Monday, January 23, 2023

Myasthenia Gravis And Overactive Bladder

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Neurogenic Bladder Control Symptoms & Treatment

Botox for the Treatment of Overactive Bladder

Neurogenic bladder is a nervous system condition that keeps you from having normal bladder control. It happens when the nerves that control your bladder get damaged, often due to illness or injury.There are two types of neurogenic bladder.

  • Overactive bladder causes you to have little or no control over your urination. It can also cause you to feel a sudden or frequent need to urinate. .
  • Underactive bladder occurs when your bladder muscles lose their ability to hold your urine. Youre no longer able to sense when your bladder is full or to empty it completely, so it over-fills and urine leaks out. .

When Should I Contact My Healthcare Provider About Neurogenic Bladder

If you have any type of nervous system disorder, chances are that your healthcare provider will already know to address the issue of neurogenic bladder. Still, its important to be honest with your provider about the issues you face. Make sure you speak to your provider if you have new or worsening concerns, including things that might indicate infection like pain or fever.

A note from Cleveland Clinic

Neurogenic bladder can be managed, even though it cant be treated. Methods for dealing with neurogenic bladder dysfunction are being refined. You can help by following the suggestions that you get from your healthcare provider about lifestyle changes and nutritional choices. Maintaining a healthy weight can help with urinary incontinence.

How Is Mg Diagnosed

MG is hard to diagnose because weakness is a common symptom of many disorders.

Your doctor will ask you about your symptoms, take a medical history, and perform a physical exam. If your doctor thinks you may have MG, she or he may run some tests:

It is important for you to see a neurologist who is an expert in diagnosing MG. Diagnosis can take a long time , so try to be patient with your doctor.

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Common Questions About Solifenacin

Solifenacin is a type of medicine called an antimuscarinic muscle relaxant.

It works by relaxing the muscle that is found in the wall of the bladder. This helps to increase the volume of pee your bladder can hold and control the release of pee.

Solifenacin starts to relax the muscle in your bladder after 3 to 8 hours of taking your first dose. However, it can take up to 4 weeks for it to reach its full effect and for your symptoms to get better.

Usually, youâll need to take solifenacin for a long time.

After 4 weeks your doctor will check that solifenacin is helping your symptoms. Theyâll also do a review every 6 to 12 months after that to check itâs still working for you.

Take solifenacin until your doctor tells you to stop. Do not stop taking it just because you feel better.

Do not take solifenacin for longer than you need to. Your doctor will check every 6 to 12 months that your treatment is still needed.

There may be an increased risk of confusion and possibly dementia in people taking solifenacin, but more study needs to be done. If you’re worried about this, talk to your doctor.

Itâs safe to take solifenacin with everyday painkillers like paracetamol and ibuprofen.

If you’ve been taking solifenacin for at least 6 months your doctor may suggest that you stop taking the medicine for up to 4 weeks to see how your symptoms change without it.

Do not stop taking solifenacin without talking to your doctor first.

  • oxybutynin

Central Nervous System Effects

Myasthenia gravis (Ascending Disease)

Toviaz is associated with anticholinergic central nervous system adverse reactions . A variety of CNS anticholinergic effects have been reported, including headache, dizziness, and somnolence. Patients should be monitored for signs of anticholinergic CNS effects, particularly after beginning treatment or increasing the dose. Advise patients not to drive or operate heavy machinery until they know how Toviaz affects them. If a patient experiences anticholinergic CNS effects, Toviaz dose reduction or discontinuation should be considered.

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Medication For Urge Incontinence And Overactive Bladder Syndrome

If bladder training is not an effective treatment for your urge incontinence, your doctor may prescribe an antimuscarinic. Antimuscarinics may also be prescribed if you have overactive bladder syndrome , which is the frequent urge to urinate with or without urinary incontinence.

The first antimuscarinic that may be tried is called oxybutynin. There are two different types of oxybutynin tablets, and it is also available as a patch that you stick to your skin. If oxybutynin is not effective or unsuitable, other antimuscarinics that may be prescribed include:

  • darifenacin
  • tolterodine

Your doctor will usually start you at a low dose to minimise any possible side effects. The dose can then be increased until the medicine is effective.

