DOCSLIB.ORG

Urinary Incontinence

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Urinary Incontinence 10/19/2015 Faculty Urinary Incontinence: Pathophysiology, Jacqueline Giddens, MSN, RN Assessment and Nurse Consultant Treatment Options Bureau of Home & Community Services Nancy Bishop, RPh Satellite Conference and Live Webcast Assistant State Pharmacy Director Wednesday, October 21, 2015 2:00 – 4:00 p.m. Central Time Alabama Department of Public Health Produced by the Alabama Department of Public Health Video Communications and Distance Learning Division Objectives Objectives • Define urinary incontinence (UI) • Discuss pharmaceutical • Describe pathophysiology and management of various types of UI clinical presentation of common • Discuss basic management options types of UI for UI symptoms and causes of UI • Discuss common medications that affect UI Urinary Incontinence Micturation • UI is the involuntary leakage of urine • Complex function • Two times more common in • Continence is voluntary women than men • Estimated one - third of women over the age of 60 are incontinent 1 10/19/2015 Causes of Urinary Incontinence • Problem with nervous system • Weakness of the muscles Medications Linked to Urinary Incontinence • Blockage of the urethra Medications That Cause Medications That Cause Urinary Incontinence Urinary Incontinence • Medications that may be associated – Estrogen replacement with urinary incontinence include the – Beta - mimetics following: – Sedatives – Cholinergic or anticholinergic drugs – Muscle relaxants – Alpha - blockers – Diuretics – Over - the - counter – Angiotensin - converting enzyme allergy medications (ACE) inhibitors Medications Linked to Medications Linked to Urinary Incontinence Urinary Incontinence • Alpha blocker anti - hypertensives: • Antidepressants: Amitriptyline, Cardura, Minipres, Hytrin desipramine, nortripyline – While improving symptoms of BPH – Impairs ability of bladder to contract, in men, these medications relax causing the bladder to not empty the muscles in the bladder of completely women causing an increase in • Diuretics: Furosemide and thiazides severity of incontinence symptoms – Increase in amount of urine, worsening incontinence symptoms 2 10/19/2015 Medications Linked to Medications Linked to Urinary Incontinence Urinary Incontinence • Sedatives and Sleeping pills: • Angiotensin - converting enzyme Patients do not wake up when (ACE) inhibitors: benazepril, bladder if full captopril • Estrogens and progestin – Can cause cough and worsen combination therapy: Increased stress incontinence risk of developing urinary incontinence in women with history of cardiovascular disease Medications Linked to Medications Linked to Urinary Incontinence Urinary Incontinence • Calcium channel blockers: diltiazem, • Antipsychotics: Haloperidol, verapamil resperidone, thioridazine, – Interfere with bladder contraction theothixene and worsen constipation, causing – Slows mobility and causes abrupt urine to be retained in the bladder urge followed by uncontrollable loss of urine Medications Linked to Medications Linked to Urinary Incontinence Urinary Incontinence • Opioids: Morphine • H-1 antagonists: Diphenhydramine – Interferes with bladder contraction and Chlopheniramine and worsens constipation, causing – Significant degree of retention of urine anticholinergic effects • Alpha agonists: Pseudoephedrine – Tightens the urinary spincter causing urine to be retained in the bladder 3 10/19/2015 Medications Linked to Medications Linked to Urinary Incontinence Urinary Incontinence • Cholinergics: Bethanechol • Pregabalin (Lyrica): Reported in – Treatment for urinary retention clinical trials – • Donepezil (Aricept): Reported in Cause unknown clinical trials • Baclofen (Lioresal): With intrathecal – Cause unknown use • Caffeine and alcohol – Increase urine production Types of UI Stress Incontinence • Stress • Stress Incontinence (SI): • Urge – Leakage that occurs when • Overflow laughing, sneezing, coughing, lifting heavy objects, or exerting • Functional other pressure on the bladder – Urine leaks as result if increased pressure on the bladder and weak muscles in the pelvic floor Stress Incontinence Causes Stress Incontinence • Weak pelvic floor muscles • Affects both men and women • Weak urethral sphincter – In women, may follow childbirth • Childbirth or menopause – • Obesity In men, may follow prostate cancer treatment, such as radical • Prostate disease or surgery prostatectomy • Medications 4 10/19/2015 Urgency Incontinence Urgency or OAB • Urgency Incontinence or Over • Bladder spasms resulting in urinary Active Bladder (OAB): frequency – Loss Urgent need to pass urine • Sudden urges to go to the bathroom and the inability to get to a toilet • Having to get up at night to go to the in time bathroom • Mobility limitations Overflow Incontinence Overflow Incontinence • Overflow Incontinence is when the • Causes of overflow incontinence: bladder does not empty properly and – Weak bladder muscles there is a slow leak, often a constant – Blockage of the urethra, such as drip or flow of urine by prostate enlargement • Often seen in men with prostate – Medical conditions, such as symptoms tumors, that cause obstruction of urine flow Overflow Incontinence Overflow Incontinence – Constipation – Parkinson’s Disease – Pelvic trauma – Polio – Pelvic organ prolapse (women) – Other Neurological disorders – Enlarged prostate (men) – Spinal Cord injury – MS 5 10/19/2015 Functional Incontinence Causes of • The inability to hold urine due to Functional Incontinence Factors that Can Cause a Person Not reasons other than neuro - urologic to Get to the Bathroom in Time and lower urinary tract dysfunction • Physical • Functional Incontinence is when a – Arthritis person has normal functioning – bladder, but is unable to physically Muscle weakness or mentally get to the bathroom to – Stroke urinate – Muscular disease Causes of Causes of Functional Incontinence Functional Incontinence Factors that Can Cause a Person Not Factors that Can Cause a Person Not to Get to the Bathroom in Time to Get to the Bathroom in Time • Cognitive • Cognitive – Dementia – Stroke – Alzheimer’s Disease – Mentally Challenged – Parkinson’s Disease – Brain Injury Mixed Incontinence Mixed Incontinence • Common • Treatment may be a combination of • Symptoms of both stress and the treatments listed for stress or urgency incontinence are present urgency incontinence • • Symptoms of one type of Treatment may be directed to the incontinence may be more severe symptoms which are the most than the other bothersome to the patient 6 10/19/2015 Anti - Cholinergic Agents Anti - Muscarinic or Muscarinic Receptor Antagonists Pharmaceutical • Treatment of urinary incontinence Management of • First line drug therapy Urinary Incontinence • Patients with more severe symptoms typically receive greater benefit Anti - Cholinergic Agents Muscarinic Receptor Anti - Muscarinic or Muscarinic Antagonists Receptor Antagonists • Mechanism of action: • May decrease dose or try another – Depress voluntary and involuntary medication if patient has inadequate bladder contractions response or intolerable adverse – Decrease in detrusor muscle effects pressure – Targets M ₂₂₂ and M ₃₃₃ receptors in the detrusor muscle Muscarinic Receptor Muscarinic Receptor Antagonists Antagonists – M₃₃₃ receptors are primarily • Adverse effects: – Dry / itchy eyes responsible for bladder function – Dry mouth* – Dyspepsia and direct contraction of the – Blurred vision – Urinary retention detrusor muscle – Constipation* – Decreased