Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/49

Click to flip

49 Cards in this Set

  • Front
  • Back
Normal physiology for bladder to fill
1)detrusor muscle relaxation (b-receptor stimulation)
2)urethral pressure increased (alpha-receptor stimulation)
3)detrusor muscle relaxation (inhibition of parasympathetic system cholinergic receptors)
normal physiology for bladder to empty
1)detrusor muscle contraction
-stimulation of cholinergic receptors
2)urethral pressure decreased
-inhibition of alpha-receptor stimulation
Consequances of urinary incontinence
1)physical
-skin breakdown, infections
2)psychological
-depression, sleep disturbance
3)social
-avoidance of sexual activity
4)economic
Transient or Reversible causes of urinary incontinence
"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)
drugs which reduce bladder wall contractility leading to overflow -> urinary retention w/ resultant frequency
1)TCA
2)antipsychotics
3)antihistamines
4)opiod analgesics
5)CCBs
drugs which increase urethral sphincter pressure leading to retention -> urinary retention w/ resultant frequency
1)ephedrine
2)pseudoephedrine
drugs which increase urine production leading to leakage -> potential to cause frequency and urgency
1)alcohol
2)caffeine
3)diuretics
What is urge incontinence?
1)overactivity due to involuntary detrusor muscle contractions
2)leakage w/ sudden, strong desire to void
3)urine frequency and nocturia
What is stress incontinence?
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
What is overflow incontinence?
1)leakage of urine associated w/ an overfilled bladder
What is functional incontinence?
1)leakage of urine occurs in setting of normal bladder and urethral function
What is mixed incontinence?
1)leakage of urine attributed to multiple factors
What is postvoid residual (PVR) urine volume?
1)amount of urine remaining in bladder after voiding (normal <50-100ml)
2)measured by catheterization method or ultrasound evaluation
High postvoid residual volumes may be related to what?
1)bladder weakness
2)outlet obstruction
counseling points on absorbent products
1)skin care
2)routine skin checks to screen for rash or skin breakdown
Lifestyle modifications
1)regulate fluid intake
2)eliminate bladder irritants
3)maintain bowel regularity
4)weight management
Environmental modifications
1)bathroom aids/bedside commode
2)decrease toilet height
3)decrease toilet distance
4)unrestrictive clothing
Behavioral Interventions examples
1)pelvic muscle exercises
2)timed voiding
3)habit training
4)prompted voiding
5)bladder training
How do you perform pelvic muscle exercises?
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
What is timed voiding?
1)toileting on a fixed schedule, usually q2 hours while awake
What is habit traning?
1)scheduled toileting w/ adjustment of voiding interval based on pts voiding pattern
What is prompted voiding?
1)caregiver asks if pt needs to void at appropriate and scheduled times during the day
What is bladder training?
1)scheduled toileting w/ progressively increasing voiding intervals using relaxation and reinforcement techniques
What is the treatment of acute incontinence?
1)resolve acute medical illness
2)treat chronic medical conditions
3)d/c offending medication
What is the first-line treatment for urge urinary incontinence?
1)implementation of bladder training
What are the current pharmacotherapy treatment strategies for urge urinary incontinence?
1)oxybutynin
2)tolterodine
3)trospium
4)solifenacin
5)darifenacin
location of M1 receptors
1)brain
2)salivary glands
location of M2 receptors?
1)brain
2)heart
3)bladder
location of M3 receptors?
1)brain
2)bladder
3)eye
4)salivary glands
5)GI tract
location of M4 receptors?
1)brain
location of M5 receptors?
1)brain
2)eye
Oxybutynin extended release dose
5mg qd
tolterodine extended release dose
4mg qd
oxybutynin patch patient counseling
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
Contraindications and/or precaution of anticholinergic meds
1)urinary or gastric retention
2)NAG
3)bladder outflow obs
4)reduced GI motility
5)reduced hepatic or renal function
geriatrics are sensitive to what anticholinergic adverse effects?
1)dry mouth
2)blurry vision
3)constipation
4)dyspepsia
5)drowsiness
6)dizziness
7)tachycardia
8)headache
Drug interactions with anticholinergic meds
1)macrolide antibiotics (clarithromycin)
2)azole antifungals (itraconazole)
4)protease inhibitors (ritonavir)
Benefits of extended-release forms?
1)more stable blood level
2)fewer adverse effects
3)improve medication adherence
What are the monitoring parameters with anticholinergic agents?
1)urinary sxs
-urgency, frequency, nocturia
2)incontinence episodes
3)adverse effects
4)QOL
What are potential reasons for treatment failure?
1)adverse effects limit titration
2)inadequate maintenance dose
3)unrealistic patient expections
4)conditions contribute to symptoms
What are 2nd line meds for urge incontinence?
1)imipramine
2)doxepin
What is pharmacotherapy for BPH aimed at?
decreasing urethral pressure
What agents are used for BPH?
1)terazosin
2)tamsulosin
3)finasteride
MOA for terazosin
alpha-adrenergic antagonists
MOA for finasteride
5-alpha reductase inhibitor
Pregnancy category for Finasteride
X
Onset of effect for Finasteride
takes up to 6 months to achieve a maximal effect
First-line treatment for stress incontinence
pelvic floor exercises
Pharmacotherapeutic agents for stress incontinence
-no FDA approved meds
-alpha agonists promote urethral sphincter closure
-duloxetine under investigation (increases urterhal resitance to leakage during periods of urine storage)