You will be assessed after six weeks to see how you are getting on with the medication, and again after three to six months to see if you still need it.

Antimuscarinics should not be taken or should be used with caution by:

  • people with an untreated eye condition called angle closure glaucoma
  • people with myasthenia gravis, a condition that causes some muscles around your body to become weak
  • people with severe ulcerative colitis, a long-term condition that affects the colon

Your doctor will discuss any other medical conditions you have to determine which antimuscarinics are suitable for you.

Side effects

There are many possible side effects of antimuscarinics, including:

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Toviaz Dosage Modifications Due To Strong Cyp3a4 Inhibitors

Adult Patients with OAB

The maximum recommended dosage is Toviaz 4 mg orally once daily in adult patients taking strong CYP3A4 inhibitors . For administration instructions, see Dosage and Administration .

Pediatric Patients with NDO

Pediatric Patients Weighing Greater than 25 kg and up to 35 kg

The use of Toviaz in pediatric patients weighing greater than 25 kg and up to 35 kg and taking strong CYP3A4 inhibitors is not recommended . For administration instructions, see Dosage and Administration .

Pediatric Patients Weighing Greater than 35 kg

The maximum recommended dosage is Toviaz 4 mg orally once daily in pediatric patients weighing greater than 35 kg and taking strong CYP3A4 inhibitors . For administration instructions, see Dosage and Administration .

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How Ms Affects Your Bladder

Over time, about 80% of MS patients will experience bladder problems. An overactive bladder is common, where the nerve damage results in frequent, uncontrollable urges to empty, even though the bladder isnt full.

Problems emptying the bladder completely are also very common. The muscles in the pelvic floor and the sphincter muscle around the urethra contract spontaneously during emptying. This closes the urethra, resulting in the bladder not being properly emptied. The residual urine then leads to the feeling of needing to urinate again, leading to more bathroom trips than if the bladder had been completely emptied.

The progression of MS can swing wildly urinating will be more problematic in some periods, relatively easy in others. It is still very important to treat bladder emptying problems consistently. Residual urine can lead to urinary tract infections, which in turn can cause new attacks or the return of an attack that had previously receded.

You can also find additional information in our enCATHopedia leaflet.

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Carcinogenesis Mutagenesis Impairment Of Fertility

SLUDGE – Cholinergic Crisis (Nursing Mnemonic)

Carcinogenicity

No evidence of drug-related carcinogenicity was found in 24-month studies with oral administration to mice and rats. The highest tolerated doses in mice correspond to 11 to 19 times and 4 to 9 times the estimated human AUC values reached with fesoterodine 8 mg, which is the Maximum Recommended Human Dose . In rats, the highest tolerated dose corresponds to 3 to 8 times and 3 to 14 times the estimated human AUC at the MRHD.

Mutagenesis

Fesoterodine was not mutagenic or genotoxic in vitro or in vivo .

Impairment of Fertility

Fesoterodine had no effect on male reproductive function or fertility at doses up to 45 mg/kg/day in mice. At 45 mg/kg/day, a lower number of corpora lutea, implantation sites and viable fetuses was observed in female mice administered fesoterodine for 2-weeks prior to mating and continuing through day 7 of gestation. The maternal No-Observed-Effect Level and the NOEL for effects on reproduction and early embryonic development were both 15 mg/kg/day. At the NOEL, the systemic exposure, based on AUC, was 0.6 to 1.5 times higher in mice than in humans at the MRHD, whereas based on peak plasma concentrations, the exposure in mice was 5 to 9 times higher.

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Who Can And Cannot Take Solifenacin

Solifenacin can be taken by adults .

It’s not suitable for everyone. To make sure it’s safe for you, tell your doctor or pharmacist before starting solifenacin if you:

  • have ever had an allergic reaction to solifenacin or any other medicine
  • have liver or kidney problems
  • have myasthenia gravis, a rare long-term condition that causes muscle weakness
  • have glaucoma, as solifenacin can increase pressure in your eye
  • have a severe stomach or bowel condition, including a rare complication of ulcerative colitis or Crohn’s disease called toxic megacolon
  • are not able to pee or empty your bladder completely
  • are pregnant, trying to get pregnant or breastfeeding

Cautions With Other Medicines

Some medicines and solifenacin can affect each other. This can increase the chance of side effects.

