pharmacology: urinary medications

the pharm lecture on the conventional medications used to treat various urinary conditions, mostly urinary incontinence. the medications used to treat incontinence are chosen depending on the type of incontinence: urge incontinence, which is caused by irritation or stimulation of the bladder's detrusor muscle, can be treated by anti-cholinergics such as oxybutynin and tolterodine, as well as an antidepressant imapramine. overflow incontinence, which is caused by retained urine leaking out of the bladder sphincter, is often related to BPH in men and therefore drugs such as tamsulosin and finasteride are used to relax prostate smooth muscle relaxation and prevent synthesis of dihydrotesterone, the hormone responsible for prostate enlargement, respectively. phenazopyridine is a drug that is used to reduce urinary lining irritation, and has the notable side effect of turning urine and tears yellow.

questions
intro...
1. two sets of bladder muscles?
2. best treatment for stress incontinence?
3. what is urge incontinence due to?
4. most common cause of "transient urge incontinence"?
5. urge incontinence plus symptoms of eye pain, muscle weakness would lead one to suspect what condition?

oxybutynin / ditropan...
6. class / mechanism of action?
7. indications?
8. side effects?

tolterodine / detrol...
9. class / mechanism?
10. comparison to oxybutynin?

imapramine / tofranil...
11. class?
12. mechanism?
13. used when for incontinence?
14. increased risk for what mental symptom?
15. overdose fatal due to what? especially in what age group?

overflow incontinence...
16. definition?
17. in men, overflow incontinence related to...
18. how are diabetes mellitus and MS related to overflow incontinence?
19. two categories of drugs that treat [17]? what do they do?

tamsulosin / flomax...
20. class / mechanism?
21. selectivity for...
22. side effect?

finasteride / proscar...
23. indication?
24. mechanism?
25. proscar is also used for...
26. which patient population should not even handle finasteride tablets and why?

cystitis...
27. dipstick findings...
28. urinalysis findings...
29. three common organisms involved in cystitis?
30. drug of choice to treat cystitis?

phenazopyridine / pyridium...
31. indicated for...
32. potential complication if used during infection?
33. side effects?

answers
1. detrusor around bladder wall, bladder sphincter muscles.
2. kegels.
3. involuntary loss of urine due to overactive detrusor.
4. cystitis.
5. MS.

6. anticholinergic (blocks M3 muscarinic receptor) prevents acetylcholine stimulation of detrusor muscle.
7. urge incontinence and hyperhidrosis.
8. dryness, dizziness, diminished sweating.

9. anticholinergic (blocks M2 and M3 muscarinic receptors)
10. marketed as having fewer side effects than oxybutynin, although this is questionable.

11. antidepressant.
12. blocks reuptake of serotonin and NE and diminishes smooth muscle uptake of acetylcholine.
13. during bed time for enuresis.
14. suicidal ideation.
15. heart block, children.

16. pressure from retained urine overcomes bladder sphincter muscles.
17. BPH.
18. both can reduce sensory input from bladder, allowing for overfilling, as well as decreasing neural input to detrusor muscle, allowing for retention.
19. alpha blockers relax smooth muscle, 5-alpha reductase inhibitors inhibit synthesis of dihydrotestosterone.

20. alpha 1 receptor antagonist leads to smooth muscle relaxation.
21. alpha 1 A receptors in prostate, instead of alpha 1 B in blood vessels.
22. possible retrograde ejaculation.

23. functional incontinence.
24. blocks conversion of testosterone into DHT.
25. male pattern baldness.
26. pregnant women-- category X drug that can be absorbed through the skin.

27. positive leukocyte esterase, nitrite, hemoglobin.
28. WBC's, RBC's, bacteria.
29. ecoli, staph, enterococci.
30. TMP-sulfa.

31. irritation of urinary tract lining.
32. analgesic effects may prevent awareness of infection spreading to kidneys.
33. turns urine and tears yellow / orange.