cognitive function *Most common 7 10/19/2015 Muscarinic Receptor Muscarinic Receptor Antagonists Antagonists • Extended release formulations may • Absolute contraindications have lower incidence of dry mouth include closed angle glaucoma, • Caution in patients with narrow angle gastroparesis, GI obstruction, glaucoma, impaired gastric emptying pyloric stenosis, and urinary or urinary retention retention Muscarinic Receptor Muscarinic Receptor Antagonists Antagonists • Interaction with CYP3A4 inhibitors: – Associated with dose - dependent – Increased anticholinergic effects prolongation of the QT interval with medications such as • Avoid in patients at risk for fluconazole and ketoconazole Torsades de pointes • Constipation, dry eyes, – Dose adjustment recommended dry mouth with strong CYP34A inhibitors Muscarinic Receptor Muscarinic Receptor Antagonists Antagonists • Darifenacin (Enablex) • Solifenacin succinate (Vesicare, • Fesoterodine (Toviaz) YM905) • • Flavozate (Urispas) Tolterodine (Detrol, Detrol LA) • • Oxybutynin (Ditropan tablets, Oxytrol Trospium (Sanctura, Sanctura XR) Transdermal Patch, Gelnique Gel) 8 10/19/2015 Muscarinic Receptor Muscarinic Receptor Antagonists Antagonists • Fesoterodine (Toviaz) – Level 2 drug interaction: – Indications: Overactive Bladder, Itraconazole, a potent CYP3A4 Urinary Incontinence, Urinary inhibitor which increases level of Urgency Toviaz, thereby increasing risk of adverse effects – Dose: Initially 4 mg by mouth daily – Interaction may be exaggerated in • May increase to 8 mg if not patients with renal or hepatic taking potent CYP3A4 inhibitor dysfunction Muscarinic Receptor Muscarinic Receptor Antagonists Antagonists • Darifenacin (Enablex) – Dose: Initially 7.5 mg by mouth – Indications: Overactive Bladder, daily Urinary Incontinence • May increase to 15 mg if not – In theory, has fewer anti - muscarinic taking potent CYP3A4 inhibitor side effects than others because of – Level 2 drug interaction: greater affinity for M ₃₃₃ receptors Conivaptan (Vaprisol), a CYP34A inhibitor Muscarinic Receptor Muscarinic Receptor
Load more

Recommended publications
  • The National Drugs List
    ^ ^ ^ ^ ^[ ^ The National Drugs List Of Syrian Arab Republic Sexth Edition 2006 ! " # "$ % &'() " # * +$, -. / & 0 /+12 3 4" 5 "$ . "$ 67"5,) 0 " /! !2 4? @ % 88 9 3: " # "$ ;+<=2 – G# H H2 I) – 6( – 65 : A B C "5 : , D )* . J!* HK"3 H"$ T ) 4 B K<) +$ LMA N O 3 4P<B &Q / RS ) H< C4VH /430 / 1988 V W* < C A GQ ") 4V / 1000 / C4VH /820 / 2001 V XX K<# C ,V /500 / 1992 V "!X V /946 / 2004 V Z < C V /914 / 2003 V ) < ] +$, [2 / ,) @# @ S%Q2 J"= [ &<\ @ +$ LMA 1 O \ . S X '( ^ & M_ `AB @ &' 3 4" + @ V= 4 )\ " : N " # "$ 6 ) G" 3Q + a C G /<"B d3: C K7 e , fM 4 Q b"$ " < $\ c"7: 5) G . HHH3Q J # Hg ' V"h 6< G* H5 !" # $%" & $' ,* ( )* + 2 ا اوا ادو +% 5 j 2 i1 6 B J' 6<X " 6"[ i2 "$ "< * i3 10 6 i4 11 6! ^ i5 13 6<X "!# * i6 15 7 G!, 6 - k 24"$d dl ?K V *4V h 63[46 ' i8 19 Adl 20 "( 2 i9 20 G Q) 6 i10 20 a 6 m[, 6 i11 21 ?K V $n i12 21 "% * i13 23 b+ 6 i14 23 oe C * i15 24 !, 2 6\ i16 25 C V pq * i17 26 ( S 6) 1, ++ &"r i19 3 +% 27 G 6 ""% i19 28 ^ Ks 2 i20 31 % Ks 2 i21 32 s * i22 35 " " * i23 37 "$ * i24 38 6" i25 39 V t h Gu* v!* 2 i26 39 ( 2 i27 40 B w< Ks 2 i28 40 d C &"r i29 42 "' 6 i30 42 " * i31 42 ":< * i32 5 ./ 0" -33 4 : ANAESTHETICS $ 1 2 -1 :GENERAL ANAESTHETICS AND OXYGEN 4 $1 2 2- ATRACURIUM BESYLATE DROPERIDOL ETHER FENTANYL HALOTHANE ISOFLURANE KETAMINE HCL NITROUS OXIDE OXYGEN PROPOFOL REMIFENTANIL SEVOFLURANE SUFENTANIL THIOPENTAL :LOCAL ANAESTHETICS !67$1 2 -5 AMYLEINE HCL=AMYLOCAINE ARTICAINE BENZOCAINE BUPIVACAINE CINCHOCAINE LIDOCAINE MEPIVACAINE OXETHAZAINE PRAMOXINE PRILOCAINE PREOPERATIVE MEDICATION & SEDATION FOR 9*: ;< " 2 -8 : : SHORT -TERM PROCEDURES ATROPINE DIAZEPAM INJ.
