Transcript Drugs and Urinary Incontinence PowerPoint

Drugs and Urinary Incontinence
Cheryl Ritchie R.Ph.,
CGP
Janzen’s Pharmacy
Thunder Bay, ON
Medications and Urinary incontinence
Presentation Outline
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Bladder receptors – Drug activity sites
Drugs contributing to urinary incontinence
Drugs for treatment of urinary incontinence
Alpha Adrenergic Receptors in Bladder
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Stimulation
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Sphincter contraction
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Inhibit urine flow
Block receptors
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Sphincter relaxation
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Allow urine flow
Beta adrenergic receptors in bladder
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Stimulation
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Detrusor muscle
relaxation
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Allows bladder filling
Block receptors
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Detrusor muscle
contraction
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Facilitates bladder
emptying
Muscarinic (M2 & M3 - Cholinergic)
Receptors
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Stimulation
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Detrusor muscle contraction
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Facilitates bladder emptying
Block receptors
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Detrusor muscle relaxation
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Facilitates bladder filling
Medications contributing to
Incontinence
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Stress Incontinence
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Alpha adrenergic blocking agents cause sphincter
relaxation
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Terazosin
doxazosin
ACE inhibitors may cause cough
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Enalapril
Ramipril
Lisinopril
fosinopril
Medications contributing to Urinary
Incontinence
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Urge incontinence due to uncontrolled
bladder contractions or increased urine
output
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Diuretics
Caffeine
Sedative Hypnotics
Medications contributing to urinary
incontinence
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Urinary retention due to decreased bladder
contractions
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Anticholinergics – oxybutynin, scopolamine
Antidepressants – amitriptyline, doxepin
Antipsychotics – chlorpromazine, prochlorperazine
Sedative hypnotics – diazepam, flurazepam
Antihistamines – diphenhydramine, hydroxyzine, chlorpheniramine
Muscle relaxants – baclofen, cyclobenzaprine
Calcium Channel Blockers – diltiazem,nifedipine, verapamil
Antiarrhytmics - quinidine
Antiparkisonian agents – trihexyphenidyl, benztropine
Medications Contributing to Urinary
Incontinence
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Urinary retention due to sphincter contraction
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Alpha adrenergic agonists
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pseudoephedrine
Urinary retention due to detrusor muscle
relaxation
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Beta adrenergic agonists
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Salbutamol
terbutaline
Medications contributing to urinary
incontinence
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If medications are a contributing factor –
consider an alternative medication
If not able to discontinue offending
medication, the lowest possible dose of the
aggravating medication should be used.
Medications to treat urinary
incontinence - goals of treatment
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Decrease uninhibited bladder contractions
Increase functional bladder capacity
Decrease frequency and urgency
Drugs in the management of urinary
incontinence – Points to consider
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Will adding medication improve or complicate
quality of life?
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Drug therapy alone rarely cures elderly
urinary incontinence sufferers.
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Ensure accurate diagnosis prior to choosing
drug therapy
Drugs in treatment of urinary
incontinence – stress incontinence
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Topical estrogens
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Increase sphincter tone
Duloxetine – unlabelled use
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By blocking norepinehrine reuptake may increase
sphincter control
Drugs in the treatment of urinary
incontinence – Urge incontinence
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Oxybutynin - Ditropan
Tolterodine - Detrol
Drugs in the treatment of urinary
incontinence – Urge incontinence
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Adverse effects of oxybutynin & tolterodine
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Dry mouth
Constipation
Dry eyes or blurred vision
Tachycardia
Worsening GERD
Worsening cognitive impairment (especially with
cholinesterase inhibitors)
Drugs in the treatment of urinary
incontinence – Urge incontinence
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Contraindications
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Urinary and gastric retention
Uncontrolled narrow angle glaucoma
Drugs in the treatment of urinary
incontinence – Urge incontinence
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Drug interactions
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Additive effects with other anticholinergic
medications
Tolterodine only (reduce dose)
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Azole antifungals
Cyclosporine
Macrolide antibiotics
Fluoxetine – if possible choose alternative SSRI
Drugs in the treatment of urinary
incontinence – Urge incontinence
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Dosage form availability
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Immediate release tablet
Extended release tablet
Transdermal patch (oxybutynin only)
Dosage form notes
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Short acting may be good choice for occasional
use for special occasions
Long-acting formulation may cause less adverse
effects
Drugs in the treatment of urinary
incontinence – overflow incontinence
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UI associated with benign prostatic
hyperplasia
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Alpha adrenergic antagonists
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Terazosin, doxazosin
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Non-selective – monitor for hypotension especially with
first dose
alfuzocin, tamsulosin
5-alpha reductase inhibitors
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Finasteride, dulasteride
Drugs in the management of urinary
incontinence – Points to consider
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Several weeks of drug therapy are usually
required to achieve maximum effect
If no subjective improvement in 4-6 weeks,
consider
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Increase dose
Change medication
Discontinue medication