35.2 Urinary Antispasmodics, Antimuscarinics, and Anticholinergics
2 min read•june 18, 2024
help calm overactive bladders, reducing those sudden urges to pee. These meds work by relaxing the muscle, giving you more control. They're a game-changer for folks dealing with frequent bathroom trips or embarrassing leaks.
While these drugs can be super helpful, they come with some side effects. , , and blurry vision are common. It's crucial to chat with your doctor about the pros and cons, especially if you're older or have other health issues.
Urinary Antispasmodics, Antimuscarinics, and Anticholinergics
Key features
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Mechanisms of Vascular Smooth Muscle Contraction and the Basis for Pharmacologic Treatment of ... View original
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Unit 8: The Urinary System – Douglas College Human Anatomy & Physiology II (2nd ed.) View original
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Frontiers | PACAP/Receptor System in Urinary Bladder Dysfunction and Pelvic Pain Following ... View original
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Mechanisms of Vascular Smooth Muscle Contraction and the Basis for Pharmacologic Treatment of ... View original
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- Treat (OAB) and other bladder disorders by acting on the responsible for bladder contraction
- Reduce involuntary bladder contractions, increase bladder capacity, decrease and urgency
- Mechanism of action: Antagonize in the bladder activated by , causing bladder contraction, leading to relaxation of the detrusor muscle
- Examples: (), (), (Enablex), (), (Sanctura)
Actions, side effects, and contraindications
- Actions: All medications in this class have similar actions in reducing bladder contractions and increasing bladder capacity, with some like oxybutynin and tolterodine also having direct smooth muscle relaxant effects
- Side effects: Anticholinergic side effects are common due to the medications' mechanism of action, including dry mouth, , , , and confusion, with newer medications like darifenacin and solifenacin having more bladder-specific effects and fewer systemic side effects
- Contraindications: , , uncontrolled , impaired hepatic or renal function, , history of QT prolongation, elderly patients due to increased risk of cognitive side effects and falls
Nursing considerations
- Assess for contraindications and precautions before administering medication
- Monitor for effectiveness and side effects by assessing urinary frequency, urgency, incontinence, signs of , and anticholinergic side effects, particularly in elderly patients
- Administer medication with or without food as directed to avoid gastrointestinal upset
- Encourage patients to take medication at the same time each day to maintain consistent therapeutic levels and advise them to avoid driving or operating machinery until they know how the medication affects them
- Educate patients on non-pharmacological interventions like and bladder training
Patient education plan
- Explain the purpose and expected benefits of the medication, emphasizing the importance of taking it as prescribed to achieve optimal results
- Discuss common side effects and how to manage them, encouraging patients to report severe or persistent side effects to their healthcare provider
- Advise patients to avoid sudden discontinuation of the medication to prevent rebound symptoms
- Encourage patients to maintain a bladder diary to track symptoms and response to treatment
- Teach patients about lifestyle modifications that can improve bladder control, such as limiting caffeine and alcohol intake, maintaining a healthy weight, and practicing good toilet habits
- Emphasize the importance of regular follow-up with their healthcare provider to assess the effectiveness of the medication and make any necessary adjustments
Key Terms to Review (63)
Acetylcholine: Acetylcholine is a neurotransmitter that plays a crucial role in the functioning of the nervous system, including the transmission of signals between nerve cells and the activation of muscle contractions. It is a key component in understanding various neurological disorders and the mechanisms of drugs used to treat them.
Anticholinergics: Anticholinergics are a class of drugs that block the action of the neurotransmitter acetylcholine, which is responsible for various physiological functions. These drugs are used to treat a variety of conditions, including overactive bladder, Parkinson's disease, and the side effects of certain psychiatric medications.
Antimuscarinic Syndrome: Antimuscarinic syndrome refers to the collection of adverse effects that can occur when medications with antimuscarinic or anticholinergic properties are used. These medications block the action of the neurotransmitter acetylcholine, leading to a disruption in normal physiological functions controlled by the parasympathetic nervous system.