    [Show full text]
  • Updatirg the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults
    Updatirg the BeersCriteria for Potentially InappropriateMedication Use in Older Adults Resultsof a US ConsensusPanel of Experts DonnaM.Fich,PhD,RN;lamesW.Cooper,PhD,RPh;WilliamE.Wade,PhannD,FASHP,FCCP; JenniJerL. Waller, PhD;J, RossMaclean, MD; Marh H. Beers,MD Bcckground: Medication toxic effectsand drug- Reruhr: This study identified 48 individual medica- relatedproblems can have profound medical and safety tions or classeso[ medicationsto avoid in older adults consequencesfor older adults and economically affect the and their potential concernsand 20 diseases/conditions health caresystem. The purpose of this initiative was to and medicationsto be avoidedin older adultswith these reviseand update the Beerscriteria for potentially inap- conditions.Of thesepotentially inappropriate drugs, 66 propriate medicationuse in adults 65 yearsand older in wereconsidered by the panelto haveadverse outcomes the United States. of high severity. lYlcthcdr: This study used a modified Delphi method, a Concludonr: This study is an importantupdate of pre- setof proceduresand methodsfor formulating a groupjudg- viously establishedcriteria that have been widely used ment for a subject matter in which precise information is and cited. The application of the Beerscriteria and other Iacking. The criteria reviewed covered 2 types of state- tools for identifying potentially inapproprlate medica- ments: (l) medicationsor medicationclasses that should tion use will continue to enableproviders to plan inter- grnerally be avoidedin persons 65 years or older because
    [Show full text]
  • Urinary Antispasmodics TCO 02.2018
    Therapeutic Class Overview Urinary antispasmodics INTRODUCTION • Overactive bladder (OAB) is defined as urinary urgency, with or without urge incontinence, usually with frequency and nocturia, in the absence of a causative infection or pathological conditions. Urinary incontinence has been shown to greatly reduce quality of life in areas such as mental and general health in addition to physical and social functioning (American Urological Association 2019, Coyne et al 2008, Haab 2014, International Continence Society 2015). Children with OAB usually have detrusor overactivity as diagnosed through cystometric evaluation. Neurogenic detrusor overactivity is predominantly caused by a congenital neural tube defect in children (Austin et al 2016, Franco ○ et al 2020). • Behavioral therapies (eg, bladder training, bladder control strategies, pelvic floor muscle training and fluid management) are considered first-line treatment in all patients with OAB (American Urological Association 2019). • Urinary antispasmodics are used as first-line pharmacological therapy in OAB (American College of Obstetricians and Gynecologists 2015, American Urological Association 2019, Blok et al 2020, Burkhard et al 2018). Anticholinergic therapy has been frequently used in patients with neurogenic detrusor overactivity, but there are limited data in this specific population (Haab 2014). • The○ urinary antispasmodics used for the treatment of OAB belong to 2 classes of drugs, which include anticholinergic compounds known as muscarinic receptor antagonists, and the beta-3 adrenergic agonist (AR), mirabegron. The anticholinergic agents act as antagonists of acetylcholine at muscarinic cholinergic receptors, thereby relaxing smooth muscle in the bladder and decreasing bladder contractions. ○ . Oral immediate-release (IR) and extended-release (ER) formulations (LA, XL, and XR) are available for oxybutynin (Ditropan), tolterodine (Detrol), and trospium.
