal nocturnal sxs |
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What is overflow incontinence?
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1)leakage of urine associated w/ an overfilled bladder
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What is functional incontinence?
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1)leakage of urine occurs in setting of normal bladder and urethral function
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What is mixed incontinence?
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1)leakage of urine attributed to multiple factors
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What is postvoid residual (PVR) urine volume?
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1)amount of urine remaining in bladder after voiding (normal <50-100ml)
2)measured by catheterization method or ultrasound evaluation |
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High postvoid residual volumes may be related to what?
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1)bladder weakness
2)outlet obstruction |
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counseling points on absorbent products
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1)skin care
2)routine skin checks to screen for rash or skin breakdown |
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Lifestyle modifications
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1)regulate fluid intake
2)eliminate bladder irritants 3)maintain bowel regularity 4)weight management |
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Environmental modifications
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1)bathroom aids/bedside commode
2)decrease toilet height 3)decrease toilet distance 4)unrestrictive clothing |
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Behavioral Interventions examples
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1)pelvic muscle exercises
2)timed voiding 3)habit training 4)prompted voiding 5)bladder training |
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How do you perform pelvic muscle exercises?
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1)empty bladder
2)tighten pelvic floor muscles and hold for 3 secs 3)relax muscles for 3 secs or for as long as muscles were tightened 4)goal is increase to 5 then 10 secs as muscles get stronger 5)increase up to 10 exercises at a time and 3 times a day |
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What is timed voiding?
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1)toileting on a fixed schedule, usually q2 hours while awake
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What is habit traning?
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1)scheduled toileting w/ adjustment of voiding interval based on pts voiding pattern
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What is prompted voiding?
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1)caregiver asks if pt needs to void at appropriate and scheduled times during the day
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What is bladder training?
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1)scheduled toileting w/ progressively increasing voiding intervals using relaxation and reinforcement techniques
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What is the treatment of acute incontinence?
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1)resolve acute medical illness
2)treat chronic medical conditions 3)d/c offending medication |
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What is the first-line treatment for urge urinary incontinence?
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1)implementation of bladder training
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What are the current pharmacotherapy treatment strategies for urge urinary incontinence?
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1)oxybutynin
2)tolterodine 3)trospium 4)solifenacin 5)darifenacin |
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location of M1 receptors
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1)brain
2)salivary glands |
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location of M2 receptors?
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1)brain
2)heart 3)bladder |
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location of M3 receptors?
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1)brain
2)bladder 3)eye 4)salivary glands 5)GI tract |
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location of M4 receptors?
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1)brain
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location of M5 receptors?
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1)brain
2)eye |
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Oxybutynin extended release dose
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5mg qd
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tolterodine extended release dose
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4mg qd
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oxybutynin patch patient counseling
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1)apply twice weekly
2)apply to clean, dry skin on abdomen, hip, or buttock 3)apply immediately after removal from pouch 4)avoid re-application to same site within 7 days 5)avoid rubbing patch w/ exercise and bathing 6)do not cut or trim patch 7)adverse effects include skin erythema and pruritus |
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Contraindications and/or precaution of anticholinergic meds
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1)urinary or gastric retention
2)NAG 3)bladder outflow obs 4)reduced GI motility 5)reduced hepatic or renal function |
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geriatrics are sensitive to what anticholinergic adverse effects?
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1)dry mouth
2)blurry vision 3)constipation 4)dyspepsia 5)drowsiness 6)dizziness 7)tachycardia 8)headache |
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Drug interactions with anticholinergic meds
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1)macrolide antibiotics (clarithromycin)
2)azole antifungals (itraconazole) 4)protease inhibitors (ritonavir) |
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Benefits of extended-release forms?
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1)more stable blood level
2)fewer adverse effects 3)improve medication adherence |
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What are the monitoring parameters with anticholinergic agents?
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1)urinary sxs
-urgency, frequency, nocturia 2)incontinence episodes 3)adverse effects 4)QOL |
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What are potential reasons for treatment failure?
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1)adverse effects limit titration
2)inadequate maintenance dose 3)unrealistic patient expections 4)conditions contribute to symptoms |
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What are 2nd line meds for urge incontinence?
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1)imipramine
2)doxepin |
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What is pharmacotherapy for BPH aimed at?
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decreasing urethral pressure
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What agents are used for BPH?
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1)terazosin
2)tamsulosin 3)finasteride |
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MOA for terazosin
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alpha-adrenergic antagonists
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MOA for finasteride
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5-alpha reductase inhibitor
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Pregnancy category for Finasteride
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X
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Onset of effect for Finasteride
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takes up to 6 months to achieve a maximal effect
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First-line treatment for stress incontinence
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pelvic floor exercises
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Pharmacotherapeutic agents for stress incontinence
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-no FDA approved meds
-alpha agonists promote urethral sphincter closure -duloxetine under investigation (increases urterhal resitance to leakage during periods of urine storage) |