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Ebook British national formulary 70 (BNF): Part 2

(BQ) Part 2 book "British national formulary 70 (BNF)" presentation of content: Genito-urinary system, malignant disease, blood and nutrition, musculoskeletal system, ear, nose and oropharynx, eye, skin, vaccines, emergency treatment of poisoning, anaesthesia. Invite you to consult. | BNF 70 Urinary frequency, enuresis, and incontinence 667 Chapter 7 Genito-urinary system 667 667 672 677 678 679 683 689 691 694 697 697 1 Bladder and urinary disorders 1.1 Urinary frequency, enuresis, and incontinence Urinary frequency, enuresis and incontinence Urinary frequency and incontinence Incontinence in adults which arises from detrusor instability is managed by combining drug therapy with conservative methods for managing urge incontinence such as pelvic floor exercises and bladder training; stress incontinence is generally managed by non-drug methods. Duloxetine p. 288 can be added and is licensed for the treatment of moderate to severe stress incontinence in women; it may be more effective when used as an adjunct to pelvic floor exercises. Antimuscarinic drugs reduce symptoms of urgency and urge incontinence and increase bladder capacity. Oxybutynin hydrochloride p. 669 also has a direct relaxant effect on urinary smooth muscle. Side-effects limit the use of oxybutynin hydrochloride, but they may be reduced by starting at a lower dose. A modified-release preparation of oxybutynin hydrochloride is effective and has fewer sideeffects; a transdermal patch is also available. The efficacy and side-effects of tolterodine tartrate p. 671 are comparable to those of modified-release oxybutynin hydrochloride. Flavoxate hydrochloride p. 669 has less marked side-effects but it is also less effective. Darifenacin p. 668, fesoterodine fumarate p. 668, propiverine hydrochloride p. 670, solifenacin succinate p. 670, and trospium chloride p. 671 are newer antimuscarinic drugs licensed for urinary frequency, urgency, and incontinence. The need for continuing antimuscarinic drug therapy should be reviewed every 4–6 weeks until symptoms stabilise, and then every 6–12 months. Propantheline bromide p. 74 and tricyclic antidepressants were used for urge incontinence but they are little used now because of their side-effects. The use of .