managing genito-urinary problems the role of the pharmacist dr rebekah moles faculty of pharmacy...
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MANAGING GENITO-URINARY
PROBLEMS
THE ROLE OF THE PHARMACIST
Dr Rebekah Moles
Faculty of [email protected]
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URINARY INCONTINENCE
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LECTURE AVAILABLE FROM
http://www.rhef.com.au/programs/program-1/?program_id=135#
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URINARY SYSTEM
http://www.umm.edu/urology-info/images/utract1.gif
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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
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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)
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TYPES OF INCONTINENCE
OVERFLOW(leakage from overfull bladder) poor bladder emptying
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PROSTATE
GLAND
http://www.daviddarling.info/images/prostate_gland.jpg
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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
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Australian Pharmacist: Feb 2003
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MANAGEMENT OF INCONTINENCELIFESTYLE
PELVIC FLOOR EXERCISES
LOOSE EXCESS WEIGHT
DECREASE CAFFEINE
AVOID ALCOHOL
AVOID CONSTIPATION(increase fluids)
BLADDER TRAINING
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MANAGEMENT OF INCONTINENCE
MEDICATIONS
ANTICHOLINERGICS OXYBUTYNIN PROPANTHELINE TOLTERODINE DARIFENACIN SOLIFENACIN TCA’s – IMIPRAMINE / NORTRIPTYLINE / AMITRIPTYLINE
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MANAGEMENT OF INCONTINENCEMEDICATIONS
ANTIDIURETIC HORMONE DESMOPRESSIN
HORMONE REPLACEMENT THERAPY ?(NO)
CHOLINERGICS?
ALPHA AGONISTS?
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MANAGEMENT OF INCONTINENCEMEDICATIONS
ALPHA BLOCKERS ALFUZOSIN PRAZOSIN TAMSULOSIN TERAZOSIN
5-ALPHA-REDUCTASE INHIBITORS FINESTERIDE DUTASTERIDE
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MANAGEMENT OF INCONTINENCEINCONTINENCE AIDS
ABSORBANT PADS AND PANTS
ABSORBENT COVERS (beds and chairs)
CATHETERS
DRAINAGE BAGS
URINARY CONDOMS
ODOUR NEUTRALISERS
ENURESIS ALARMS
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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
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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
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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