69. Overactive Bladder (OAB) Flashcards Preview

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Flashcards in 69. Overactive Bladder (OAB) Deck (20):
1

Agnes, an 82 year-old female, will begin Detrol LA for urge incontinence. Which of the following statements concerningDetrol LA are correct? (Select ALL that apply.)

A. She is likely to experience some dry mouth and should be counseled on ways to relieve this condition.
B. Patients having incontinence should always be treated with prescription agents, if affordable, as incontinence episodes are a major contributor to nursing home placement.
C. Patients should be started on immediate release medications rather than long-acting medications.
D. It is best to combine the use of prescription drugs with pelvic floor (Kegel) exercises.
E. She is likely to experience noticeable cognitive dysfunction, disorientation and dizziness, which are significant in someone this age.

A, D. The agents in common use do not penetrate the CNS to a great degree; if they did, they could not be used for this purpose. However, some will experience more CNS effects than others, and the risk is present with any of these agents. A centrally-acting anticholinergic such as benztropine (and even diphenhydramine, to some extent) would cause urinary retention, but would have much higher CNS penetration and CNS side effects. Patients having incontinence should not always be treated with prescription agents even though incontinence episodes are a major contributor to nursing home placement; the anticholinergics used for urge incontinence have mild benefit and contribute (primarily) to dry mouth.

2

Which of the following agents used for urge incontinence comes in an oral formulation, a transdermal patch and a topical gel?

A. Oxybutynin
B. Solifenacin
C. Trospium
D. Darifenacin
E. Tolterodine

A. The oxybutynin patch (Oxytrol) causes less dry mouth than oral oxybutynin. A topical formulation of oxybutynin, Gelnique, was released in 2009. Gelnique is designed to cause less dry mouth and other anticholinergic side effects. Oxytrol is now OTC for women.

3

Drugs used for urge incontinence bind to a specific subtype of anticholinergic receptor. Choose the correct statement concerning the receptor:

A. These drugs bind primarily to the nicotinic N2 receptor on the bladder muscle wall.
B. These drugs bind primarily to the nicotinic N3 receptor on the bladder muscle wall.
C. These drugs bind primarily to the muscarinic M2 receptor on the bladder muscle wall.
D. These drugs bind primarily to the muscarinic M1 receptor on the bladder muscle wall.
E. These drugs bind primarily to the muscarinic M3 receptor on the bladder muscle wall.

E. The agents used for urge incontinence are anticholinergics (or acetylcholine antagonists) that block acetylcholine at the M3 receptor. Some are more specific for M3 and some hit other receptors as well.

4

A physician is wondering if he should use oxybutynin immediate-release or the long-acting formulation. Both are on the patient’s formulary. He asks the pharmacist which formulation is likely to cause more side effects such as dry mouth or blurry vision. He also wants to know why the formulation changes the side effect profile. Choose the most appropriate response:

A. The short-acting formulation has less dry mouth because it goes in and goes out quickly.
B. The short-acting formulation has less dry mouth because it does not cause a high drug "peak".
C. The short-acting formulation has less dry mouth because it is metabolized rapidly.
D. The long-acting formulation has less dry mouth because it does not cause a high drug "peak".
E. The long-acting formulation has less dry mouth because it is more specific for the muscarinic receptor.

D. Side effects generally occur when drugs hit the "wrong" receptor. When an immediate-release formulation is used, it reaches a higher peak than the longer-acting formulation. More of the drug is available to interact with the "wrong" receptor and side effects increase.

5

Although incontinence is not usually dangerous, it can take a significant toll on a person's emotional state. Which of the following might occur if an elderly female suffers with incontinence? (Select ALL that apply.)

A. Depression
B. Lower self esteem
C. Nursing home placement
D. Embarrassment
E. Social isolation

A, B, C, D, E. When asked why they are putting their elderly relative in a nursing home, the "smell of urine" or "wet furniture" is a common reason.

6

There are different types of incontinence. Younger women predominantly have a problem with leakage of urine when they laugh, sneeze, cough, jog, or lift something heavy. What is the term for this type of incontinence?

A. Overflow
B. Mixed
C. Urge
D. Stress
E. Functional

D. Stress incontinence results when the muscles and tissue that help support the bladder become weak. The muscles can be strengthened with exercise.

