52 Questions
Which patient population is most likely to benefit from the use of oxybutynin?
Patients with uninhibited neurogenic bladder, including those with detrusor overactivity associated with a neurological condition
What is the main reason why a different antibiotic should be chosen to treat any concurrent urinary tract infection when prescribing oxybutynin?
Oxybutynin increases blood levels and bioavailability of nitrofurantoin
What is the initial recommended dose of oxybutynin for frail older adults?
2.5 mg given two or three times a day
What is the maximum recommended daily dose of the immediate-release formulation of oxybutynin?
20 mg/day
Which of the following statements about the transdermal formulation of oxybutynin is correct?
It is available in a 3.9 mg system
What is the initial recommended dose of darifenacin, an extended-release formulation?
7.5 mg once daily
How does a high-fat meal affect the absorption of the extended-release formulation of trospium?
It reduces the absorption, with AUC and Cmax values 70% and 80% lower than those obtained while fasting
What is the recommended initial dosage of mirabegron, the newest drug approved for the treatment of overactive bladder in adults?
25 mg once daily
How long does it typically take for mirabegron to reach full effectiveness?
Up to 8 weeks
What is a potential safety concern with the use of mirabegron?
Increased risk of poorly controlled hypertension
What is the first-line management approach for Parkinson's disease?
Dopaminergics
In Parkinson's disease, cholinergic blockers are primarily used for what purpose?
To control tremor by relaxing smooth muscle
Which patient group is most likely to benefit from cholinergic blockers early in the course of Parkinson's disease?
Middle-aged patients with little rigidity or bradykinesia
What is the initial dose of Trihexyphenidyl when used as an adjunct to carbidopa/levodopa therapy?
1-2 mg/day
When is it recommended to switch a patient from regular formulations to sustained-release capsules of medication in Parkinson's disease management?
After initial stabilization on regular formulations
How should high doses of Trihexyphenidyl be administered in Parkinson's disease management?
Four times daily at mealtimes and bedtime
What is the most common adverse effect associated with the drugs discussed in the text?
Nausea
What is the recommended dose adjustment for fesoterodine and solifenacin in patients with severe renal impairment (CrCl less than 30 mL/min)?
The dose should not exceed the initial dose.
How should trospium be dosed in patients with severe renal impairment?
The dose must not exceed the initial dose of 20 mg.
Which of the drugs discussed is contraindicated in the presence of severe hepatic impairment?
All of the drugs except trospium
What is the recommended initial adult dose of atropine for the management of irritable bowel syndrome (IBS) and peptic ulcer disease?
400 mcg every 4 to 6 hours
What is the only oral dose of dicyclomine shown to be effective for the management of irritable bowel syndrome (IBS)?
160 mg/day in four equally divided doses
How is scopolamine transdermal used for the prevention of nausea and vomiting associated with motion sickness?
One disk is applied to the clean, dry, postauricular skin at least 4 hours before the antiemetic effect is desired.
What is the maximum dose of atropine recommended for children?
400 mcg
What is the antidote for atropine poisoning?
Physostigmine
Which of the following is a symptom of atropine poisoning in infants and children?
All of the above
What is the recommended daily fluid intake for patients taking cholinergic blockers?
At least 2 quarts of noncaffeinated fluid
Which activity should be avoided when taking cholinergic blockers due to the drug's side effects?
Vigorous activities in warm weather
What is a common side effect of cholinergic blockers on the respiratory system?
Decreased sweating
How can dry mouth caused by cholinergic blockers be alleviated?
Chewing sugarless gum
What should patients do if they experience a heart rate above 100 bpm while on medication?
Report it immediately
Besides medications, what other therapies can be used in treating incontinence and related disorders?
Kegel exercises and bladder retraining
What is the recommended dose of propantheline for adults?
15 mg 30 minutes before meals and 30 mg at bedtime
For which group of patients is the lower dose of propantheline recommended?
Patients with mild manifestations, older adults, and patients of small stature
What is the recommended dose of propantheline for children for antisecretory indications?
1.5 mg/kg per day
Which drug was commonly prescribed as an adjunct treatment for IBS?
Donnatal
How is benztropine recommended to be administered to minimize gastric irritation?
With food or immediately after meals
When should oxybutynin be administered?
On an empty stomach
How long should the scopolamine disk be left in place for its antiemetic effect?
Up to 3 days
'Slightly fewer adverse reactions' is associated with some drugs based on what parameter?
'Adherence'
'Monitoring beyond adverse reactions' is not required for which type of medications?
'Cholinergic blockers'
'Calibrated measuring instruments' should be used with liquid formulations to ensure what?
'Accurate dose'
Which medication is used for the treatment of symptomatic neurogenic orthostatic hypotension caused by Parkinson's disease?
Droxidopa
What is a potential adverse effect of droxidopa that requires regular monitoring?
Supine hypertension
Which medication is recommended for the management of akathisia arising from antipsychotic drugs?
Both trihexyphenidyl and benztropine
What is the initial recommended dose of trihexyphenidyl for managing extrapyramidal symptoms (EPS)?
1 mg
Which of the following statements is true regarding the use of benztropine for managing extrapyramidal symptoms?
Dosage titration is in 0.5 mg increments at 5- or 6-day intervals.
Which of the following medications is used for the treatment of overactive bladder and urinary incontinence?
Oxybutynin
Which of the following statements is true about the mechanism of action of medications used for overactive bladder and urinary incontinence?
They inhibit the muscarinic action of acetylcholine on smooth muscle.
What is the recommended approach for managing extrapyramidal symptoms (EPS) caused by antipsychotic drugs?
Temporarily reduce the dose of the antipsychotic drug while initiating trihexyphenidyl or benztropine therapy.
Which of the following statements is true regarding the use of trihexyphenidyl for managing extrapyramidal symptoms (EPS)?
Symptoms have been controlled with as little as 1 mg/day in some patients.
What is a potential approach for determining the need for continued therapy with trihexyphenidyl or benztropine for extrapyramidal symptoms (EPS)?
Withdraw the drug after several weeks to see if symptoms return.
Learn about the first-line management of Parkinson’s disease with dopaminergics and dopamine agonists. Understand the use of cholinergic blockers as adjuncts early in the course of the disease to control tremor and oral secretions.
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