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An antimuscarinic is a drug which disrupts the action of muscarine on the nervous system.
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What do antimuscarinic agents do?
Antimuscarinic agents are so called because they block muscarine, a poisonous substance found in the Amanita muscaria, a nonedible mushroom species.
What is the agent that blocks parasympathetic nerve impulses?
antimuscarinic - refers to an agent used to block parasympathetic effects such as salivation & bradycardia.
Why does high level of atropine cause vasodilation?
this from katznug pharma( almost all vessels containendothelial muscarinic receptors that mediate vasodilationThese receptors are readily blocked by antimuscarinic drugs.At toxic doses, and in some individuals at normal doses, antimuscarinic agents cause cutaneousvasodilation, especially in the upper portion of the body. The mechanism is unknown)
What are the categories of anticholinergics?
Anticholinergics are divided into three categories in accordance with their specific targets in the central and/or peripheral nervous system : antimuscarinic agents, ganglionic blockers, and neuromuscular blockers.
What is medication used to dry up secretions?
Two of the most common medications used to treat secretions are both antimuscarinic - scopolamine and glycopyrrolate.
Tricyclic antidepressants compared to selective serotonin re-uptake inhibitors?
Tricyclics are more potent antidepressants compared to the newer SSRIs. The reason SSRIs tend to be prescribed more, however, is because tricyclics are less well tolerated due to their antimuscarinic effects, such as: dryness of mouth, constipation, dizziness, abnormal heart rhythm, blurred vision and urinary retention. Trycyclics cannot be given to people with with hypotension or heart problems. SSRIs generally have a longer half life (15-50 hrs vs. 12-32 hrs for trycyclics) and do not require as high a concentration in the blood as tricyclics for their therapeutic effect.
Is solifenacin succinate indicated in uti?
no.Solifenacin succinate is indicated to treat overactive bladder, also known as urge incontinence.A urinary tract infection (UTI) is an infection that affects part of the urinary tract. When it affects the lower urinary tract it is known as a simple cystitis (a bladder infection) and when it affects the upper urinary tract it is known as pyelonephritis (a kidney infection). Symptoms from a lower urinary tract include painful urination and either frequent urination or urge to urinate (or both), while those of pyelonephritis include fever and flank pain in addition to the symptoms of a lower UTI. In the elderly and the very young, symptoms may be vague or non specific. The main causal agent of both types is Escherichia coli, however other bacteria, viruses or fungi may rarely be the cause. Women are generally affected more often than men. The most common symptoms are burning with urination and having to urinate frequently (or an urge to urinate) and significant pain, during urination especially, but in general as well.. These symptoms may vary from mild to severe. Some pain above the pubic bone or in the lower back may be present. People experiencing an upper urinary tract infection, or pyelonephritis, may experience flank pain, fever, or nausea and vomiting in addition to the classic symptoms of a lower urinary tract infection. Rarely the urine may appear bloody or contain visible pyuria (pus in the urine). In certain people, symptoms may be different from the above. In young children, the only symptom of a urinary tract infection (UTI) may be a fever. In older children, new onset urinary incontinence (loss of bladder control) may occur. Urinary tract symptoms are frequently lacking in the elderly The presentations may be vague with incontinence, a change in mental status, or fatigue as the only symptoms. While some present to a health care provider with sepsis, an infection of the blood, as the first symptoms. Diagnosis can be complicated by the fact that many elderly people have preexisting incontinence or dementia.From past experience, I know that it is possible, but not overly likely that people can have UTIs that are asymptomatic until they get to a more serious stage when fever, nausea and vomiting are present. I have a long (20+yrs) history of occasional UTIs and so I know the symptoms all too well. I could tell, at a fairly early stage, when I'd be getting an infection and was usually able to get rid of them using at home remedies with only a handful requiring antibiotics. But, from about 2007 on, I had a problem where I had NO clue I had a UTI until I had a urine analysis as part of an ER workup. I had symptoms of the stomach flu, and because of medications I am