pharm urinary incont.
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Questions and Answers

Which type of incontinence is described as the inability to go when you want to go?

  • Functional incontinence (correct)
  • Urge incontinence
  • Stress incontinence
  • Overflow incontinence

    • What is the first-line drug treatment for urge incontinence?

  • Habit training
  • Anticholinergics (correct)
  • Scheduled voiding
  • Environmental adjustment

    • Which medication inhibits the action of acetylcholine in synapses as a treatment for urge incontinence?

  • Oxybutynin Patch
  • Oxybutynin IR/ER/XL (correct)
  • ALL of the Anticholinergics
  • Oxybutynin Gel 10%

    • Which side effect is associated with anticholinergic therapy for urge incontinence?

    <p>Dry mouth/skin</p> Signup and view all the answers

    What is a potential contraindication for using anticholinergics in treating urge incontinence?

    <p>Glaucoma</p> Signup and view all the answers

    Which medication is used for the symptomatic treatment of overflow response incontinence?

    <p>Bethanechol</p> Signup and view all the answers

    What is a common side effect associated with Bethanechol use in the treatment of overflow response incontinence?

    <p>Bradycardia</p> Signup and view all the answers

    Which condition is a contraindication for using Bethanechol in patients with urinary incontinence?

    <p>Hypotension</p> Signup and view all the answers

    Which patient factor guides the selection of specific drugs for the treatment of urinary incontinence?

    <p>Age</p> Signup and view all the answers

    What is one key component of patient education and counseling when prescribing therapy for adult patients with urinary incontinence?

    <p>Discussing dietary modifications</p> Signup and view all the answers

    What is the mechanism of action of botulinum toxin in creating muscle relaxation?

    <p>Inhibition of cholinergic receptors</p> Signup and view all the answers

    Which of the following is NOT a potential side effect of pseudoephedrine (Sudafed)?

    <p>Stress incontinence</p> Signup and view all the answers

    Which of the following is NOT a recommended treatment for stress incontinence according to the text?

    <p>Estrogens</p> Signup and view all the answers

    Which of the following medications is a 5-alpha-reductase inhibitor used for the treatment of overflow incontinence?

    <p>Finasteride</p> Signup and view all the answers

    What is a potential side effect of alpha-1 adrenergic antagonists used for the treatment of overflow incontinence?

    <p>Renal failure</p> Signup and view all the answers

    According to the information provided, which of the following is true regarding immediate-release (IR) medications?

    <p>The maximum benefit may not be seen until after 4 weeks of use.</p> Signup and view all the answers

    Which of the following statements about the medication patch is correct?

    <p>It may cause pruritus (itching) and erythema (redness).</p> Signup and view all the answers

    According to the information provided, which of the following is the first-line treatment for urge incontinence that requires renal dosing/adjustments (very expensive)?

    <p>β-3 agonists (Mirabegron XR, Vibegron)</p> Signup and view all the answers

    Which of the following statements about Vibegron is correct?

    <p>It selectively binds to β-3 adrenergic receptors, relaxing the detrusor muscle.</p> Signup and view all the answers

    Which of the following statements about renal dosing adjustments for Mirabegron (Myrbetriq) for Urge UI is correct?

    <p>For patients with a CrCl less than 15 mL/min, the medication should not be used.</p> Signup and view all the answers

    Based on the information provided, which of the following statements about Botulinum A (Botox C) is correct?

    <p>It is used as an outpatient procedure for urinary incontinence that can cause retention of urine.</p> Signup and view all the answers

    What is NOT helpful in the treatment of functional incontinence?

    <p>Pharmaceuticals</p> Signup and view all the answers

    What is NOT a contraindication for the use of Anticholinergic drugs in urge incontinence?

    <p>urinary retention</p> Signup and view all the answers

    What drug interaction can cause decreased calcium levels in a patient taking Oxybutynin Immediate Release (Ditropan IR)

    <p>3A4 inhibitors</p> Signup and view all the answers

    What is the optimal dose for Oxybutynin Immediate Release (Ditropan IR) daily?

    <p>5 mg</p> Signup and view all the answers

    What is the maximum dose for Oxybutynin Extended Release (Ditropan XL)?

    <p>30 mg</p> Signup and view all the answers

    What Anticholinergic for urge comes in syrup form?

    <p>Oxybutynin Immediate Release Ditropan IR</p> Signup and view all the answers

    It is safe and reasonable to have your patient crush Oxybutynin Extended Release (Ditropan XL) if they cannot take the medication whole.

