Quizlet UI

What is urinary incontinence (UI)?

Involuntary loss of urine, often accompanied by bothersome lower urinary tract symptoms (LUTS) such as urgency, increased daytime frequency, and nocturia.

What are the common health impacts of urinary incontinence?

UI can significantly impact quality of life and may lead to medical complications if left untreated.

Who is most affected by urinary incontinence?

Prevalence is highest in women, older adults, and those in long-term care settings, with rates of 37% in short-stay and 70% in long-term nursing home residents.

What are the common causes of urinary incontinence?

Causes include age-related changes, medical conditions, and differences in anatomy between sexes.

What role does the detrusor muscle play in bladder function?

The detrusor muscle is smooth muscle in the bladder wall that contracts during voiding and relaxes during filling.

What is the function of the internal urethral sphincter?

The internal urethral sphincter is smooth muscle that relaxes during voiding and contracts during filling.

What is the role of the external urethral sphincter?

The external urethral sphincter is skeletal muscle that allows voluntary control over urination.

What neurotransmitter is primarily involved in bladder contraction?

Acetylcholine (Ach) is the primary neurotransmitter that causes detrusor contraction and bladder voiding.

What is acute or transient urinary incontinence?

Recent onset UI associated with acute medical problems such as infections or polyuria.

What does the acronym D.R.I.P. stand for in relation to urinary incontinence?

Drugs, Delirium, Retention, Restricted mobility, Infection, Impaction, Inflammation, Polyuria, Prostatitis.

What are common drug classes that can cause urinary incontinence?

Diuretics, anticholinergics, narcotic analgesics, and antidepressants can lead to urinary retention or incontinence.

What factors can contribute to urethral underactivity?

Decreased or inadequate urethral closure can result from compromised musculature of the urethral sphincter or surrounding tissues.

What is the prevalence of urinary incontinence in nursing home residents?

37% in short-stay residents and 70% in long-term residents.

What is the impact of UI on quality of life?

UI can significantly affect daily activities, emotional well-being, and social interactions.

What is the relationship between UI and other medical conditions?

UI is associated with falls, urinary tract infections (UTIs), skin breakdown, sexual dysfunction, and depression.

What is the role of pelvic floor muscles in urinary function?

Pelvic floor muscles support the bladder and urethra, playing a crucial role in urinary continence.

What is the effect of age on urinary flow rate?

Age-related changes can lead to decreased urinary flow rate and increased risk of urinary incontinence.

What are the differences in urinary incontinence between sexes?

There are considerable differences in the causes and treatments of UI between men and women.

What is the significance of bladder emptying?

Complete bladder emptying is essential to prevent urinary retention and associated complications.

What happens to the nervous system signaling once the bladder is empty?

The micturition center sends inhibitory signals to the parasympathetic nervous system and stimulates the sympathetic nervous system.

What is Stress Urinary Incontinence (SUI)?

Characterized by episodic, usually low-volume urinary leakage proportional to physical exertion.

What are common risk factors for SUI in women?

Pregnancy, childbirth, menopause, cognitive impairment, obesity, and aging.

What are common risk factors for SUI in men?

Prior LUT surgery or injury to the sphincter mechanism; TURP is a common cause.

What medications can aggravate SUI?

Alpha-receptor antagonists and ACE inhibitors.

What is Overactive Bladder (OAB)?

A condition characterized by urinary urgency, incontinence, nocturia, and urinary frequency.

What are common identifiable risk factors for OAB?

Normal aging, neurologic diseases (like stroke and Parkinson's), and bladder outlet obstruction.

What drugs can cause or aggravate UUI?

Diuretics, alcohol, and acetylcholinesterase inhibitors.

What are common causes of urethral overactivity in men?

Benign prostatic hyperplasia (BPH) and prostate cancer.

What is bladder underactivity?

Weakening of the detrusor muscle, leading to incomplete voiding and large residual volume.

What drugs can decrease bladder contractility?

Anticholinergics, tricyclic antidepressants, calcium channel blockers, narcotic analgesics, and antipsychotics.

What is functional urinary incontinence?

Inability to reach the toilet in time due to physical or mental impairment, not caused by bladder or urethra-specific factors.

What are common signs and symptoms of Urgency UI?

Frequent urination (>8 times/day), large urine loss (>100 mL), and nocturia (>1 time/night).

What are common signs and symptoms of Stress UI?

Urine leakage during physical activity, lifting, coughing, or sneezing.

What is the most common type of urinary incontinence?

Stress Urinary Incontinence (SUI).

What is the goal of treatment for urinary incontinence?

Restoration of continence, reduction in UI episodes, and improvement in quality of life.

What is the first-line treatment for urinary incontinence?

Nonsurgical, nonpharmacologic interventions.

When is drug therapy considered for urinary incontinence?

When UI is not adequately controlled by nonpharmacological therapies and there are no major contraindications.

What factors should be considered when selecting a pharmacologic agent for UI?

Type of UI and patient characteristics, including comorbidities and current drug therapies.

What is nocturnal enuresis?

Involuntary urination during the night, often associated with OAB.

What is the significance of the detrusor muscle in urinary function?

It is responsible for bladder contraction and expelling urine.

What is the relationship between BPH and urinary incontinence?

BPH can lead to overflow urinary incontinence due to bladder outlet obstruction.

What is the impact of cognitive deficits on urinary incontinence?

They can contribute to functional incontinence by impairing the ability to reach the toilet in time.

What are the symptoms of mixed urinary incontinence?

Symptoms of both stress and urge incontinence may coexist in the same patient.

What is the role of environmental factors in urinary incontinence?

Environmental barriers, such as stairs, can increase the risk of functional incontinence.

What are lifestyle modifications for managing urinary incontinence?