Antimuscarinics: Antimuscarinics are a class of drugs that block the muscarinic acetylcholine receptors, reducing involuntary muscle spasms in the bladder and gastrointestinal tract. They are commonly used to treat conditions like overactive bladder and urinary incontinence.
Antimuscarinics: Antimuscarinics, also known as anticholinergics, are a class of medications that block the action of the neurotransmitter acetylcholine at muscarinic receptors in the body. This inhibits the parasympathetic nervous system, leading to a range of physiological effects that can be therapeutically useful.
Antispasmodics: Antispasmodics are medications that help to relieve muscle spasms, particularly in smooth muscles. They are commonly used to treat conditions affecting the urinary and bladder systems.
Bladder: The bladder is a hollow, muscular organ located in the pelvis that serves as a storage and collection vessel for urine produced by the kidneys. It plays a crucial role in the urinary system, responsible for temporarily holding urine until it can be voluntarily expelled from the body.
Blurred Vision: Blurred vision is a common symptom characterized by the inability to see objects or text clearly, resulting in a loss of visual sharpness and focus. This term is particularly relevant in the context of adrenergics, anticholinergics, urinary antispasmodics, antimuscarinics, and ocular anesthetics and lubricants, as these drug classes can potentially cause or contribute to this visual disturbance.
Cholinergic Receptors: Cholinergic receptors are a class of receptors that respond to the neurotransmitter acetylcholine (ACh), which is involved in various physiological processes throughout the body. These receptors play a crucial role in the functioning of the parasympathetic nervous system and are relevant in the context of several pharmacological topics.
Cognitive Impairment: Cognitive impairment refers to a decline in one or more cognitive functions, such as memory, attention, language, or problem-solving, that can interfere with an individual's ability to perform daily activities. This term is particularly relevant in the context of 35.2 Urinary Antispasmodics, Antimuscarinics, and Anticholinergics, as these medication classes can potentially cause cognitive side effects.
Constipation: Constipation is a condition characterized by infrequent bowel movements or difficulty in passing stools. It can be a common side effect of opioid medications.
Constipation: Constipation is a common gastrointestinal condition characterized by infrequent or difficult bowel movements, often accompanied by hard, dry stool. This term is particularly relevant in the context of various medication classes, as certain drugs can either cause or alleviate constipation as a side effect or therapeutic effect.
Darifenacin: Darifenacin is a selective muscarinic acetylcholine receptor antagonist primarily used in the treatment of overactive bladder. It acts by blocking the M3 receptor subtype, which is responsible for bladder smooth muscle contraction, thereby reducing involuntary bladder contractions and improving bladder storage capacity.
Detrol: Detrol (tolterodine) is a medication used to treat overactive bladder symptoms such as frequent or urgent urination and urinary incontinence. It works as an antimuscarinic agent, relaxing the bladder muscles to reduce spasms.
Detrol LA: Detrol LA is an extended-release medication used to treat overactive bladder symptoms such as frequent or urgent urination and incontinence. It works by blocking acetylcholine receptors which reduces bladder muscle contractions.
Detrusor Muscle: The detrusor muscle is a smooth muscle layer in the wall of the urinary bladder that is responsible for the contraction and relaxation of the bladder, allowing it to store and expel urine. It is a key component of the urinary system and plays a crucial role in the regulation of bladder function.
Dicyclomine: Dicyclomine is an antispasmodic medication that acts as an antimuscarinic and anticholinergic agent, primarily used to manage symptoms associated with irritable bowel syndrome and other gastrointestinal disorders by relaxing smooth muscle and reducing spasms in the digestive tract.
Ditropan: Ditropan is a brand name for oxybutynin, a medication used to treat overactive bladder by reducing muscle spasms of the bladder. It works as an antimuscarinic and anticholinergic agent.
Ditropan XL: Ditropan XL is an extended-release formulation of oxybutynin, used to treat overactive bladder symptoms such as frequent or urgent urination and urinary incontinence. It works by relaxing the bladder muscles.
