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18 Cards in this Set
- Front
- Back
What is the prevalence of OAB?
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12-17%
- increases with age |
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What non-gynaecological comorbidities are associated with OAB?
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- depression
- falls and fractures - increased admissions to hospitals and nursing homes |
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List conservative management options for OAB
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- behavioural management protocols
- bladder training programs - functional electrical stimulation |
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List approved anticholinergic medications for OAB
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- oxybutinin (Ditropan)
- tolterodine (Detrol) - tropsium (Trosec) - solifenacin (Vesicare) - darifenacin (Enablex) - fesoterodine (Toviaz) |
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What receptors and neural pathways are involved in voiding?
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- voiding occurs via parasympathetic activation of M2 or M3 receptors
- M2 receptors also inhibit sympathetically mediated bladder relaxation - receptors are in detrusor muscles and urothelium |
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What are some CNS side effects of anticholinergics?
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- immediate
- confusion - delirium - headache - blurred vision - dizziness - hallucinations - delayed: memory loss - smaller molecules, neutral in charge, lipophilic are more likely to cross BBB and cause CNS S/Es |
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What are some cardiac side effects of anticholinergics?
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- increase in heart rate
- small increases in QT interval (tolterodine and solifenacin) - do not cause clinically significant outcomes |
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Which anticholinergic is renally metabolized instead of hepatically?
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tropsium
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Which anticholinergic has the highest discontinuation rates due to side effects?
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oxybutinin
- adverse events in up to 80% - discontinuation rates of up to 33% |
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Which anticholinergic can be used in conjunction with cholinesterase inhibitor (Tx for Alzheimer's)?
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tropsium
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Which anticholinergic can be used in conjunction with medications that inhibit CYP450 (eg. antifungals, antiretrovirals, macrolide antibiotics, OCPs)?
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tropsium
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Absolute contraindications to anticholinergics
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- urinary retention
- gastric retention - uncontrolled narrow-angle glaucoma - known hypersensitivity |
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Relative contraindications to anticholinergics
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- partial bladder outlet obstruction (borderline or high PVRs)
- controlled narrow-angle glaucoma - impaired cognitive function - reduced renal or hepatic function - concomitant excessive EtOH use - decreased GI motility - constipation - myasthenia gravis |
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What pregnancy classification are anticholinergics?
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Category C
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List factors that increase the odds of early discontinuation of anticholinergics
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- previous depression
- previous UTI diagnosis - polypharmacy |
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Should estrogen supplementation be recommended as treatment for OAB?
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- oral or transdermal estrogen should not be recommended (comparable to placebo)
- vaginal estrogen can be used for subjective improvements in OAB symptoms |
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What is the role of TCAs in treating OAB?
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- biological plausibility
- mild anticholinergic (relaxes detrusors) - alpha agonist (contracts urethral sphincter) - minimal evidence for TCAs |
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What are treatment options for refractory OAB?
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- intravesical botulinum toxin injection (80% improvement, 43% w/ urinary retention requiring self-cath)
- sacral nerve stimulation (64-88% effective, 33% reoperation rate to treat lead migration, pain, and infection) - tibial nerve stimulation |