Reducing caffeine and alcohol consumption, decreasing salt intake, smoking cessation, monitoring fluid intake, weight reduction, and increasing exercise.

What is the purpose of scheduling regimens in UI management?

To establish a fixed toileting schedule to help patients manage their incontinence.

What is prompted voiding?

Toileting on a fixed schedule with prompts from a caregiver and positive responses from the patient.

What is habit training in the context of urinary incontinence?

Scheduled toileting with adjustments based on the patient's voiding patterns.

What is biofeedback in pelvic floor rehabilitation?

A technique that provides visual or auditory feedback about neuromuscular bladder activity to teach correct pelvic floor muscle contractions.

What is external neuromodulation?

Application of electric current through electrodes to inhibit bladder overactivity and improve pelvic floor muscle function.

What are some supportive interventions for urinary incontinence?

Toileting substitutes, environmental modifications, and the use of absorbent products.

What is the purpose of surgical interventions in urinary incontinence?

To address secondary complications when nonsurgical therapies are ineffective or undesired.

What are antimuscarinic agents used for?

Second-line treatment for urge urinary incontinence and overactive bladder.

What is the significance of weight reduction in managing urinary incontinence?

It can alleviate pressure on the bladder and improve symptoms.

What is the expected time frame for behavioral interventions to show effectiveness?

8-12 weeks.

What is the role of pelvic floor muscle rehabilitation?

To strengthen the pelvic floor muscles and improve bladder control.

What are some examples of non-implantable electrical stimulation methods?

Handheld stimulators for home use and percutaneous tibial nerve stimulation.

What factors should be considered before surgical treatment of urinary incontinence?

Degree of bother, lifestyle compromise, and patient willingness to accept surgical risks.

What are some common medications used as second-line options for urinary incontinence?

Oxybutynin, Tolterodine, Trospium chloride, Solifenacin, Darifenacin, and Fesoterodine.

What is the purpose of urine collection devices?

To manage urinary incontinence by collecting urine externally.

What are bed or pant alarms used for?

To respond to wetness, primarily for nocturnal enuresis.

What are pessaries used for?

Intravaginal devices designed to support the bladder neck and pelvic floor muscles.

What is the effect of detrusor muscle contraction?

It promotes bladder contraction and urination.

What is the role of the external sphincter during urination?

It contracts to prevent urination.

What happens to the internal sphincter during urination?

It relaxes to allow urine to flow.

What is the goal of urinary incontinence treatment regarding M3 and M1 receptor activity?

To achieve greater M3 receptor activity than M1.

Which muscarinic receptors are primarily involved in urinary incontinence?

M1 and M3 receptors.

What are the characteristics of M1 receptors?

Located in the brain and salivary glands.

Where are M3 receptors located?

In salivary glands, lower bowel, and ciliary smooth muscle.

Name a tertiary amine used to treat urinary incontinence.

Oxybutynin.

What is a key feature of quaternary amines like trospium chloride?

They are hydrophilic and less likely to cross the blood-brain barrier.

What is the primary action of muscarinic antagonists in urinary incontinence?

To antagonize parasympathetic control of the bladder and suppress premature detrusor contractions.

What is a common side effect of anticholinergic medications?

Dry mouth.

What should be avoided when adjusting doses of urinary incontinence medications?

Avoid escalating the dose or abandoning therapy too soon.

What is the significance of receptor selectivity in anticholinergic side effects?

It affects the extent and severity of side effects.

What does 'mad as a hatter' refer to in anticholinergic side effects?

Cognitive impairment and confusion.

What does 'dry as a bone' indicate in terms of side effects?

Dry mouth, constipation, and urinary retention.

What is the mechanism of action of oxybutynin?

It is a muscarinic antagonist that reduces bladder contractions.

What is a common adverse effect of oxybutynin?

Sedation.

What is the initial dose of Oxybutynin IR?

2.5 mg twice daily.

What is the typical range for Oxybutynin XL?

5-30 mg once daily.

What formulation of oxybutynin has a lower incidence of anticholinergic effects?

Patch and gel formulations.

What is the brand name for fesoterodine?

Toviaz.

What is the usual range for fesoterodine ER?

4-8 mg once daily.

What is a notable characteristic of tolterodine?

It is a prodrug metabolized to an active metabolite.

What is the primary elimination route for fesoterodine?

Primarily unchanged in urine.

What is the initial dose for trospium chloride IR?

20 mg twice daily.

Why does trospium not cause CNS side effects despite being non-selective?

It has poor CNS penetration due to its quaternary ammonium structure.

What is a pro-drug?

A drug that is metabolized into an active form that cannot cross the blood-brain barrier (BBB).

What is the effect of a tertiary amine in drug design?

It is charged to facilitate crossing the BBB.

What is the role of a quaternary amine in drug design?

It is charged to prevent crossing the BBB.

What is first-pass metabolism?

The process where a drug is metabolized in the liver before reaching systemic circulation, which can support movement across the BBB.

What is the primary indication for second-generation antimuscarinic agents?

Treatment of overactive bladder (OAB) with urgency incontinence, urgency, and urinary frequency.

What are common adverse effects of second-generation antimuscarinic agents?

Dry mouth, constipation, urinary tract infections (UTI), and blurred vision.

What is the significance of solifenacin in OAB treatment?

It is indicated for OAB and has less dry mouth side effects compared to oxybutynin IR.

What is the initial dose of solifenacin?

5 mg daily.

What should be done if a patient is taking CYP3A4 inhibitors while on solifenacin?

Reduce the dose to 5 mg daily.

What is the usual dose range for darifenacin ER?

7.5-15 mg once daily.

What are the contraindications for antimuscarinic agents?

Narrow angle glaucoma, urinary retention, and gastric retention.

What is the initial dose of mirabegron?

25 mg once daily.