Aging beautifully part 2 urinary incontinence

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ciehortl

Santé & Médecine Sports

We live in a
beautiful
world.
http://www.flickr.com/photos/thinkoutsidethebox2008/5371059213/

...where there are many sights to see.
http://www.flickr.com/photos/cubagallery/5104802230/sizes/l/in/photostream/

…places to visit.
http://www.flickr.com/photos/94123706@N00/183247588

… and streets to walk.
http://www.flickr.com/photos/cwazeewabbit/6085377631/sizes/l/in/photostream/

It’s a good life.
http://www.flickr.com/photos/achua/7135655129/

but a better life if
urinary incontinence
was not an issue.

Aging
Beautifully:Visions & Realities
Part II: Urinary Incontinence
http://www.goodlifeguide.net/wp-content/uploads/2012/09/beach-seniors-X-license.jpg
By Christine Hortillosa
Pharm.D. 2013 Candidate
University of Texas at Austin College of Pharmacy
5. 1. 2013

1 in 10 Males
4 in 10 Females
UIaffects…

NOT all UI
are the same.
Stress UI Urge UI
Mixed
Incontinence
Overflow
Incontinence
Functional
Incontinence

NOT all UI
are the same.
Stress UI Urge UI
1. Leaking during physical activity
2. Usually small urine amount
3. Nocturia
1. Urgency
2. Frequency with urgency
3. Not able to reach toilet
4. Large urine amount

Nonpharmacologic
Pharmacologic
Surgery
How to
manage?

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

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

0
20
40
60
80
Dry Mouth Constipation Dizziness Vision
Disturbance
Oxybutynin IR
Oxybutynin XL
Oxybutynin TDS
Oxybutynin Gel
Tolterodine
Tolterodine LA
Trospium Cl IR
Trospium Cl XR
Solifenacin
Darifenacin
Fesoterodine
Adverse Event Incidence Rates of Anticholinergics/Antispasmodics

..for adverse drug effects and therapy effectiveness.

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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Dr. Faiza delivers an insightful lecture on the distinguishing characteristics of skeletal, smooth, and cardiac muscles, offering a comprehensive understanding of their histology, physiological anatomy, electrophysiological properties, and contractile mechanisms. Through meticulous tabulation and comparison, she aims to equip learners with a detailed comprehension of the unique features and functionalities of each muscle type. Beginning with a detailed exploration of histological differences, Dr. Faiza outlines key distinctions such as multinucleation in skeletal muscle, mononucleation in smooth and cardiac muscles, and the presence of striations in skeletal and cardiac muscles. She meticulously elucidates the structural arrangement of each muscle type, highlighting their cellular morphology and organization within tissues. Transitioning to physiological anatomy, Dr. Faiza navigates through various aspects including innervation, level of control, initiation of contraction, and modification by hormones. By delineating the role of the somatic nervous system in skeletal muscle control, and contrasting it with the autonomic nervous system's influence on smooth and cardiac muscles, she offers a nuanced understanding of neural regulation in muscle physiology. Furthermore, Dr. Faiza delves into electrophysiological properties, elucidating the mechanisms underlying action potential generation, duration, and ionic basis in each muscle type. Through insightful analysis, she reveals how differences in action potential characteristics contribute to variations in muscle contraction speed, duration, and resistance to fatigue. Finally, Dr. Faiza meticulously examines the contractile mechanisms of skeletal, smooth, and cardiac muscles, shedding light on the sliding filament theory, mechanisms of calcium action, and speed of contraction. By comprehensively comparing these mechanisms, she provides learners with a deep understanding of the intricate processes governing muscle contraction and function. Through engaging presentation and meticulous analysis, Dr. Faiza's lecture serves as a valuable resource for students seeking a thorough understanding of the fundamental differences between skeletal, smooth, and cardiac muscles.

Difference Between Skeletal Smooth and Cardiac Muscles

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These are simplified slides discussing the regulation of cardiac output and venous return. Learning objectives: 1. Comprehend the determinants of cardiac output and factors affecting cardiac output 2. Comprehend the factors affecting stroke volume and heart rate and total peripheral resistance 3. Identify the factors regulating venous return 4. Discuss the causes of high and low output cardiac failure 5. Enlist the functions of veins and recognise the significance of venous reservoirs Study Resources: 1. Chapter 20, Guyton and Hall Textbook of Medical Physiology, 14th edition 2. Chapter 30 and 32, Ganong’s Review of Medical Physiology, 26th edition 3. Chapter 10, Human Physiology by Lauralee Sherwood, 9th edition 4. Physiology, Cardiac Output - StatPearls https://www.ncbi.nlm.nih.gov/books/NBK470455/

Cardiac Output, Venous Return, and Their Regulation

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