Transcript UROLOGY LECTURES

MANAGING
GENITO-URINARY
PROBLEMS
THE ROLE OF THE PHARMACIST
Dr Rebekah Moles
Faculty of Pharmacy
[email protected]
URINARY INCONTINENCE
LECTURE AVAILABLE FROM
 http://www.rhef.com.au/programs
/program-1/?program_id=135#
URINARY SYSTEM
http://www.umm.edu/urology-info/images/utract1.gif
TYPES OF INCONTINENCE
 STRESS (small leakage during physical activity)
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Weak Pelvic Floor Muscles
http://myhealth.ucsd.edu/library/healthguide/en-us/images/media/medical/hw/nr55551951.jpg
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Relaxed Sphincter (can be caused by drugs)
TYPES OF INCONTINENCE
 URGE (loss of urine with strong desire to
urinate, unable to get to toilet in time)

Detrussor Overactivity
 MIXED (combination of stress and urge)
TYPES OF INCONTINENCE
 OVERFLOW(leakage from overfull bladder)

poor bladder emptying
PROSTATE
GLAND
http://www.daviddarling.info/images/prostate_gland.jpg
TYPES OF INCONTINENCE
 NOCTURNAL ENURESIS (Bedwetting)
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Detrussor Instability
 FUNCTIONAL(inability to reach toilet in time)
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Physical Factors
Environmental Factors
 REFLEX(spontaneous emptying of bladder with
no sensation or control)
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Neurological Damage
Australian Pharmacist: Feb 2003
MANAGEMENT OF INCONTINENCE
LIFESTYLE
 PELVIC FLOOR EXERCISES
 LOOSE EXCESS WEIGHT
 DECREASE CAFFEINE
 AVOID ALCOHOL
 AVOID CONSTIPATION(increase fluids)
 BLADDER TRAINING
MANAGEMENT OF INCONTINENCE
MEDICATIONS
 ANTICHOLINERGICS
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OXYBUTYNIN
PROPANTHELINE
TOLTERODINE
DARIFENACIN
SOLIFENACIN
TCA’s – IMIPRAMINE / NORTRIPTYLINE / AMITRIPTYLINE
MANAGEMENT OF INCONTINENCE
MEDICATIONS
 ANTIDIURETIC HORMONE

DESMOPRESSIN
 HORMONE REPLACEMENT THERAPY ?(NO)
 CHOLINERGICS?
 ALPHA AGONISTS?
MANAGEMENT OF INCONTINENCE
MEDICATIONS
 ALPHA BLOCKERS
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ALFUZOSIN
PRAZOSIN
TAMSULOSIN
TERAZOSIN
 5-ALPHA-REDUCTASE INHIBITORS
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FINESTERIDE
DUTASTERIDE
MANAGEMENT OF INCONTINENCE
INCONTINENCE AIDS
 ABSORBANT PADS AND PANTS
 ABSORBENT COVERS (beds and chairs)
 CATHETERS
 DRAINAGE BAGS
 URINARY CONDOMS
 ODOUR NEUTRALISERS
 ENURESIS ALARMS
Drugs which can Cause Incontinence
Type of Drug
Examples
Polyuria,
frequency,
urgency,
sedation,
Alcohol
Anticholinergics
Effects
Antihistamines,
TCAs
Urinary
retention,
delirium,
constipation,
sedation
Drugs which can Cause Incontinence
Type of Drug
Examples
Diuretics
Frusemide, Caffeine
Narcotics
Opioids
Alpha-blockers
Prazosin
Effects
Polyuria,
frequency,
urgency,
Urinary
retention,
Constipation,
Sedation,
Delirium
Urethral
relaxation
Drugs which can Cause Incontinence
Type of Drug
Examples
Effects
Alpha agonists
Pseudoephedrine
Increase
prostate tone
ACE Inhibitors
Captopril, Lisinopril
Cough