    [Show full text]
  • Pharmacological and Ionic Characterizations of the Muscarinic Receptors Modulating [3H]Acetylcholine Release from Rat Cortical Synaptosomes’
    0270.6474/85/0505-1202$02.00/O The Journal of Neuroscience CopyrIght 0 Society for Neuroscrence Vol. 5, No. 5, pp. 1202-1207 Printed in U.S.A. May 1985 Pharmacological and Ionic Characterizations of the Muscarinic Receptors Modulating [3H]Acetylcholine Release from Rat Cortical Synaptosomes’ EDWIN M. MEYER* AND DEBORAH H. OTERO Department of Pharmacology and Therapeutics, University of Florida School of Medicine, Gainesville, Florida 32610 Abstract brain (Gonzales and Crews, 1984). M,-receptors, however, appear pre- and postsynaptically in brain, are regulated by an intrinsic The muscarinic receptors that modulate acetylcholine membrane protein that binds to GTP (g-protein), and may not be release from rat cortical synaptosomes were characterized coupled to changes in phosphatidylinositol turnover. with respect to sensitivity to drugs that act selectively at M, The present studies were designed to determine whether M,- or or Ma receptor subtypes, as well as to changes in ionic Mp-receptors mediate the presynaptic modulation of ACh release. strength and membrane potential. The modulatory receptors These studies involve dose-response curves for the release of appear to be of the M2 type, since they are activated by synaptosomal [3H]ACh in the presence of selected muscarinic ago- carbachol, acetylcholine, methacholine, oxotremorine, and nists and antagonists, as well as treatments that selectively alter MI- bethanechol, but not by pilocarpine, and are blocked by or M,-receptor activity. Our results indicate that the presynaptic atropine, scopolamine, and gallamine (at high concentra- modulation of [3H]ACh release is mediated by MP- but not MI- tions), but not by pirenzepine or dicyclomine.
    [Show full text]
  • Printed Formulary Catalog Basic
    Scripps Health Formulary July 2016 Foreword Pharmacy and Therapeutics Committee. MedImpact approves such multi- This document represents the efforts of the MedImpact Healthcare Systems source drugs for addition to the MAC list based on the following criteria: Pharmacy and Therapeutics (P & T) and Formulary Committees to provide physicians A multi-source drug product manufactured by at least one (1) nationally and pharmacists with a method to evaluate the safety, efficacy and cost-effectiveness marketed company. of commercially available drug products. A structured approach to the drug selection At least one (1) of the generic manufacturer’s products must have an “A” process is essential in ensuring continuing patient access to rational drug therapies. rating or the generic product has been determined to be unassociated with The ultimate goal of the Portfolio Formulary is to provide a process and framework to efficacy, safety or bioequivalency concerns by the MedImpact P & T support the dynamic evolution of this document to guide prescribing decisions that Committee. reflect the most current clinical consensus associated with drug therapy decisions. Drug product will be approved for generic substitution by the MedImpact P & T Committee. This is accomplished through the auspices of the MedImpact P & T and Formulary Committees. These committees meet quarterly and more often as warranted to ensure This list is reviewed and updated periodically based on the clinical literature and clinical relevancy of the Formulary. To accommodate changes to this document, pharmacokinetic characteristics of currently available versions of these drug updates are made accessible as necessary. products. As you use this Formulary, you are encouraged to review the information and provide If a member or physician requests a brand name product in lieu of an approved your input and comments to the MedImpact P & T and Formulary Committees.
