We live in a beautiful world.

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...where there are many sights to see.

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…places to visit.

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… and streets to walk.

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It’s a good life.

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

AgingBeautifully:Visions & Realities

Part II: Urinary Incontinence

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By Christine HortillosaPharm.D. 2013 CandidateUniversity of Texas at Austin College of Pharmacy5. 1. 2013

Realities.

1 in 10 Males

4 in 10 Females

UI affects…

3

QoL12

NOT

COOL

It causes…

NOT all UI are the same.

Stress UI Urge UI

MixedIncontinence

OverflowIncontinence

FunctionalIncontinence

NOT all UI are the same.

Stress UI Urge UI

1. Leaking during physical activity

2. Usually small urine amount 3. Nocturia

1. Urgency2. Frequency with urgency 3. Not able to reach toilet4. Large urine amount

Nonpharmacologic

Pharmacologic

Surgery

How tomanage?

1

2

3

Nonpharmacologic

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

Dry Mouth Constipation Dizziness Vision Disturbance0

20

40

60

80

Oxybutynin IROxybutynin XLOxybutynin TDSOxybutynin GelTolterodineTolterodine LATrospium Cl IRTrospium Cl XRSolifenacinDarifenacinFesoterodine

Adverse Event Incidence Rates of Anticholinergics/Antispasmodics

..for adverse drug effects and therapy effectiveness.

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Pharmacists are critical in effective urinary incontinence management.

With your help, they can...

enjoy a better life…

..and age Beautifully.

References1. Rovner ES, Wyman J, Lackner T, GUAY DR. Chapter 94. Urinary

Incontinence. In: Talbert RL, DiPiro JT, Matzke GR, Posey LM, Wells BG, Yee

GC, eds. Pharmacotherapy: A Pathophysiologic Approach. 8th ed. New York:

McGraw-Hill; 2011. http://www.accesspharmacy.com/content.aspx?

aID=7995036. Accessed May 1, 2013.2. Andersson KE. Antimuscarinics for treatment of overactive bladder.

Lancet Neurol 2004;3:46–53.3. Pictures throughout the slide deck: see bottom of individual slide.

Discussion.