Drowsiness: Drowsiness refers to a state of sleepiness or lethargy, where an individual experiences a strong desire to sleep or a lack of alertness. This term is particularly relevant in the context of various medical conditions and pharmacological interventions that can induce or exacerbate drowsiness as a side effect.
Dry Eyes: Dry eyes, also known as dry eye disease, is a condition characterized by insufficient tear production or poor tear quality, leading to discomfort, irritation, and a range of other symptoms. This term is particularly relevant in the context of 35.2 Urinary Antispasmodics, Antimuscarinics, and Anticholinergics, as certain medications within these drug classes can contribute to the development of dry eyes as a side effect.
Dry Mouth: Dry mouth, also known as xerostomia, is a condition characterized by a decrease in the production and flow of saliva. This can have significant impacts on various aspects of health and daily functioning.
Fesoterodine: Fesoterodine is a medication used to treat overactive bladder, a condition characterized by a sudden urge to urinate that is difficult to control. It works by blocking the action of acetylcholine, a neurotransmitter that stimulates the bladder muscles, thereby reducing bladder contractions and improving bladder control.
Flavoxate hydrochloride: Flavoxate hydrochloride is a urinary antispasmodic medication used to relieve symptoms of bladder spasms. It works by relaxing the smooth muscles in the urinary tract.
Gastric Retention: Gastric retention refers to the delayed emptying of the stomach, resulting in a prolonged residence time of food and liquids within the gastric cavity. This term is particularly relevant in the context of 35.2 Urinary Antispasmodics, Antimuscarinics, and Anticholinergics, as these drug classes can potentially impact gastrointestinal motility and gastric emptying.
Glycopyrrolate: Glycopyrrolate is a synthetic anticholinergic medication that is primarily used to reduce excessive secretions, such as saliva, sweat, and gastrointestinal fluids. It acts by blocking the action of the neurotransmitter acetylcholine, which is responsible for stimulating these secretions, making it a valuable tool in the management of various nervous system disorders, cholinergic effects, and urinary tract conditions.
Hepatic Impairment: Hepatic impairment refers to the reduced or compromised functioning of the liver, which can impact the metabolism and clearance of various medications. This term is particularly relevant in the context of opioid agonists and antagonists, bile acid sequestrants, fibrates, niacin, urinary antispasmodics, antimuscarinics, and anticholinergics, as the liver plays a crucial role in the pharmacokinetics and pharmacodynamics of these drug classes.
Intestinal Obstruction: Intestinal obstruction refers to a partial or complete blockage in the small or large intestine, preventing the normal passage of contents through the digestive tract. This condition can have significant implications in the context of 35.2 Urinary Antispasmodics, Antimuscarinics, and Anticholinergics, as certain medications within these drug classes can potentially contribute to or exacerbate intestinal obstruction.
Mirabegron: Mirabegron is a beta-3 adrenergic agonist used to treat overactive bladder by relaxing the detrusor muscle during the storage phase, increasing bladder capacity. It offers an alternative to antimuscarinics for patients who do not tolerate or respond well to them.
Muscarinic Receptors: Muscarinic receptors are a type of acetylcholine receptor that are primarily found in the parasympathetic nervous system and are responsible for mediating the effects of the neurotransmitter acetylcholine. These receptors play a crucial role in regulating various physiological processes, including cardiac function, gastrointestinal motility, and bladder control, and are the target of both therapeutic drugs and toxins.
Myasthenia Gravis: Myasthenia Gravis is an autoimmune neuromuscular disorder characterized by muscle weakness and fatigue, caused by the body's own antibodies disrupting the communication between nerves and muscles. This condition is closely related to the topics of Introduction to Myasthenia Gravis, Cholinergic Drugs, and Urinary Antispasmodics, Antimuscarinics, and Anticholinergics.
Myasthenia gravis (MG): Myasthenia gravis (MG) is an autoimmune neuromuscular disorder characterized by weakness and fatigue of voluntary muscles. It occurs due to the destruction or blockage of acetylcholine receptors at the neuromuscular junction.