Tell your pharmacist or doctor if you’re taking:

  • any medicine that makes you drowsy, gives you a dry mouth, or makes it difficult for you to pee. Taking solifenacin might make these side effects worse
  • ketoconazole or itraconazole, medicines used to treat fungal infections
  • ritonavir, a medicine used to treat HIV

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What Causes Neurogenic Bladder

Neurogenic bladder can be congenital . Birth defects that can cause neurogenic bladder include:

  • Spina bifida : This disorder occurs when the spine doesnt completely develop during the first month of pregnancy. Babies born with myelomeningocele often have paralysis or weakness that affects how their bladder works.
  • Sacral agenesis: This is a condition in which parts of the lower spine are missing.
  • Cerebral palsy: Cerebral palsy refers to a group of chronic disorders that weaken a person’s ability to control body movement and posture. These disorders result from injury to the motor areas of their brain. The problem causing cerebral palsy may occur while during development or after birth. Cerebral palsy isnt always found during a child’s first year of life.

Medical conditions that involve the nervous system can cause neurogenic bladder. Common causes include:

  • Trauma/accidents.

Other Useful Counseling Information

PPT

The pharmacist should be familiar with other usefulinformation regarding Oxytrol For Women that is not required on thenonprescrip-tion product label.4 For instance, patients usinganticholinergics such as oxybutynin should be warned not to enter hotenvironments, since that group of medications reduces the ability tosweat, and the wearer may suffer heat prostration, with fever and heatstroke. Oral dosage forms of oxybutynin have caused angioedema,4and patients should be informed that the appearance of any symptomsthat might be angioedema is sufficient cause for a 911 call, withimmediate transport to an emergency room.

The label warning against use in gastric retention is required because anticholinergics decrease gastric motility.4However, the label omits other examples of patients who are at highrisk of complications due to decreased gastric motility, such as thosewith ulcerative colitis, intestinal atony, and myasthenia gravis. It isalso vital to know that patients with gastroesophageal reflux should useOxytrol For Women with caution, a warning that also includes patientswho are taking bisphosphonates , since these drugs can induce or worsen reflux.4

To facilitate compliance, patients can be instructed tochange patches on the same 2 days each week. Product packages have acalendar on the back to help patients remember when changing is due.4

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Having An Open Discussion

There are all kinds of questions. Which ones work the best? When and how do I decide to use diapers or pads? Do I just go to a store and get them off the shelf? … Or do I order incontinence supplies and have them ship directly to me, discreetly.

To me, this second option keeps us from having an open and honest discussion about urinary incontinence. Not that there is anything wrong with having them shipped. But it adds to the feeling of being alone and guarding our secret. It leaves us to suffer by ourselves.

Society tells us it is something to be ashamed of … like it is our fault. For everyone that needs diapers or pads, no matter the reason, it is not your fault.

How And When To Take Solifenacin

Always read the information that comes with your medicine.

You’ll usually take solifenacin once a day. You can take your dose at any time but try to take it at the same time each day.

Swallow your tablets whole with a drink of water, do not chew or crush them. You can take solifenacin with or without food.

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Bladder Problems Common In Mg Particularly For Late

Bladder problems like urinary incontinence, urgency, and nocturia waking up frequently to urinate are common in people with myasthenia gravis , particularly those with late-onset disease, a study found.

Late-onset MG, or LOMG, is defined as disease symptoms that begin after age 50, while symptoms in early-onset MG start at earlier ages.

MG is caused by self-reactive antibodies that mistakenly attack proteins involved in nerve-muscle communication, causing patients to experience muscle weakness and tiredness.

Neuroanatomy Of Pelvic Floor

Parasympathetic Nervous System Drugs

The striated muscle forming the urethral rhabdosphincter and the periurethral striated muscle together make up the external urethral sphincter mechanism in humans. In women, the rhabdosphincter forms a 1.5-cm long circular ring around the middle third of the urethra, extending cranially as far as the posterior bladder base. In men, the rhabdosphincter has 3 sections extending over a greater length of urethra. On cystoscopy, this striated muscle can be seen to contract with electrical stimulation of the pudendal nerve.

