UI- Heeter

What are “LUTS” and what do they include?

What are “LUTS” and what do they include?

• Lower urinary tract symptoms

• Think: LUTS are not FUN

• F- Frequency

  • > 8 micturitions a day

• U- Urgency

• N- Nocturia

  • > 1 micturition a night

Drugs that aggravate stress UI and why:

• a-antagonists

  • relax the bladder

• ACE-Is

  • ADR is coughing, coughing equals peeing a lil

Drugs that aggravate Overactive bladder and why:

(basic explanations on why)

• Anticholinesterase Inhibitors

  • increase urination

• Diuretics

  • increase urination

• Alcohol

  • increase urination

Drugs that aggravate Overflow Incontinence and why:

• a-agonists

  • contract the bladder

• antipsychotics

  • anticholinergic ADRs

• narcotics

  • urinary retention

• CCBs

  • urinary retention

• anticholinergics

  • urinary retention

“DIAPPERS” stands for:

D- Delirium

I- Infection

A- Atrophic Urethritis

P- Pharmaceuticals

P- Psychologic

E- excess urine output

R- restricted mobility

S- stool impaction

List examples of nonpharm tx for UI:

• Lifestyle modifications

  • limit fluid intake

  • avoid caffeine

  • weight loss

  • smoking cessation

  • prevent constipation

• Scheduling toilet times

• pelvic floor exercises

• anti-incontinence devices

  • alarms

• supportive devices

  • fake toilets, diapers, PT

Main cause of Stress UI:

atrophic vaginitis/urethritis

Off-label treatments for Stress UI:

1. Estrogen (topical/systemic)

2. alpha-agonists

3. SNRIs

Cause of Overactive Bladder/ Urge Incontinence:

none known, usually idiopathic

Risk Factors of Overactive Bladder:

• aging

• neurologic conditions

• bladder obstructions (BPH, Prostate cancer)

Causes of Overflow Incontinence:

Anything that obstructs the bladder

• BPH

• prostate cancer

• diabetes

1st line therapy for Overactive Incontinence/ Urge UI:

nonpharm tx

2nd line therapy for Overactive Incontinence/ Urge UI:

• anticholinergics/antimuscarics

• beta adrenergic agonists

3rd line therapy for Overactive Incontinence/ Urge UI:

• botox

What are some counseling points for botox as tx for urge UI?

• must be able to self-catheter

• must go back to the doctor to check for residuals after

What are some anticholinergic side effects?

• DRY!!!!

• dry mouth

• dry eyes/skin

• constipation

• dizzy

• blurred vision

All anti-muscarics/cholingerics have the potential for drug interactions due to…

CYP3A4

Contraindications for ALL Anti-Muscarinics:

“UGG”

U- urinary retention

G- gastric retention

G- Glaucoma

Oxybutynin Dosing Frequency for

• IR tab

• XL tab

• syrup

• gel

• transdermal patch

• IR tab

  • BID- QID

• XL tab

  • daily

• syrup

  • BID-QID

• gel

  • daily

• transdermal patch

  • apply patch twice weekly

What, if any, dosing adjustments must be made for Oxybutynin?

• age related

What, if any, dosing adjustments must be made for Tolterodine?

• renal

• hepatic

What, if any, dosing adjustments must be made for Trospium?

• renal

• age

What, if any, dosing adjustments must be made for Solifenacin?

• renal

• hepatic

What, if any, dosing adjustments must be made for Darifenacin?

• hepatic

What, if any, dosing adjustments must be made for Fesoterodine?

• renal

How are the anticholinergic side effects reduced for Oxybutynin?

• ER formulation

• Gel or Transdermal formulation

Tolterodine Dosing Frequency for

• IR tab

• ER tab

• IR

  • BID

• ER

  • daily

What are the specific renal and age dosing adjustments for Trospium?

• CrCl <30 ml/min

  • IR QHS

  • ER not recommended

• Ages 75 and up

  • limit IR dose from BID to QHS

Solifenacin dosing frequency:

daily

Darifenacin dosing frequency:

daily

Fesoterodine dosing frequency:

daily

Advantages/Disadvantages of using Mirabegron?

Advantages- less anticholinergic SEs

Disadvantages- more CV effects, pricey

Any drug used to treat stress UI is going to aggravate _______________.

overflow incontinence

Off-label tx for Overflow Incontinence:

• alpha-blockers

  • drugs that end in -osin