    [Show full text]
  • Toviaz) Reference Number: ERX.ST.16 Effective Date: 09.01.17 Last Review Date: 08.17 Line of Business: Commercial [Prescription Drug Plan] Revision Log
    Clinical Policy: Fesoterodine (Toviaz) Reference Number: ERX.ST.16 Effective Date: 09.01.17 Last Review Date: 08.17 Line of Business: Commercial [Prescription Drug Plan] Revision Log See Important Reminder at the end of this policy for important regulatory and legal information. Description Fesoterodine (Toviaz®) is a muscarinic antagonist. FDA approved indication Toviaz is indicated for the treatment of overactive bladder with symptoms of urge urinary incontinence, urgency, and frequency. Policy/Criteria Provider must submit documentation (which may include office chart notes and lab results) supporting that member has met all approval criteria It is the policy of health plans affiliated with Envolve Pharmacy Solutions™ that Toviaz is medically necessary when the following criteria are met: I. Initial Approval Criteria A. Step Therapy for Toviaz (must meet all): 1. Age ≥ 18 years; 2. Previous use of 2 formulary generic overactive bladder agents, each trialed for 30 days, unless all are contraindicated or clinically significant adverse effects are experienced; 3. Previous use of Myrbetriq and Vesicare, each trialed for 30 days, unless both are contraindicated or clinically significant adverse effects are experienced; 4. One of the aforementioned trials occurred within the past 6 months, unless all are contraindicated or clinically significant adverse effects are experienced; 5. Dose does not exceed 8 mg per day (1 tablet per day). Approval duration: 12 months II. Continued Therapy A. Step Therapy for Toviaz (must meet all): 1. Currently receiving medication via a health plan affiliated with Envolve Pharmacy Solutions or member has previously met initial approval criteria; 2. If request is for a dose increase, new dose does not exceed 8 mg per day (1 tablet per day).
    [Show full text]
  • Fesoterodine
    PATIENT & CAREGIVER EDUCATION Fesoterodine This information from Lexicomp® explains what you need to know about this medication, including what it’s used for, how to take it, its side effects, and when to call your healthcare provider. Brand Names: US Toviaz Brand Names: Canada Toviaz What is this drug used for? It is used to treat an overactive bladder. It is used in some children to treat a bladder problem called neurogenic detrusor overactivity (NDO). What do I need to tell my doctor BEFORE I take this drug? If you are allergic to this drug; any part of this drug; or any other drugs, foods, or substances. Tell your doctor about the allergy and what signs you had. If you have any of these health problems: Glaucoma, liver problems, kidney problems, constipation, slow emptying of the stomach, or trouble passing urine. If you take any other drugs (prescription or OTC, natural products, vitamins). There are many drugs that interact with this drug, like certain drugs that are used for HIV, infections, or seizures. Fesoterodine 1/6 This is not a list of all drugs or health problems that interact with this drug. Tell your doctor and pharmacist about all of your drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for you to take this drug with all of your drugs and health problems. Do not start, stop, or change the dose of any drug without checking with your doctor. What are some things I need to know or do while I take this drug? Tell all of your health care providers that you take this drug.
    [Show full text]
  • Supplemental Table 1: Patient Characteristics, Interventions and Definitions/Variables of Persistence, Adherence and Discontinuation Reported in the Studies
    Adherence and persistence to OAB medication Supplemental Table 1: Patient characteristics, interventions and definitions/variables of persistence, adherence and discontinuation reported in the studies. Author (year) and Definition of persistence/adherence/discontinuation and Length of country (database) Participants Drug/intervention* independent variables on persistence follow-up Brostrøm and Hallas n=2477 Any prescription of OAB Patients who continued taking a particular drug for up to 7 years with Up to 7 (2009)1 Male: n=836 (33.8%) medication: no more than 120-day gaps were regarded as experiencing single- years Odense University Female: n=1641 (66.2%) flavoxate (n=21) treatment episodes Pharmacoepidemio- Mean age: 68.3 yearsa oxybutynin TD (n=48) logical Database tolterodine (n=1478) Variables: age, gender, prior use of OAB agents and use of (OPED); Denmark) solifenacin (n=774) anti-diabetic drugs (1999–2006) trospium (n=271) darifenacin (n=52) Chancellor et al (2013)2 n=103 250 First (new) prescription of OAB To be considered a discontinuation, patients were required to have a 2 years IMS Lifelink Database, Male: n≈25 916a (25.1%) medication in adults ≥18 years: gap of at least 45 days in therapy based on fill dates and days’ Connecticut; USA Female: n≈77 334a (74.9%) tolterodine ER (n=43 881)a supply (2005–2008) Mean (SD) age: 58.7 (15.7) solifenacin (n=15 488)a years oxybutynin (n=15 075)a Adherence rate was defined as the proportion of patients filling more darifenacin (n=10 532)a than one prescription with an MPR of ≥80% oxybutynin