on (some of which suppress my immune system) I cannot miss some of those meds or become dehydrated. So when the stomach flu hits, and lasts longer than 24 hrs or so, I need to get fluids and medications in my body, which means I get to go to the ER if it occurs on a weekend. I had a few ER trips for what seemed to be the stomach flu but always ended up with being treated for that but also being treated for a UTI. After the third time, I told the ER I thought it was the stomach flu, but that I might also have a UTI since my prior experiences proved that to be true.In uncomplicated cases, urinary tract infections are easily treated with a short course of antibiotics, although resistance to many of the antibiotics used to treat this condition is increasing. In complicated cases, longer course or intravenous antibiotics may be needed, and if symptoms have not improved in two or three days, further diagnostic testing is needed. In women, urinary tract infections are the most common form of bacterial infection with 10% developing urinary tract infections yearly. Phenazopyridine (Pyridium) is occasionally prescribed during the first few days in addition to antibiotics to help with the burning and urgency sometimes felt during a bladder infection. Oral antibiotics such as trimethoprim/sulfamethoxazole (TMP/SMX), cephalosporins, nitrofurantoin, or a fluoroquinolone substantially shorten the time to recovery with all being equally effective. A three-day treatment with trimethoprim, TMP/SMX, or a fluoroquinolone is usually sufficient, whereas nitrofurantoin requires 5-7 days. With treatment, symptoms should improve within 36 hours. About 50% of people will recover without treatment within a few days or weeks.Overactive bladder (OAB) is a urological condition defined by a set of symptoms: urgency, with or without urge incontinence, usually with frequency and nocturia. Frequency is usually defined as urinating more than 8 times a day. (Notice the lack of bacterial, viral or fungal cause.) there may be multiple possible causes. It is often associated with overactivity of the Detrusor urinae muscle, a pattern of bladder muscle contraction observed during urodynamics. Treatments for OAB are usually synonymous with treatments for detrusor overactivity. OAB is distinct from stress urinary incontinence, but when they occur together, the condition is usually known as mixed incontinence.Treatment for OAB includes lifestyle modification (fluid restriction, avoidance of caffeine), bladder retraining, antimuscarinic drugs (e.g. darifenacin, hyoscyamine, oxybutynin, tolterodine, solifenacin, trospium, fesoterodine), β3 adrenergic receptor agonists (e.g. mirabegron), and various devices (Urgent PC Neuromodulation System, InterStim). Botulinum toxin A (Botox) is approved by the FDA in adults with neurological conditions, including multiple sclerosis and spinal cord injury. Botulinum Toxin A injections into the bladder wall can suppress involuntary bladder contractions by blocking nerve signals and may be effective for up to 9 months. A surgical intervention involves the enlargement of the bladder using bowel tissues, although generally used as a last resort. This procedure can greatly enlarge urine volume in the bladder.As a result of repeated UTIs over the course of an 11 mo span, in combination with a being catheterized frequently, as well as being bed-bound, I became completely incontinent for a time. That was the least of my worries at the time, as I was facing multiple potentially life-threatening infections, problems with being able to control nausea and vomiting, which lead to a weight loss of more than 100lbs as well as being told I'd never walk again. So needless to say, the issue of continence was not as much of a concern as staying alive, being able to keep food down, etc. After awhile, I progressed to a point that was not thought possible. I walk now, albeit rather slowly and with the aid of crutches as well as frequently using a wheelchair because of extreme fatigue and pain. But, I also made improvements with regard to no longer being totally incontinent. Now, I deal with a form of mixed bladder incontinence. For me, it's mostly in the form of OAB/urge incontinence where I am frequently using the bathroom along with some stress incontinence. If I were not dealing with the mobility issues, I'd not have as much of a problem. But when you cannot walk quickly and the urge to use the bathroom doesn't hit early enough that you have time to get up and walk to the bathroom, it can be quite a problem. I do take solifenacin succinate and it helps quite a bit. It's not a perfect solution. But for those times I get a UTI, I still must take an antibiotic. Solifenacin succinate does absolutely NOTHING for a UTI.
Stress incontinence?