Spinal cord nuclei supplying the vesicourethral smooth muscle and rhabdosphincter are in the lumbosacral region. The sympathetic autonomic nucleus is in the anteromediolateral gray matter at T10-T12, and the parasympathetic nucleus is at S2-S4. Motor neurons of the urethral rhabdosphincter are in the nucleus of Onufrowicz in the sacral ventral horns. The neurons are smaller, more spherical, and more closely packed than other anterior horn cells.

The nucleus of Onuf and the sacral parasympathetic nucleus are at slightly different levels. This can be of clinical significance in lesions of the conus. The neurons of the Onuf nucleus are relatively spared in many neuromuscular disorders.

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What Is Neurogenic Bladder

Your bladder is a hollow organ located in your pelvis or lower abdomen. One of the main jobs of your bladder is to store urine . The other is to remove urine from your body in response to signals from your spinal cord and brain.

Neurogenic bladder is the term for what happens when neurological conditions affect the way your bladder works. There are two major types of bladder control problems linked to neurogenic bladder. Depending on the nerves involved and the nature of the damage, your bladder becomes either overactive or underactive .

How Can Diet Affect Overactive Bladder

Some foods and drinks irritate the bladder, possiblycontributing to the problem. You should strive to eliminate caffeinefrom your diet by halting use of coffee, tea, and all caffeinated softdrinks. Alcohol should be eliminated entirely, as it is another bladderirritant. Spices such as pepper add flavor to foods, but they also cancause severe irritation to the bowels and bladder. It may be helpful tokeep a diary of your intake of these foods and drinks to see if theyactually do produce a worsening of symptoms.

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The Refractory Mg Patient And Novel Therapies

In our experience, where we have treated a small cohort of 17 MG patients with MuSK-MG, AChR-MG, and MG with no detectable antibodies, the majority of patients improved significantly but remain dependent on immunosuppression . Our single MuSK-MG patient, within this small cohort, responded best to Rituximab although this did not induce complete remission of her disease. In contrast, about a third of MG patients did not respond to Rituximab and their MG status was not altered by this therapy. In general, we have found that the drug is well-tolerated with minimal side effects. However, in two patients we have observed delayed neutropenia developing many months after Rituximab treatment, including one patient whose presentation was complicated by two neutropenic sepsis episodes several months after their Rituximab treatment. This has been observed in other patient groups treated with Rituximab .

Efgartigimod has been trialed in generalized MG in a phase-2 randomized double-blind, placebo-controlled study in 15 centers . ARGX-113 is the anti-neonatal Fc receptor immunoglobulin IgG1 fragment. It has been modified to increase its normal affinity for IgGs, thus blocking the formation of disease-causing IgG. Efgartigimod was well-tolerated in this trial. In the 12 patients treated with the active drug, there was a rapid decline in total Ig levels and in AChR titers, which in turn correlated with a clinical improvement of their MG, and this was sustained in the majority.

A New Nonprescription Product

Overactive bladder

Women may try the behavioral changes mentioned above, aswell as one of several prescription medications that relax the muscles of the bladder to preventcontractions. Physicians may also attempt such therapies as applicationof electrical impulses or Botox.

A new nonprescription product may be helpful for overactive bladder. It is known as Oxytrol For Women, which is available as a patch that is worn continuously on the skin for 4 days and contains the medication oxybutynin.

This product may be appropriate for you if you have hadtwo or more of the following symptoms for at least 3months: 1) urinary frequency, more than 8 times in 24 hours 2) urinaryurgency and 3) urge incontinence. However, urinary frequency can alsobe caused by urinary tract infections, diabetes, pregnancy , and other more serious conditions. If you think you have anyof these, you should see a physician instead.

The products label will have many additional useprecautions, warnings, and instructions. You should read and heed eachof these. Further, it is wise to Consult Your Pharmacist for additional assistance regarding use of this innovative new approach to overactive bladder.

Remember, if you have questions, Consult Your Pharmacist.

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