    [Show full text]
  • BETHANECHOL CHLORIDE TABLETS, USP5 Mg, 10 Mg, 25 Mg
    BETHANECHOL CHLORIDE- bethanechol chloride tablet Upsher-Smith Laboratories, LLC ---------- BETHANECHOL CHLORIDE TABLETS, USP 5 mg, 10 mg, 25 mg and 50 mg Rx only DESCRIPTION Bethanechol chloride, USP, a cholinergic agent, is a synthetic ester which is structurally and pharmacologically related to acetylcholine. It is designated chemically as 2-[(aminocarbonyl)oxy]-N, N, N-trimethyl-1-propanaminium chloride. Its molecular formula is C7H17ClN2O2 and its structural formula is: It is a white, hygroscopic crystalline powder having a slight amine-like odor, freely soluble in water, and has a molecular weight of 196.68. Each tablet for oral administration contains 5 mg, 10 mg, 25 mg or 50 mg bethanechol chloride, USP. Tablets also contain the following inactive ingredients: colloidal silicon dioxide, lactose monohydrate, magnesium stearate, microcrystalline cellulose, sodium starch glycolate, (25 mg and 50 mg) D&C Yellow #10 Lake and FD&C Yellow #6 Lake. CLINICAL PHARMACOLOGY Bethanechol chloride acts principally by producing the effects of stimulation of the parasympathetic nervous system. It increases the tone of the detrusor urinae muscle, usually producing a contraction sufficiently strong to initiate micturition and empty the bladder. It stimulates gastric motility, increases gastric tone and often restores impaired rhythmic peristalsis. Stimulation of the parasympathetic nervous system releases acetylcholine at the nerve endings. When spontaneous stimulation is reduced and therapeutic intervention is required, acetylcholine can be given, but it is rapidly hydrolyzed by cholinesterase and its effects are transient. Bethanechol chloride is not destroyed by cholinesterase and its effects are more prolonged than those of acetylcholine. Effects on the GI and urinary tracts sometimes appear within 30 minutes after oral administration of bethanechol chloride, but more often 60 to 90 minutes are required to reach maximum effectiveness.
    [Show full text]
  • Drug Benefit Council (DBC) Recommendation and Reasons for Recommendation FINAL
    Drug Benefit Council (DBC) Recommendation and Reasons for Recommendation FINAL Overactive Bladder Therapeutic Review Description: The purpose of the therapeutic review was to review medications for the treatment of overactive bladder (OAB) in adults. In their review, the DBC considered the following: a systematic review of the clinical evidence, a pharmacoeconomic report; previous CEDAC, CDEC, and DBC Recommendations and Reasons for the applicable agents; Clinical Practice Review from a Specialist, Manufacturer comments; responses to Patient Input Questionnaires from 12 patients; and a Budget Impact Analysis. No patient input was received from caregivers and no patient groups met the inclusion criteria. Dosage Forms: fesoterodine (Toviaz®) 4 and 8 mg tablet; oxybutynin IR (Ditropan®) 5 mg immediate release tablet; oxybutynin ER (Ditropan® XL) 5 and 10 mg extended-release tablet; oxybutynin CR (Uromax®) 10 and 15 mg controlled-release tablet; oxybutynin (Oxytrol™) 36 mg transdermal patch; oxybutynin (Gelnique™) 100 mg/g topical gel; tolterodine (Detrol™) 1 and 2 mg tablet; tolterodine ER (Detrol™ LA) 2 and 4 mg extended-release tablet; solifenacin (Vesicare®) 5 and 10 mg tablet; and darifenacin (Enablex™) 7.5 and 15 mg extended-release tablet. trospium (Trosec®) 20 mg tablet Recommendations: 1. The Drug Benefit Council (DBC) maintains their previous recommendations that oxybutynin CR, oxybutynin gel, and oxybutynin ER not be listed. 2. The DBC recommends that the Ministry of Health (Ministry) should consider adding one of the following long-acting (once daily) agents for patients with OAB who are unable to tolerate oxybutynin IR due to dry mouth. This agent should be selected based on the relative cost of the listed alternatives.