DefinitionStress incontinence is an involuntary loss of urine that occurs during physical activity, such as coughing, sneezing, laughing, or exercise.Alternative NamesIncontinence - stressCauses, incidence, and risk factorsThe ability to hold urine and control urination depends on the normal function of the lower urinary tract, the kidneys, and the nervous system. You must also have the ability to recognize and respond to the urge to urinate.The average adult bladder can hold over 2 cups (350ml - 550 ml) of urine. Two muscles are involved in the control of urine flow:The sphincter, which is a circular muscle surrounding the urethra. You must be able to squeeze this muscle to prevent urine from leaking out.The detrusor, which is the muscle of the bladder wall. This must stay relaxed so that the bladder can expand.In stress incontinence, the sphincter muscle and the pelvic muscles, which support the bladder and urethra, are weakened. The sphincter is not able to prevent urine flow when there is increased pressure from the abdomen (such as when you cough, laugh, or lift something heavy).Stress incontinence may occur as a result of weakened pelvic muscles that support the bladder and urethra or because of a malfunction of the urethral sphincter. The weakness may be caused by:Injury to the urethral areaSome medicationsSurgery of the prostate or pelvic areaStress urinary incontinence is the most common type of urinary incontinence in women.Stress incontinence is often seen in women who have had multiple pregnancies and vaginal childbirths, and whose bladder, urethra, or rectal wall stick out into the vagina (pelvic prolapse).Risk factors for stress incontinence include:Being femaleChildbirthChronic coughing (such as chronic bronchitis and asthma)Getting olderObesitySmokingSymptomsThe main symptom of stress incontinence is involuntary loss of urine. It may occur when:CoughingSneezingStandingExercisingEngaging in other physical activityEngaging in sexual intercourseSigns and testsThe health care provider will perform a physical exam, including a:Genital exam in menPelvic exam in womenRectal examIn some women, a pelvic examination may reveal that the bladder or urethra is bulging into the vaginal space.Tests may include:Inspection of the inside of the bladder (cystoscopy)Pad test (after placement of a preweighed sanitary pad, the patient is asked to exercise -- following exercise, the pad is reweighed to determine the amount of urine loss)Pelvic or abdominal ultrasoundPost-void residual (PVR) to measure amount of urine left after urinationRarely, an electromyogram (EMG) is performed to study muscle activity in the urethra or pelvic floorTests to measure pressure and urine flow (urodynamic studies)Urinalysis or urine culture to rule out urinary tract infectionUrinary stress test (the patient is asked to stand with a full bladder, and then cough)X-rays with contrast dye of the kidneys and bladderThe health care provider may also measure the change in the angle of the urethra when at rest and when straining (Q-tip test). An angle change of greater than 30 degrees often means there is significant weakness of the muscles and tissues that support the bladder.TreatmentTreatment depends on how severe the symptoms are and how much they interfere with your everyday life.The doctor may ask that you stop smoking (if you smoke) and avoid caffeinated beverages (such as soda) and alcohol. You may be asked to keep a urinary diary, recording how many times you urinate during the day and night, and how often urinary leaking occurs.There are four major categories of treatment for stress incontinence:Behavioral changesMedicationPelvic floor muscle trainingSurgeryBEHAVIORAL CHANGEExamples of behavior changes include:Decreasing any excessive fluid intake (you should not decrease your fluid intake if you drink normal amounts of fluid)Urinating more frequently to decrease the amount of urine that leaksChanging physical activities to avoid jumping or running movements, which can cause more urine leakageRegulating bowel movements with dietary fiber or laxatives to avoid constipation (which can worsen incontinence)Quitting smoking to reduce coughing and bladder irritation (and your risk of bladder cancer)Avoiding alcohol and caffeine, which can overstimulate the bladderLosing weight if you are overweightAvoiding food and drinks that irritate the bladder, such as spicy foods, carbonated beverages, and citrusKeeping blood sugar under control if you have diabetesPELVIC FLOOR MUSCLE TRAININGPelvic muscle training exercises (called Kegel exercises) may help control urine leakage. These exercises improve the strength and function of the urethral sphincter.Some women may use a device called a vaginal cone along with pelvic exercises. The cone is placed into the vagina, and the woman tries to contract the pelvic floor muscles in an effort to hold it in place. The device may be worn for up to 15 minutes. This procedure should be done two times a day. Within 4 - 6 weeks, most women have some improvement in their symptoms.Biofeedback and electrical stimulation may be helpful for those