Podcast
Questions and Answers
Which type of incontinence is described as the inability to go when you want to go?
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?
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?
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?
Which side effect is associated with anticholinergic therapy for urge incontinence?
What is a potential contraindication for using anticholinergics in treating urge incontinence?
What is a potential contraindication for using anticholinergics in treating urge incontinence?
Which medication is used for the symptomatic treatment of overflow response incontinence?
Which medication is used for the symptomatic treatment of overflow response incontinence?
What is a common side effect associated with Bethanechol use in the treatment of overflow response incontinence?
What is a common side effect associated with Bethanechol use in the treatment of overflow response incontinence?
Which condition is a contraindication for using Bethanechol in patients with urinary incontinence?
Which condition is a contraindication for using Bethanechol in patients with urinary incontinence?
Which patient factor guides the selection of specific drugs for the treatment of urinary incontinence?
Which patient factor guides the selection of specific drugs for the treatment of urinary incontinence?
What is one key component of patient education and counseling when prescribing therapy for adult patients with urinary incontinence?
What is one key component of patient education and counseling when prescribing therapy for adult patients with urinary incontinence?
What is the mechanism of action of botulinum toxin in creating muscle relaxation?
What is the mechanism of action of botulinum toxin in creating muscle relaxation?
Which of the following is NOT a potential side effect of pseudoephedrine (Sudafed)?
Which of the following is NOT a potential side effect of pseudoephedrine (Sudafed)?
Which of the following is NOT a recommended treatment for stress incontinence according to the text?
Which of the following is NOT a recommended treatment for stress incontinence according to the text?
Which of the following medications is a 5-alpha-reductase inhibitor used for the treatment of overflow incontinence?
Which of the following medications is a 5-alpha-reductase inhibitor used for the treatment of overflow incontinence?
What is a potential side effect of alpha-1 adrenergic antagonists used for the treatment of overflow incontinence?
What is a potential side effect of alpha-1 adrenergic antagonists used for the treatment of overflow incontinence?
According to the information provided, which of the following is true regarding immediate-release (IR) medications?
According to the information provided, which of the following is true regarding immediate-release (IR) medications?
Which of the following statements about the medication patch is correct?
Which of the following statements about the medication patch is correct?
According to the information provided, which of the following is the first-line treatment for urge incontinence that requires renal dosing/adjustments (very expensive)?
According to the information provided, which of the following is the first-line treatment for urge incontinence that requires renal dosing/adjustments (very expensive)?
Which of the following statements about Vibegron is correct?
Which of the following statements about Vibegron is correct?
Which of the following statements about renal dosing adjustments for Mirabegron (Myrbetriq) for Urge UI is correct?
Which of the following statements about renal dosing adjustments for Mirabegron (Myrbetriq) for Urge UI is correct?
Based on the information provided, which of the following statements about Botulinum A (Botox C) is correct?
Based on the information provided, which of the following statements about Botulinum A (Botox C) is correct?
What is NOT helpful in the treatment of functional incontinence?
What is NOT helpful in the treatment of functional incontinence?
What is NOT a contraindication for the use of Anticholinergic drugs in urge incontinence?
What is NOT a contraindication for the use of Anticholinergic drugs in urge incontinence?
What drug interaction can cause decreased calcium levels in a patient taking Oxybutynin Immediate Release (Ditropan IR)
What drug interaction can cause decreased calcium levels in a patient taking Oxybutynin Immediate Release (Ditropan IR)
What is the optimal dose for Oxybutynin Immediate Release (Ditropan IR) daily?
What is the optimal dose for Oxybutynin Immediate Release (Ditropan IR) daily?
What is the maximum dose for Oxybutynin Extended Release (Ditropan XL)?
What is the maximum dose for Oxybutynin Extended Release (Ditropan XL)?
What Anticholinergic for urge comes in syrup form?
What Anticholinergic for urge comes in syrup form?
It is safe and reasonable to have your patient crush Oxybutynin Extended Release (Ditropan XL) if they cannot take the medication whole.
It is safe and reasonable to have your patient crush Oxybutynin Extended Release (Ditropan XL) if they cannot take the medication whole.
What is the best way to apply Oxybutynin Transdermal Patch (Oxytrol) for urge incontinence?
What is the best way to apply Oxybutynin Transdermal Patch (Oxytrol) for urge incontinence?
What recommendation is NOT appropriate for a patient starting Oxybutynin Transdermal (Gel Gelnique) for urge UI?
What recommendation is NOT appropriate for a patient starting Oxybutynin Transdermal (Gel Gelnique) for urge UI?
Do not crush, break, or chew Anticholinergics for Urge UI.
Do not crush, break, or chew Anticholinergics for Urge UI.
Mirabegron (Myrbetriq) for Urge UI is contraindicated in:
Mirabegron (Myrbetriq) for Urge UI is contraindicated in:
What is not a side effect known for Mirabegron (Myrbetriq) for Urge UI?
What is not a side effect known for Mirabegron (Myrbetriq) for Urge UI?
Vibegron (Gemtesa) for Urge UI may increase levels of what drug?
Vibegron (Gemtesa) for Urge UI may increase levels of what drug?
Vibegron (Gemtesa) for Urge UI Does NOT inhibit the 2D6 pathway
Vibegron (Gemtesa) for Urge UI Does NOT inhibit the 2D6 pathway
No drugs are FDA approved for adult stress incontinence
No drugs are FDA approved for adult stress incontinence
What medication stimulate smooth muscle receptors in bladder neck and proximal urethra in order to help with stress UI?
What medication stimulate smooth muscle receptors in bladder neck and proximal urethra in order to help with stress UI?
What is NOT an adverse effect of Pseudoephedrine 30-60mg tid for stress UI?
What is NOT an adverse effect of Pseudoephedrine 30-60mg tid for stress UI?
alpha-adrenergic blockers (prazosin, doxazosin, terazosin, alfuzosin, labetalol, methyldopa, clonidine) can worsen stress UI.
alpha-adrenergic blockers (prazosin, doxazosin, terazosin, alfuzosin, labetalol, methyldopa, clonidine) can worsen stress UI.
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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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