    [Show full text]
  • Role of Muscarinic Cholinergic Receptors in Regulation Of
    Proc. Nat. Acad. Sci. USA Vol. 69, No. 11, pp. 3287-3291, November 1972 Role of Muscarinic Cholinergic Receptors in Regulation of Guanosine 3':5'-Cyclic Monophosphate Content in Mammalian Brain, Heart Muscle, and Intestinal Smooth Muscle (cyclic AMP/nicotine receptors/atropine) TEE-PING LEE, J. F. KUO, AND PAUL GREENGARD* Department of Pharmacology, Yale University School of Medicine, 333 Cedar St., New Haven, Connecticut 06510 Communicated by Lewis Thomas, August 22, 1972 ABSTRACT Effects of acetylcholine and of agents that Recent studies indicate that acetylcholine can cause the mimic or block its physiological actions have been studied upon concentrations of guanosine 3':5'-cyclic monophos- accumulation of cyclic GMP in heart (10, 11), brain (11, 12), phate (cyclic GMP) and adenosine 3':5'-cyclic monophos- and ductus deferens (13). Perfusion of isolated rat heart with phate (cyclic AMP) in slices of mammalian cerebral cortex, acetylcholine caused an increase of up to 140% in cyclic heart ventricle, and ileum. Acetylcholine, and cholino- GMP content (10). Moreover, application of low concentra- mimetic agents with a predominantly muscarinic action, tions of acetylcholine to slices of rat heart caused increases of such as methacholine, bethanechol, and pilocarpine, induced an increase in the concentration of cyclic GMP, up to 10-fold in the concentration of cyclic GMP (11). The accompanied by no change or a slight decrease in the con- amount of cyclic GMP in brains of rats was increased up to centration of cyclic AMP, in all three tissues studied. 80% (12) by the injection of oxotremorine, an agent known to Tetramethylammonium, a cholinomimetic agent with a affect cholinergic mechanisms in the nervous system.
    [Show full text]
  • August 2021 California Signaturevalue 4 Tier HMO Formulary
    Pharmacy | Formulary | California 2021 California SignatureValue 4-Tier HMO Formulary Please note: This Formulary is accurate as of August 1, 2021 and is subject to change after this date. All previous versions of this Formulary are no longer in effect. Your estimated coverage and copay/coinsurance may vary based on the benefit plan you choose and the effective date of the plan. This Formulary can also be accessed online at myuhc.com > Pharmacy Information > Prescription Drug Lists > California plans > SignatureValue HMO plans. Plan-specific coverage documents may be accessed online at uhc.com/statedruglists > Small Group Plans > California. If you are a UnitedHealthcare member, please register or log on to myuhc.com, or call the toll-free number on your health plan ID card to find pharmacy information specific to your benefit plan. This Formulary is applicable to the following health insurance products offered by UnitedHealthcare: • SignatureValue • SignatureValue Advantage • SignatureValue Alliance • SignatureValue Flex • SignatureValue Focus • SignatureValue Harmony • SignatureValue Performance Updated 6/17/2021 6/21 © 2021 United HealthCare Services, Inc. All Rights Reserved. WF3890815-N Contents At UnitedHealthcare, we want to help you better understand your medication options. ..................................................... 3 How do I use my Formulary? ............................................. 4 What are tiers? ........................................................ 5 When does the Formulary change? ........................................ 5 Utilization Management Programs ......................................... 6 Your Right to Request Access to a Non-formulary Drug ....................... 6 Requesting a Prior Authorization or Step Therapy Exception ................... 7 How do I locate and fill a prescription through a retail network pharmacy? . 7 How do I locate and fill a prescription through the mail order pharmacy? . 7 How do I locate and fill a prescription at a specialty pharmacy? ...............
    [Show full text]