7

A patient gave the pharmacist a prescription for Vesicare 5 mg once daily #30. Which of the following is an appropriate generic substitution for Vesicare?

A. Oxybutynin
B. Solifenacin
C. Trospium
D. Darifenacin
E. Tolterodine

B. The generic name of Vesicare is solifenacin.

8

Alison is a 78 year-old female with incontinence. Alison has sudden urges to use the restroom and often does not get there in time. In addition, she "leaks" whenever she coughs or hiccups. What is the term for this type of incontinence?

A. Overflow
B. Mixed
C. Urge
D. Stress
E. Functional

B. Many women have a combination of urge and stress incontinence, or mixed incontinence.

9

A patient gave the pharmacist a prescription for Enablex 7.5 mg once daily #30. Which of the following is an appropriate generic substitution for Enablex?

A. Oxybutynin
B. Solifenacin
C. Trospium
D. Darifenacin
E. Tolterodine

D. The generic name of Enablex is darifenacin.

10

A patient gave the pharmacist a prescription for Detrol 1 mg twice daily #60. Which of the following is an appropriate generic substitution for Detrol?

A. Oxybutynin
B. Solifenacin
C. Trospium
D. Darifenacin
E. Tolterodine

E. The generic name of Detrol is tolterodine.

11

Mirabegron is a new drug approved for overactive bladder. It increases the filling capacity of the bladder by stimulating beta-3 receptors (it is a beta-3 agonist). Which of the following statements concerning mirabegron are correct? (Select ALLthat apply.)

A. The side effect of most concern with the use of this drug is blood pressure elevation.
B. The brand name of mirabegron is Enablex.
C. Reduce the dose with severe renal impairment (15-29 mL/min) and avoid use altogether with a CrCl less than 15 mL/min.
D. Mirabegron is administered by the patient in an injectable (SC) delivery device.
E. The digoxin dose may need to be increased when using concurrently with mirabegron.

A, C. The brand name of mirabegron is Myrbetriq. Incontinence drugs have mild benefit. The formulations are mostly oral, with a couple of novel formulations (the oxybutynin patch and topical gel).

12

Older women predominantly have a problem with a sudden need to use the restroom, which can result in leakage of a larger amount of urine. What is the term for this type of incontinence?

A. Overflow
B. Mixed
C. Urge
D. Stress
E. Functional

C. The term "overflow incontinence" is used primarily for BPH, and "functional incontinence" means that the person cannot reach the restroom in time, which could be due to having a problem with movement from a stroke, Parkinson disease, paralysis or other conditions.

13

A female with overactive bladder has been prescribed darifenacin once daily. Choose the correct statements concerning darifenacin: (Select ALL that apply.)

A. Darifenacin is taken once daily, with liquid.
B. Darifenacin is available in oral and transdermal formulations.
C. The most common side effects are dry mouth and constipation.
D. Do not use this or other urge incontinence medications if you have glaucoma.
E. Darifenacin should be swallowed whole and not chewed, divided or crushed.

A, C, D, E. Darifenacin (Enablex) is taken once daily, with liquid, and with or without food. The anticholinergics are not safe to use if the patient has glaucoma. Nothing that has considerable anticholinergic properties can be used safely with glaucoma; they can raise intraocular pressure.

14

PR is a 67 year-old woman who reports frequent nightly awakenings and trips to the bathroom several nights per week. She explains that she often gets the urge to urinate unexpectedly and cannot always make it to the bathroom in time. She tells you of an incident the other day when she “was out with friends and had an accident in the restaurant.” PR was extremely embarrassed and does not want that to happen again. She asks you, as her pharmacist, what she can do to treat her frequent and sometimes uncontrollable urge to go to the bathroom. Which of the following are appropriate recommendations? (Select ALL that apply.)

A. Perform pelvic floor muscle exercises
B. Take diphenhydramine 25 mg PO prior to going out in public
C. Limit consumption of caffeinated beverages
D. Start oxybutynin OTC transdermal patch
E. Increase fluid intake during the daytime

A, C, D.