Myrbetriq: Myrbetriq is a brand name for mirabegron, a medication used to treat overactive bladder (OAB) by relaxing the bladder muscle. It belongs to a class of drugs known as beta-3 adrenergic agonists.
Narrow-Angle Glaucoma: Narrow-angle glaucoma is a type of glaucoma characterized by a sudden increase in intraocular pressure due to a blockage in the drainage angle between the iris and cornea, which can lead to optic nerve damage and vision loss if not treated promptly. This term is relevant in the context of 35.2 Urinary Antispasmodics, Antimuscarinics, and Anticholinergics as certain medications in these classes can potentially exacerbate narrow-angle glaucoma.
Neurogenic Bladder: Neurogenic bladder is a condition where the normal function of the bladder is impaired due to a neurological disorder or injury that affects the nerves responsible for bladder control. This term is particularly relevant in the context of topics 35.2 Urinary Antispasmodics, Antimuscarinics, and Anticholinergics, as well as 35.4 Urinary Stimulants, as these pharmacological agents are often used to manage the symptoms and complications associated with neurogenic bladder.
Nicotinic Receptors: Nicotinic receptors are a type of cholinergic receptor that respond to the neurotransmitter acetylcholine. They are found in the central and peripheral nervous systems, as well as in the neuromuscular junctions, and play a crucial role in the regulation of various physiological processes, including nervous system disorders and urinary tract function.
Overactive Bladder: Overactive bladder (OAB) is a condition characterized by a sudden, uncontrollable urge to urinate that is difficult to suppress. This condition is often associated with increased frequency of urination and nocturia (waking up at night to urinate).
Oxybutynin: Oxybutynin is a medication primarily used to treat overactive bladder, a condition characterized by an urgent and frequent need to urinate. It works by blocking the action of acetylcholine, a neurotransmitter that stimulates the bladder muscle, effectively reducing involuntary bladder contractions and increasing the volume of urine the bladder can hold.
Oxybutynin chloride: Oxybutynin chloride is a medication used to relieve urinary and bladder difficulties, including frequent urination and inability to control urination. It works by relaxing the muscles in the bladder.
Oxytrol: Oxytrol is a transdermal patch used to treat overactive bladder symptoms such as frequent or urgent urination and incontinence. It works by delivering oxybutynin, an anticholinergic medication, through the skin into the bloodstream.
Parasympathetic nervous system: The parasympathetic nervous system (PNS) is a division of the autonomic nervous system that conserves energy by slowing the heart rate and increasing intestinal and gland activity. It is often referred to as the 'rest and digest' system.
Parasympathetic Nervous System: The parasympathetic nervous system is a division of the autonomic nervous system responsible for the body's rest-and-digest functions. It plays a crucial role in maintaining homeostasis and regulating various physiological processes, including digestion, heart rate, and urination.
Pelvic Floor Exercises: Pelvic floor exercises, also known as Kegel exercises, are a series of movements and contractions that target the muscles of the pelvic floor. These exercises are commonly used to improve bladder control, prevent or treat urinary incontinence, and strengthen the pelvic floor muscles, which play a crucial role in various bodily functions.
Post-Void Residual Volume: Post-void residual volume (PVR) refers to the amount of urine that remains in the bladder after urination. It is an important measurement in evaluating bladder function and lower urinary tract symptoms.
Propantheline: Propantheline is a medication that belongs to the class of drugs known as urinary antispasmodics, antimuscarinics, and anticholinergics. It works by blocking the action of acetylcholine, a neurotransmitter responsible for various physiological functions, including the regulation of bladder and bowel function.
Renal Impairment: Renal impairment refers to the reduced ability of the kidneys to effectively filter waste products and maintain fluid and electrolyte balance in the body. This condition can have significant implications for the pharmacokinetics and pharmacodynamics of various medications, including opioid agonists and antagonists, as well as urinary antispasmodics, antimuscarinics, and anticholinergics.
Solifenacin: Solifenacin is a medication that belongs to the class of drugs known as urinary antispasmodics, antimuscarinics, and anticholinergics. It is primarily used to treat overactive bladder, a condition characterized by an urgent and frequent need to urinate.