who have trouble doing pelvic muscle training exercises. These two methods can help you identify the correct muscle group to work. Biofeedback is a method that helps you learn how to control certain involuntary body responses.Electrical stimulation therapy uses low-voltage electrical current to stimulate and contract the correct group of muscles. The current is delivered using an anal or vaginal probe. The electrical stimulation therapy may be done at the doctor's office or at home.Treatment sessions usually last 20 minutes and may be done every 1 - 4 days. Newer techniques are being investigated, including one that uses a specially designed electromagnetic chair that causes the pelvic floor muscles to contract when the patient is seated.MEDICATIONSMedicines tend to work better in patients with mild to moderate stress incontinence. There are several types of medications that may be used alone or in combination. They include:Anticholinergic agents (oxybutynin, tolterodine, enablex, sanctura, vesicare, oxytrol)Antimuscarinic drugs block bladder contractions (many doctors prescribe these types of drugs first)Alpha-adrenergic agonist drugs, such as phenylpropanolamine and pseudoephedrine (common ingredients in over-the-counter cold medications), help increase sphincter strength and improve symptoms in many patientsImipramine, a tricyclic antidepressant, works in a similar way to alpha-adrenergic drugsEstrogen therapy can be used to improve urinary frequency, urgency, and burning in postmenopausal women. It also can improve the tone and blood supply of the urethral sphincter muscles.However, whether estrogen treatment improves stress incontinence is controversial. Women with a history of breast or uterine cancer usually should NOT use estrogen therapy for the treatment of stress urinary incontinence.SURGERIESSurgical treatment is only recommended after the exact cause of the urinary incontinence has been determined. Most of the time, your doctor will try bladder retraining or Kegel exercises before considering surgery.Anterior vaginal repair or paravaginal repair procedures are often done in women when the bladder is bulging into the vagina (a condition is called a cystocele). Anterior repair is done through a surgical cut in the vagina, and a paravaginal repair is done through a surgical cut in the vagina or abdomenArtificial urinary sphincter is a surgical device used to treat stress incontinence mainly in men (rarely in women)Collagen injections make the area around the urethra thicker, which helps control urine leakage (the procedure may need to be repeated after a few months to achieve bladder control)Retropubic suspension are a group of surgical procedures done to lift the bladder and urethra. They are done through a surgical cut in the abdomen. The Burch colposuspension and Marshall-Marchetti-Krantz (MMK) procedures differ based on the structures that are used to anchor and support the bladderTension-free vaginal tapeVaginal sling procedures are often the first choice for the treatment of uncomplicated stress incontinence in women (it is rarely done in men). A sling made of synthetic material is placed so that it supports the urethraMost health care providers advise their patients to try other treatments before having surgery.Depending on the success of treatment and other medical problems the person may have, some people may require a urinary catheter to drain urine from the bladder.Expectations (prognosis)Behavioral changes, pelvic floor exercise therapy, and medication usually improve symptoms rather than cure stress incontinence. Surgery can cure most carefully selected patients.Treatment does not work as well in people with:Conditions that may prevent healing or make surgery more difficultOther genital or urinary problemsPrevious surgical failuresComplicationsComplications are rare and usually mild. They can include:Erosion of surgically placed materials such as a sling or artificial sphincterFistulas or abscessesIrritation of the vulva (vaginal lips)Pain during intercourseSkin breakdown and pressure ulcers in bed- or chair-bound patientsUnpleasant odorsUrinary tract infectionsVaginal dischargeThe condition may affect or disrupt social activities, careers, and relationships.Calling your health care providerCall for an appointment with your health care provider if you have symptoms of stress incontinence and they are bothersome.PreventionPerforming Kegel exercises (tightening the muscles of the pelvic floor as if trying to stop the urine stream) may help prevent symptoms. Doing Kegel exercises during and after pregnancy can decrease the risk of developing stress urinary incontinence after childbirth.ReferencesGerber GS, Brendler CB. Evaluation of the urologic patient: History, physical examination, and urinalysis. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Sauders Elsevier; 2007: chap 3.Holroyd-Leduc JM, Tannenbaum C, Thorpe KE, Straus SE. What type of urinary incontinence does this woman have? JAMA. 2008; 299:1446-1456.Rogers RG. Clinical practice. Urinary stress incontinence in women. N Engl J Med. 2008; 358:1029-1036.