15

Pharmacists who work in the community and witness the large numbers of elderly patients purchasing Depends and other adult diapers understand the high prevalence of incontinence. Over half of elderly women have some form of incontinence. Which of the following are risk factors for incontinence? (Select ALL that apply.)

A. Increased age
B. Underweight
C. Prior vaginal delivery
D. Obesity
E. History of stroke or dementia

A, C, D, E. Obesity, not underweight, increases incontinence risk. Other risk factors include diabetes, hysterectomy, neurologic conditions (such as having had a stroke, dementia or Parkinson's disease), and pelvic injury.

16

A female with overactive bladder has been prescribed Detrol LA. The pharmacist is wondering if he should take the time to give the patient a handout on Kegel exercises. Choose the correct responses: (Select ALL that apply.)

A. Exercises to strengthen the pelvic muscles are not as effective as prescription therapy, but can be tried.
B. No one does the exercises so it is not worth the bother.
C. The exercises may help more than the prescription drugs.
D. For many women the best benefit is combination of the exercises and incontinence medication.
E. The pharmacist should contact the provider before providing this information.

C, D. Try to encourage patients to use pelvic floor muscle ("Kegel") exercises. Strengthening the pelvic floor muscles can reduce incontinence episodes more than the use of prescription medications. In many patients, the combination of exercises and medicine can significantly enhance the quality of life. Many patients do not do Kegel exercises correctly; it can be helpful to have a flyer on the correct method to distribute when an urge incontinence medication is dispensed or to those purchasing adult diapers.

17

A patient gave the pharmacist a prescription for Ditropan XL 5 mg once daily #30. Which of the following is an appropriate generic substitution for Ditropan XL?

A. Oxybutynin extended-release
B. Solifenacin extended-release
C. Trospium extended-release
D. Darifenacin extended-release
E. Tolterodine extended-release

A. The generic name of Ditropan XL is oxybutynin extended-release.

18

Which of the following drug classes can worsen incontinence? (Select ALL that apply.)

A. Beta blocker eye drops
B. ACE inhibitors
C. Antiplatelets
D. Sedatives and hypnotics
E. Diuretics

B, D, E. Drugs that can worsen continence include diuretics (particularly loops which causes urine to rapidly enter the bladder), sedatives and hypnotics (which can delay response time), ACE Inhibitors (if the cough is present it contributes to stress incontinence), bethanechol, cholinesterase inhibitors and alpha blockers.

19

A female with overactive bladder has been prescribed Detrol LA. The recently-graduated pharmacist is wondering if he should take the time to give the patient a handout on Kegel exercises and what type of counseling is required. Choose the correct responses concerning incontinence, drugs used for overactive bladder and side effect management: (Select ALLthat apply.)

A. Encourage the patient to use sugarless hard candy or gum.
B. Over-the-counter saliva substitutes may provide some benefit.
C. Reduce the use of other drugs that cause dry mouth, such as clonidine, tricyclics and antihistamines.
D. Change to long-acting anticholinergics, the topical oxybutynin gel or patch.
E. Over-the-counter diphenhydramine may provide some benefit.

A, B, C, D. Try to encourage patients to use pelvic floor muscle ("Kegel") exercises. Strengthening the pelvic floor muscles can reduce incontinence episodes more than the use of prescription medications. In many patients, the combination of exercises and medicine can significantly enhance the quality of life. Many patients do not do Kegel exercises correctly; it can be helpful to have a flyer on the correct method to distribute when an urge incontinence medication is dispensed or to those purchasing adult diapers.

20

Alison is a 78 year-old female who has been spending a large percentage of her disposable income on adult diapers. She has been to the physician who instructed her on the use of pelvic floor muscle exercises and gave her a prescription for oxybutynin extended-release 10 mg once daily. What is the most likely side effect that Alison will experience with oxybutynin therapy?

A. Diarrhea
B. Headache
C. Dry mouth
D. Tachycardia
E. Rash

C. Anticholinergic medications used for incontinence can cause anticholinergic side effects, including constipation, dry mouth and dry/blurry vision. The anticholinergic receptor that is blocked on the bladder muscle (muscarinic type 3, or M3) is also prevalent on the salivary glands. This makes dry mouth difficult to avoid, but longer-acting formulations are helpful.

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