Incontinence Medications

Pseudophedrine, phenylephrine and midodrine are?

alpha-adrenergic agonists

What is the MOA for alpha adrenergic agonists?

increase bladder outlet resistance by contracting the bladder neck (where there is a high concentration of receptors that are sensitive to alpha-agonists)

What are alpha adrenergic agonists used to treat?

stress incontinence

What are the CI for pseudophedrine?

severe HTN with severe CAD

cannot be used if MAOI was used within the last 14 days

What is a box warning for midodrine?

may cause marked elevation of supine BP

Anticholinergics and antimuscarinic agents are first line therapy for which type of incontinence?

urge

What are the 5 anticholinergics and antimuscarinics?

tolterodine

fesoterodine

trospium

solifenacin

darifenacin

What is the method of action for anticholinergic antimuscarinics?

inhibit binding of ACh suppressing involuntary bladder contraction

increase the urine volume at which first involuntary bladder contraction occus

decrease the amplitude of the involuntary bladder contraction

increase bladder capacity

What are the AE of anticholinergics and antimuscarinic agents?

blurred vision

dry mouth

heart palpitations

drowsiness

facial flushing

What is a complication of excess anticholinergic drugs?

urinary retention

What are the CI of anticholinergic and antimuscarinic agents?

narrow angle glaucoma

urinary retention

bowel obstruction

ulcerative colitis

myasthenia gravis

severe heart disease

What is the MOA for darifenacin?

elicits competitive muscarinic receptor antagonist activity which reduces smooth muscle contractions

Darifenacin has a high affinity for which type of receptors?

M3 receptors involved in bladder, GI smooth muscle contraction and iris sphincter function

What are the AEs of darifenacin and solifenacin ?

dry mouth

constipation

What is important about patient education with darifenacin and solifenacin?

do not chew, divide or crush

What is the MOA of solifenacin?

competitive muscarinic antagonist activity which results in anticholinergic effects and inhibition of bladder smooth muscle contraction

How does Tolterodine different from other anticholinergic and antimuscarinic agents?

it has a selectivity for urinary bladder over salivary glads

What is an AE of tolterodine, trospium chloride and fesoterodine?

dry mouth

Tolterodine and fesoterodine work by?

competitive muscarinic receptor antagonist that causes decreased bladder smooth muscle contractions

What is the mOA of trospium chloride?

elicits antispasmodic and antimuscarinic affects

antagonizes ACh effect

parasympathetic effect reduces smooth muscle tone in bladder

Oxybutynin chloride is what type of drug?

muscarinic antagonist

What is the MOA of muscarninc antagonists? What is its effects?

relax the smooth muscles of the urinary bladder

increase bladder capacity and decrease or eliminate urge incontinence

What are the AE of muscarinic antagonists?

impair the ability to perform activities requiring mental alertness and physical coordination

Is oxybutynin chloride a better anticholinergic or antispasmodic in comparison to atropine?

antispasmodic

What is CI with muscarinic antagonists?

alcohol

other antispasmodic drugs

What is oxybutynin chloride used for?

overactive uninhibited neurogenic or reflex neurogenic bladder

If a patient has OAB due to spina bifida what is the best pharmacological treatment?

oxybutynin chloride

What are the CIs of oxybutynin chloride?

uncontrolled narrow angle glaucome

gastric or urinary obstruction or retention

paralytic ileus

severe ulcerative colitis

What are the relative contraindication of oxybutynin chloride?

myasthenia gravis

tachycardia secondary to cardiac insufficiency or thyrotoxicosis

Flavoxate is what type of medication?

antispasmodic

What is the MOA of flavoxate?

direct relaxant effect on smooth muscles via phosphodiesterase inhibition

What are the contraindications for flavoxate?

obstructive uropathy

pyloric/duodenal obstruction

ileus

GI bleeding

achalasia

Duloxetine is a?

SNRI

What is the MOA of Duloxetine?

inhibitor of neuronal serotonin and norepinephrine reuptake

What are SNRIs used to treat?

stress incontinence

What is the box warning for duloxetine?

suicidal thoughts and behaviors

What are the CI for duloxetine?

