2. MANAGING GENITO-URINARY PROBLEMS THE ROLE OF THE PHARMACIST Dr Rebekah Moles Faculty of Pharmacy Rebekah.moles@sydney.edu.au

3. URINARY INCONTINENCE

4. LECTURE AVAILABLE FROM §http://www.rhef.com.au/programs /program-1/?program_id=135#

5. URINARY SYSTEM http://www.umm.edu/urology-info/images/utract1.gif

6. TYPES OF INCONTINENCE §STRESS (small leakage during physical activity) l Weak Pelvic Floor Muscles l Relaxed Sphincter (can be caused by drugs) http://myhealth.ucsd.edu/library/healthguide/en-us/images/media/medical/hw/nr55551951.jpg

7. TYPES OF INCONTINENCE §URGE (loss of urine with strong desire to urinate, unable to get to toilet in time) l Detrussor Overactivity §MIXED (combination of stress and urge)

8. TYPES OF INCONTINENCE §OVERFLOW(leakage from overfull bladder) l poor bladder emptying

9. PROSTATE GLAND http://www.daviddarling.info/images/prostate_gland.jpg

10. TYPES OF INCONTINENCE §NOCTURNAL ENURESIS (Bedwetting) l Detrussor Instability §FUNCTIONAL(inability to reach toilet in time) l Physical Factors l Environmental Factors §REFLEX(spontaneous emptying of bladder with no sensation or control) l Neurological Damage

11. Australian Pharmacist: Feb 2003

12. MANAGEMENT OF INCONTINENCE LIFESTYLE §PELVIC FLOOR EXERCISES §LOOSE EXCESS WEIGHT §DECREASE CAFFEINE §AVOID ALCOHOL §AVOID CONSTIPATION(increase fluids) §BLADDER TRAINING

13. MANAGEMENT OF INCONTINENCE MEDICATIONS §ANTICHOLINERGICS l OXYBUTYNIN l PROPANTHELINE l TOLTERODINE l DARIFENACIN l SOLIFENACIN l TCA’s – IMIPRAMINE / NORTRIPTYLINE / AMITRIPTYLINE

14. MANAGEMENT OF INCONTINENCE MEDICATIONS §ANTIDIURETIC HORMONE l DESMOPRESSIN §HORMONE REPLACEMENT THERAPY ?(NO) §CHOLINERGICS? §ALPHA AGONISTS?

15. MANAGEMENT OF INCONTINENCE MEDICATIONS §ALPHA BLOCKERS l ALFUZOSIN l PRAZOSIN l TAMSULOSIN l TERAZOSIN §5-ALPHA-REDUCTASE INHIBITORS l FINESTERIDE l DUTASTERIDE

16. MANAGEMENT OF INCONTINENCE INCONTINENCE AIDS §ABSORBANT PADS AND PANTS §ABSORBENT COVERS (beds and chairs) §CATHETERS §DRAINAGE BAGS §URINARY CONDOMS §ODOUR NEUTRALISERS §ENURESIS ALARMS

17. Drugs which can Cause Incontinence Type of Drug ExamplesEffects Alcohol Polyuria, frequency, urgency, sedation, AnticholinergicsAntihistamines,TCAs Urinary retention, delirium, constipation, sedation

18. Drugs which can Cause Incontinence Type of Drug ExamplesEffects Diuretics Frusemide, Caffeine Polyuria, frequency, urgency, NarcoticsOpioids Urinary retention, Constipation, Sedation, Delirium Alpha-blockersPrazosin Urethral relaxation

19. Drugs which can Cause Incontinence Type of Drug ExamplesEffects Alpha agonists Pseudoephedrine Increase prostate tone ACE Inhibitors Captopril, Lisinopril Cough