Question

QUESTIONS:

1. What is Urinary Incontinence?

2. Name and define six types of incontinence.

3. What is the physiologic cause and type(s) of incontinence associated with:

a)Benign Prostatic Hypertrophy

b)Uterine prolapse after vaginal delivery

c)Paraplegia after a spinal cord injury

d)cystitis

e)Parknson’s disease

f)Diabetes Mellitus

g)Diabetes Insipidus

4. Describe the class, primary use, and pharmacodynamics of the following drugs in creating incontinence

a)PRAZOSIN

b)CLONIDINE

c)HALOPERIDOL

e)PSEUDOEPHEDRINE

f)ATROPINE

g)PAROXITINE

h)BENZODIAZIPINE

i)CAPTOPRIL

j)ESTROGEN

k)HYDROXYCHLOROQUINE

l)LASIX

5. Some of the antimuscarinics can cross the blood–brain barrier. What are the properties of a drug that would make them more likely to cross the blood–brain barrier?

6. What symptoms could be reported as adverse side effects in a drug that was able to cross the blood–brain barrier?

7. Some of the antimuscarinic agents are metabolised by the cytochrome P450 enzymes. Drawing on your knowledge of these important metabolising enzymes, explain the effect of the cytochrome P450 enzymes

8. List some of the drugs or foods that could interfere with the metabolism of the antimuscarinic agents.

9. Bearing in mind Lorraine’s identification of the most bothersome urinary incontinence symptom, what would be your choice of first-line management for her?

10. With reference to their pharmacological properties, describe how antimuscarinics can lead to the side effects of dry mouth and constipation.

11. Contraindications to the use of antimuscarinic drugs are all of the following except:

a) Glaucoma

b) Myasthenia

c) Bronchial asthma

d) Paralytic ileus and atony of the urinary bladder


12. Adverse peripheral effects, such as loss of accommodation, dry mouth, tachycardia, urinary retention, constipation are related to:

a) Alpha adrenoreceptor blockade

b) Muscarinic cholinoreceptor blockade

c) Supersesitivity of the dopamine receptor d) Dopamine receptor blockade

13. Please create a drug card for:

Oxybutynin

Duloxetine

Imipramine

Answer 1

1.Answer

Urinary incontinence means loss of bladder control that resulted in leaking urine when you cough or sneeze to having an urge to urinatethat's so sudden and strong you don't get to a toilet in time

2. answer

1. Urge incontinence – Due to an overactive bladder

2. Stress incontinence – due to poor closure of the bladder sphincter

3. Overflow incontinence - due to either poor bladder contraction or blockage of the urethra

4. Functional incontinence - due to medications or health problems making it difficult to reach the bathroom

5. Athletic incontinence – Due to frequent exercise in high-impact activities

6. Mixed urinary incontinence – after menopause urethral tissue will demonstrate atrophy with the tissue of the urethra becoming weaker and thinner

3. Answer

1. a)Benign Prostatic Hypertrophy - the enlarged prostate presses against and pinches the urethra. Eventually, the bladder may weaken and lose the ability to empty, leaving some urine in the bladder.

b)Uterine prolapse after vaginal delivery - with pelvic organ prolapse are also diagnosed with urinary incontinence

c)Paraplegia after a spinal cord injury - A spinal cord injury may interrupt communication between the nerves in the spinal cord that control bladder and bowel function and the brain, causing incontinence

d)cystitis - overactive bladder and interstitial cystitis overlap resulted in incontinence

e)Parknson’s disease – Will have a less control on sphincter

f)Diabetes Mellitus - overactive bladder and urge incontinence to decreased bladder sensation and overflow incontinence.

g)Diabetes Insipidus – overflow of dilute urine, over distension is resulted in incontinence

4. Answer

1. a)PRAZOSIN –

clause - anti hypertensives

Use – lowers the high blood pressure

Pharmacodynamics - It has also been used to decrease urinary obstruction and relieve symptoms associated with symptomatic benign prostatic hyperplasia. α₁-Receptors mediate contraction and hypertrophic growth of smooth muscle cells.

b)CLONIDINE

Clause - anti hypertensives

Use- lowers the high blood pressure

Pharmacodynamic – It reduces renal vascular resistance

c)HALOPERIDOL

Clause – Antipsychotic medication

Use- to treat psychotic disorders like schizophrenia

Pharmacodynamics – It increases urinary flow

e)PSEUDOEPHEDRINE

Clause- Nasal decongestants

Use - It reduces tissue hyperemia, edema, and nasal congestion commonly associated with colds or allergies

Pharmacodynamics - Pseudoephedrine has direct- and indirect- sympathomimetic activity and is an effective decongestant in the upper respiratory tract, It may induce stress incontinence due to continuous sneezing and cough

f)ATROPINE

Clause – Anti cholenergic

Use - atropine is used to help keep the heartbeat normal

Pharmacodynamics - Atropine reduces secretions in the mouth and respiratory passages, relieves the constriction and spasm of the respiratory passages, and may reduce the paralysis of respiration, which results from actions of the toxic agent on the central nervous system

g)PAROXITINE

Clause – Anti depressant, serotonin reuptake inhibitor class

Use - used to treat depression, panic attacks, obsessive-compulsive disorder (OCD), anxiety disorders, and post-traumatic stress disorder.

Pharmacodynamics - antidepressant properties induced by selective inhibition of the neuronal high affinity uptake of serotonin

h)BENZODIAZIPINE

Clause – Anti psychotic drug

Use - This is an anxiety-reducing, hypnotic, sedative, and anticonvulsant drug that acts rapidly. It is used to treat panic attacks, insomnia,seizures, restless leg syndrome, and alcohol withdrawal.

Pharmacodynamics - the effect of the neurotransmitter gamma-aminobutyric acid (GABA) at the GABA_A receptor, resulting in sedative, hypnotic (sleep-inducing), anxiolytic (anti-anxiety), anticonvulsant, and muscle relaxant properties.

i)CAPTOPRIL

Clause- Antihypertensives

Use- To lower the blood pressure

Pharmacodynamics- competitive inhibitor of angiotensin-converting enzyme (ACE), the enzyme responsible for the conversion of angiotensin I (ATI) to angiotensin II (ATII). ATII regulates blood pressure and is a key component of the renin-angiotensin-aldosterone system, It inducesincontinence

j)ESTROGEN

Clause - Hormone

Use – Used as hormonal replacement therapy

Pharmacodynamics - Conjugated equine estrogens(Premarin), are used extensively for estrogen replacement therapy and prevention of osteoporosis and cardiovascular disease in postmenopausal women

k)HYDROXYCHLOROQUINE

Clause – Antimalarial

Use – To treat malaria by killing malarial parasite

Pharmacodynamics - In acute attacks of malaria, it interrupts erythrocytic schizogony of the parasite.

l)LASIX

Clause – Anti diuretic

Use – To treat kidney disease and heart failure

Pharmacodynamics – It is a loop diuretic, act on the Na⁺-K⁺-2Cl⁻ symporter (NKCC2) in the thick ascending limb of the loop of Henle to inhibit sodium, chloride and potassium reabsorption.