MAOIs

What are the AEs of duloxetine?

nausea

dry mouth

headache

somnolence

fatigue

What is the MOA of conjugated estrogens?

increase tone of urethral muscle by increasing the response of alpha adrenergic receptors in the surrounding area

enhance alpha adrenergic contractile response to strengthen the pelvic muscles

What are conjugated estrogens used for?

stress incontinence

What is the most effect treatment in post menopausal women with mild to moderate UI?

conjugated estrogens

Premarin is a? What is it used for?

conjugated estrogen used for postmenopausal women with stress or mixed incontinence

Imipramine hydrochloride and amitriptyline hydrochloride?

Tricyclic antidepressants

What is the MOA of imipramine hydrochloride?

helps urine storage by decreasing bladder contractility and increasing outlet resistance

has an alpha adrenergic effect on the bladder neck

antispasmodic effect on the detrusor muscle

local anesthetic effect on bladder mucosa

What is the box warning with tricyclic antidepressants?

increase risk of suicidal thinking in less than 24 years old

MOA of amitriptyline hydrochloride?

increases the circulating levels or norepinephrine and serotonin by blocking their re uptake at nerve endings

What is amitriptyline hydrochloride used for?

urinary frequency in women with pelvic flood muscle spasms

Tamsulosin, alfuzosin, silodosin, and prazosin are?

alpha 1 adrenergic antagonist

What is the MOA for tamsulosin?

blocking 1A adrenorecptors which leads to relaxation of smooth muscle in the bladder neck and prostate

What are the indications for tamsulosin?

BPH

ureteral stones

bladder outlet obstruction symptoms

What are the AE of tamsulosin?

orthostatic hypotension

headache

dizziness

ED

rhinitis

What is the use for BOTOX?

adults with OAB symptoms who cannot use or do not adequately respond to anticholinergic meds

How is BOTOX administered?

100 units given using cystoscopy

inserted into the detrusor muscle (2mm)

30 injections equally spaced 1 cm apart

What are the complications of BOTOX?

increased post void residual (may require intermittent cath)

What is the MOA of BOTOX?

prevents ACh release from the presynaptic cleft

What are the AE of BOTOX?

UTI

residual urine volume

urinary retention

somnolence and sedation

dizziness

urinary retention

What is the box warning for BOTOX?

produce symptoms consistent with botulinum toxin effects

What drugs are beta 3 agonists?

mirabegron

What is the MOA of mirabegron?

relaxation of the detrusor smooth muscle of the urinary bladder and increases bladder capacity

What are the indications for mirabegron?

urge incontinence

What can mirabegron be combined with?

solifenacin (antimuscarinic)

What is the onset for mirabegron?

must wait 8 weeks to see full effect

What are the AE of mirabegron?

elevated BP

UTI

headache

fatigue

diarrhea

What are the CI for mirabegron?

severe uncontrolled BP

What type of drug is bethanechol and what is the MOA?

muscarinic agonists

stimulates parasympathetic receptors to increase bladder muscle tone

What are the uses for bethanechol?

urinary retention

neurogenic bladder (off label)

What are the CI for bethanechol?

heart disease

asthma

Bethanechol should never be given?

IV or IM because of life threatening cardiovascular and GI reactions

What are the AE of bethanechol?

SLUDGE

flushing

bronchoconstriction

What are the PDE 5 inhibitors?

tadalafil

What is tadalafil used for?

BPH

What is the mOA of tadalafil?

PDE-5 mediated reduction in smooth muscle and endothelial cell proliferation

decreased nerve activity

increased smooth muscle relaxation and tissue perfusion of the prostate and bladder

What are the AE of tadalafil?

flushing

headache

nausea

dyspesia

What do you need to monitor with tadalafil?

BP

What meds are CI with tadalafil?

nitrates

A post void catheterization showing a large residual volume suggests what type of incontinence?

overflow

overflow incontinence is caused by?

inappropriate contraction or sensation of the detrusor muscle during bladder filling

What medications are best to treat overflow incontinence if caused by BPH or under activity of the detrusor muscle?

PDE 5 inhibitors (tadalafil)

alpha blockers for BPH (tamsulosin)

5 alpha reductase inhibitors

Which drug classes increase bladder outlet resistance. to improve symptoms of stress incontinence?

estrogen

tricyclic agents

alpha adrenergic agonists (pseudophedrine, phenylephrine, midodrine)