Solifenacin succinate: Solifenacin succinate is a medication used to treat overactive bladder by relaxing the bladder muscles. It is classified as an antimuscarinic and anticholinergic agent.
Tolterodine: Tolterodine is a medication that acts as an antimuscarinic agent, primarily used in the treatment of overactive bladder and other urinary incontinence conditions. It works by blocking the action of acetylcholine, a neurotransmitter that stimulates the bladder muscles, thereby reducing involuntary bladder contractions and improving bladder control. Tolterodine is also known to have potential applications in the management of certain neurological disorders, such as multiple sclerosis, where it may help alleviate bladder dysfunction.
Tolterodine tartrate: Tolterodine tartrate is an antimuscarinic medication used to treat overactive bladder with symptoms of urinary frequency, urgency, and incontinence. It works by inhibiting the action of acetylcholine on muscarinic receptors in the bladder.
Toxic Megacolon: Toxic megacolon is a life-threatening complication of certain gastrointestinal disorders, characterized by the rapid and severe dilation of the colon. This condition can lead to perforation, sepsis, and other potentially fatal consequences if not promptly recognized and treated.
Trosec: Trosec (fesoterodine) is a medication used to treat symptoms of overactive bladder, such as frequent or urgent urination and urinary incontinence. It works by blocking specific receptors that cause bladder muscle contractions.
Trospium: Trospium is a quaternary ammonium compound that functions as an antimuscarinic agent, primarily used to treat overactive bladder and urinary incontinence. It acts by blocking the action of acetylcholine at muscarinic receptors, thereby reducing detrusor muscle contractions and increasing bladder capacity.
Trospium chloride: Trospium chloride is an antispasmodic and antimuscarinic medication used to treat overactive bladder symptoms. It reduces urinary frequency, urgency, and incontinence by relaxing the bladder muscles.
Ulcerative Colitis: Ulcerative colitis is a chronic inflammatory bowel disease that affects the large intestine, causing inflammation and ulceration of the inner lining of the colon. It is characterized by periods of flare-ups and remission, and can significantly impact a person's quality of life.
Urge Incontinence: Urge incontinence is a type of bladder control problem characterized by a sudden, intense urge to urinate that is difficult to control, often leading to involuntary urine leakage. It is closely related to the functioning of the urinary system and the use of certain medications that affect bladder and urinary tract function.
Urinary Antispasmodics: Urinary antispasmodics are a class of medications that help relax the muscles of the bladder, reducing involuntary contractions and improving the storage and release of urine. These drugs are often used to manage overactive bladder and other urinary tract conditions by alleviating symptoms like urgency, frequency, and incontinence.
Urinary Frequency: Urinary frequency refers to the increased need to urinate more often than normal, with a person having the sensation of a full bladder and the urge to urinate more frequently throughout the day. This term is particularly relevant in the context of 35.2 Urinary Antispasmodics, Antimuscarinics, and Anticholinergics, as these drug classes can affect the bladder and urinary function.
Urinary retention: Urinary retention is the inability to completely or partially empty the bladder. It can be acute or chronic and requires medical intervention.
Urinary Retention: Urinary retention is the inability to completely empty the bladder, resulting in a buildup of urine within the bladder. This condition can have various underlying causes and is an important consideration across several medication classes.
Urinary Urgency: Urinary urgency is the sudden and compelling desire to urinate that is difficult to defer. It is a common symptom associated with various urinary tract conditions and can significantly impact a person's quality of life.
Urispas: Urispas (Flavoxate) is a urinary antispasmodic medication used to relieve symptoms of bladder spasms, such as dysuria, urgency, and nocturia. It works by relaxing the smooth muscle in the urinary tract.
Vesicare: Vesicare is a brand name for solifenacin succinate, an antimuscarinic medication used to treat overactive bladder symptoms like frequent urination and urge incontinence. It works by relaxing bladder muscles to reduce spasms and increase storage capacity.