aging beautifully part 2 urinary incontinence
TRANSCRIPT
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We live in a beautiful world.
http://www.flickr.com/photos/thinkoutsidethebox2008/5371059213/
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...where there are many sights to see.
http://www.flickr.com/photos/cubagallery/5104802230/sizes/l/in/photostream/
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…places to visit.
http://www.flickr.com/photos/94123706@N00/183247588/
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… and streets to walk.
http://www.flickr.com/photos/cwazeewabbit/6085377631/sizes/l/in/photostream/
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It’s a good life.
http://www.flickr.com/photos/achua/7135655129/
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but a better life if urinary incontinence was not an issue.
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AgingBeautifully:Visions & Realities
Part II: Urinary Incontinence
http://www.goodlifeguide.net/wp-content/uploads/2012/09/beach-seniors-X-license.jpg
By Christine HortillosaPharm.D. 2013 CandidateUniversity of Texas at Austin College of Pharmacy5. 1. 2013
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Realities.
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1 in 10 Males
4 in 10 Females
UI affects…
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3
QoL12
NOT
COOL
It causes…
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NOT all UI are the same.
Stress UI Urge UI
MixedIncontinence
OverflowIncontinence
FunctionalIncontinence
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NOT all UI are the same.
Stress UI Urge UI
1. Leaking during physical activity
2. Usually small urine amount 3. Nocturia
1. Urgency2. Frequency with urgency 3. Not able to reach toilet4. Large urine amount
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Nonpharmacologic
Pharmacologic
Surgery
How tomanage?
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1
2
3
Nonpharmacologic
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Stress UI
Duloxetine
α- Adrenergic agonist Imipramine
• First line therapy• Dose: 40-80 mg/day• Not FDA approved• ADE diminish over time
• PSE 15-60mg TID • PE 10mg QID
• 25-100mg QHS•Optional
Pharmacologic
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Anticholinergics/ Antispasmodics
Tricyclic Antidepressants Estrogen
• 1st line drug therapy• Oxybutynin or Tolterodine = preferred• Oxybutynin XL 5-30mg Qday• Tolterodine LA 2-4mg Qday• Trospium ER, Solifenacin, Darifenacin,
Fesoterodine
• Imipramine, doxepin, nortriptyline, or desipramine
• 25-100mg QHS• If with depression/neuropathic pain
• Cream, insert, or ring• If with urethritis/
vaginitis
Urge UI
Pharmacologic
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Dry Mouth Constipation Dizziness Vision Disturbance0
20
40
60
80
Oxybutynin IROxybutynin XLOxybutynin TDSOxybutynin GelTolterodineTolterodine LATrospium Cl IRTrospium Cl XRSolifenacinDarifenacinFesoterodine
Adverse Event Incidence Rates of Anticholinergics/Antispasmodics
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..for adverse drug effects and therapy effectiveness.
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http://www.toledoblade.com/image/2012/01/22/800x_b1_cCM_z_cT/pharmacist-bryan-01-23-2012.jpg
Pharmacists are critical in effective urinary incontinence management.
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With your help, they can...
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enjoy a better life…
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..and age Beautifully.
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References1. Rovner ES, Wyman J, Lackner T, GUAY DR. Chapter 94. Urinary
Incontinence. In: Talbert RL, DiPiro JT, Matzke GR, Posey LM, Wells BG, Yee
GC, eds. Pharmacotherapy: A Pathophysiologic Approach. 8th ed. New York:
McGraw-Hill; 2011. http://www.accesspharmacy.com/content.aspx?
aID=7995036. Accessed May 1, 2013.2. Andersson KE. Antimuscarinics for treatment of overactive bladder.
Lancet Neurol 2004;3:46–53.3. Pictures throughout the slide deck: see bottom of individual slide.
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Discussion.