MANAGING GENITO-URINARY PROBLEMS THE ROLE OF THE PHARMACIST Dr Rebekah Moles Faculty of Pharmacy...

MANAGING GENITO-URINARY

PROBLEMS

THE ROLE OF THE PHARMACIST

Dr Rebekah Moles

Faculty of PharmacyRebekah.moles@sydney.edu.au

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 INCONTINENCESTRESS (small leakage during physical activity)

Weak Pelvic Floor Muscles

Relaxed Sphincter (can be caused by drugs)

http://myhealth.ucsd.edu/library/healthguide/en-us/images/media/medical/hw/nr55551951.jpg

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 INCONTINENCENOCTURNAL ENURESIS (Bedwetting)

Detrussor Instability

FUNCTIONAL(inability to reach toilet in time) Physical Factors Environmental Factors

REFLEX(spontaneous emptying of bladder with no sensation or control)

Neurological Damage

Australian Pharmacist: Feb 2003

MANAGEMENT OF INCONTINENCELIFESTYLE

PELVIC FLOOR EXERCISES

LOOSE EXCESS WEIGHT

DECREASE CAFFEINE

AVOID ALCOHOL

AVOID CONSTIPATION(increase fluids)

BLADDER TRAINING

MANAGEMENT OF INCONTINENCE

MEDICATIONS

ANTICHOLINERGICS OXYBUTYNIN PROPANTHELINE TOLTERODINE DARIFENACIN SOLIFENACIN TCA’s – IMIPRAMINE / NORTRIPTYLINE / AMITRIPTYLINE

MANAGEMENT OF INCONTINENCEMEDICATIONS

ANTIDIURETIC HORMONE DESMOPRESSIN

HORMONE REPLACEMENT THERAPY ?(NO)

CHOLINERGICS?

ALPHA AGONISTS?

MANAGEMENT OF INCONTINENCEMEDICATIONS

ALPHA BLOCKERS ALFUZOSIN PRAZOSIN TAMSULOSIN TERAZOSIN

5-ALPHA-REDUCTASE INHIBITORS FINESTERIDE DUTASTERIDE

MANAGEMENT OF INCONTINENCEINCONTINENCE AIDS

ABSORBANT PADS AND PANTS

ABSORBENT COVERS (beds and chairs)

CATHETERS

DRAINAGE BAGS

URINARY CONDOMS

ODOUR NEUTRALISERS

ENURESIS ALARMS

Drugs which can Cause IncontinenceDrugs which can Cause Incontinence

Type of DrugType of Drug ExamplesExamples EffectsEffects

AlcoholAlcohol

Polyuria, Polyuria, frequency, frequency, urgency, urgency, sedation, sedation,

AnticholinergicsAnticholinergics Antihistamines, Antihistamines,

TCAsTCAs

Urinary Urinary retention, retention, delirium, delirium,

constipation, constipation, sedationsedation

Drugs which can Cause IncontinenceDrugs which can Cause Incontinence

Type of DrugType of Drug ExamplesExamples EffectsEffects

DiureticsDiuretics Frusemide, CaffeineFrusemide, CaffeinePolyuria, Polyuria,

frequency, frequency, urgency, urgency,

NarcoticsNarcotics OpioidsOpioids

Urinary Urinary retention, retention,

Constipation, Constipation, Sedation, Sedation, DeliriumDelirium

Alpha-blockersAlpha-blockers PrazosinPrazosin Urethral Urethral relaxationrelaxation

Drugs which can Cause IncontinenceDrugs which can Cause Incontinence

Type of DrugType of Drug ExamplesExamples EffectsEffects

Alpha agonistsAlpha agonists PseudoephedrinePseudoephedrine Increase Increase prostate tone prostate tone

ACE InhibitorsACE Inhibitors Captopril, LisinoprilCaptopril, Lisinopril CoughCough