Today I will discuss Urinary Incontinence, the 2nd part of the Aging beautifully series.
The condition affects people of all age groups but the peak incidence in women occur around the age of menopause and in men, with the oldest patient cohorts. Chronic UI is one of the most common reasons cited for institutionalization of the elderly. 4 in 10 females today over the age of 60 and 1 in 10 Males have UI.
Patient with UI have an overall decreased quality of life. Several studies have objectively shown that UI is associated with increased psychological distress and reduced levels of social and personal activities.
OxybutyninDose: IR 2.5-5mg up to QID, XL 5-30mg QDay, Patch 1/wk, Gel 1 sachet/dTolterodineDose: IR 1-2mg BID, LA 2-4mg/d
Pharmacists, we have a role to play… As patient advocates and front-line health care professionals we can educate, recommend better treatment alternatives, ensure their safety, and listen… so someday, our patients can say…
Dance to their hearts content
Aging beautifully part 2 urinary incontinence
We live in abeautifulworld.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 ifurinary incontinencewas not an issue.
AgingBeautifully:Visions & RealitiesPart II: Urinary Incontinencehttp://www.goodlifeguide.net/wp-content/uploads/2012/09/beach-seniors-X-license.jpgBy Christine HortillosaPharm.D. 2013 CandidateUniversity of Texas at Austin College of Pharmacy5. 1. 2013
NOT all UIare the same.Stress UI Urge UIMixedIncontinenceOverflowIncontinenceFunctionalIncontinence
NOT all UIare the same.Stress UI Urge UI1. Leaking during physical activity2. Usually small urine amount3. Nocturia1. Urgency2. Frequency with urgency3. Not able to reach toilet4. Large urine amount
Stress UIDuloxetineα- 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• OptionalPharmacologic
Anticholinergics/ AntispasmodicsTricyclic 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, ordesipramine• 25-100mg QHS• If with depression/neuropathic pain• Cream, insert, or ring• If with urethritis/vaginitisUrge UIPharmacologic