    <p>False</p> Signup and view all the answers

    What is the best way to apply Oxybutynin Transdermal Patch (Oxytrol) for urge incontinence?

    <p>Applied twice weekly to dry, intact skin on abdomen, hip, or buttock rotating sites</p> Signup and view all the answers

    What recommendation is NOT appropriate for a patient starting Oxybutynin Transdermal (Gel Gelnique) for urge UI?

    <p>Shower after application within 20 minutes</p> Signup and view all the answers

    Do not crush, break, or chew Anticholinergics for Urge UI.

    <p>True</p> Signup and view all the answers

    Mirabegron (Myrbetriq) for Urge UI is contraindicated in:

    <p>Severe HTN; pregnancy</p> Signup and view all the answers

    What is not a side effect known for Mirabegron (Myrbetriq) for Urge UI?

    <p>Dizziness</p> Signup and view all the answers

    Vibegron (Gemtesa) for Urge UI may increase levels of what drug?

    <p>digoxin</p> Signup and view all the answers

    Vibegron (Gemtesa) for Urge UI Does NOT inhibit the 2D6 pathway

    <p>True</p> Signup and view all the answers

    No drugs are FDA approved for adult stress incontinence

    <p>True</p> Signup and view all the answers

    What medication stimulate smooth muscle receptors in bladder neck and proximal urethra in order to help with stress UI?

    <p>Pseudoephedrine 30-60mg tid with food</p> Signup and view all the answers

    What is NOT an adverse effect of Pseudoephedrine 30-60mg tid for stress UI?

    <p>thrombocytopenia</p> Signup and view all the answers

    alpha-adrenergic blockers (prazosin, doxazosin, terazosin, alfuzosin, labetalol, methyldopa, clonidine) can worsen stress UI.

    <p>True</p> Signup and view all the answers

    Study Notes

    Types of Incontinence

    • Functional Incontinence: inability to reach the bathroom in time
    • Urge Incontinence: strong, sudden need to urinate
    • Stress Incontinence: leakage during physical activity
    • Overflow Incontinence: constant dribbling

    Medications for Urge Incontinence

    Anticholinergics

    • Oxybutynin IR (Ditropan IR): Immediate Release oral medication
    • Oxybutynin XL (Ditropan XL): Extended Release oral medication
    • Oxybutynin Patch (Oxytrol): Transdermal patch
    • Oxybutynin Gel 10% (Gelnique): Topical gel
    • Mechanism of Action: Inhibit acetylcholine in synapses, parasympathetic inhibition
    • Indications: Urge incontinence, dry mouth/skin, constipation, blurred vision, confusion, tachycardia, cognitive dysfunction
    • Side Effects: Tachycardia, dry mouth, constipation, blurred vision, confusion, cognitive dysfunction
    • Contraindications: Gastric retention, uncontrolled narrow-angle glaucoma
    • Pregnancy Category: C
    • Caution: Elderly patients, CYP3A4 inhibitors

    β-3 Agonists

    • Mirabegron XR (Myrbetriq): Oral medication
    • Vibegron (Gemtesa): Oral medication
    • Mechanism of Action: Selectively binds to β-3 adrenergic receptors, relaxes detrusor muscle
    • Indications: Urge incontinence, UTI, HTN
    • Side Effects: Headache, severe HTN
    • Renal Dosing: CrCl < 30 = 25mg, CrCl < 15 = contraindicated
    • Caution: Cardiac disease, tachyarrhythmias, hyperthyroidism, renal failure, narrow-angle glaucoma

    Botulinum Toxin

    • Botox: Outpatient procedure
    • Mechanism of Action: Creates diffuse muscle relaxation via cholinergic inhibition
    • Indications: Urge incontinence, urinary retention

    Other Medications

    For Stress Incontinence

    • Pseudoephedrine (Sudafed): Stimulates smooth muscle receptors in bladder neck and proximal urethra
    • Duloxetine (Cymbalta): Inhibits reuptake of serotonin and norepinephrine
    • Estrogen: Oral and topical formulations (Estring)

    For Overflow Incontinence

    • 5-α-reductase inhibitors: Finasteride (Proscar), Dutasteride (Avodart)
    • α1-adrenergic antagonists: Nonselective (Prazosin, Terazosin, Doxazosin), Selective (Tamsulosin)
    • Cholinergics: Bethanechol

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    Description

    Learn about the different types of incontinence such as functional, urge, stress, overflow, and transient. Explore treatment options including habit training, scheduled voiding, environmental adjustments, and medication examples like anticholinergics and oxybutynin.

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