Chapter 52: Urinary Incontinence

Question 1

What is the priamry symptom of overactive bladder?

Answer 1

Urinary urgency with or without incontinence

Question 2

What is urge incontinence associated with?

Answer 2

Neuropathy

Question 3

What is stress incontinence?

Answer 3

Urine leaks out during any form of exertion

Question 4

What is the most common cause of overflow incontinence?

Answer 4

BPH

Question 5

What nervous system innervates the detrusor muscle?

Answer 5

Parasympathetic

Ach acts on muscarinic receptors

Question 6

Which receptor is responsible for both emptying contractions as well as involuntary bladder contractions?

Answer 6

M3

Question 7

Risk factors for overactive bladder

Answer 7

• Age > 40 years
• Diabetes
• Prior vaginal delivery
• Obesity
• Neurological conditions (PK, stroke)
• Drugs that increase incontinence

Question 8

What is the first-line treatment to improve overactive bladder symptoms?

Answer 8

Behavioral therapies (pelvic floor muscle exercises - Kegel exercises)

Question 9

What are the first-line drugs for urge/mixed incontinence?

Answer 9

Anticholinergics (e.g., oxybutinin) and B3 receptor agonist (i.e., mirabegron)

Question 10

Which formulation of anticholinergics are preferred for OAB?

Answer 10

Extended release (ER) due to a lower risk of dry mouth

Question 11

In which population should anticholinergics be avoided?

Answer 11

Elderly 65+ due to risk of delirium and cognitive impairment (BEERS criteria)

Question 12

Oxybutinin XL brand name

Answer 12

Ditropan CL

Question 13

Oxybutinin patch brand name

Answer 13

Oxytrol

Question 14

How often is oxybutinin patch applied

Answer 14

twice weekly

Question 15

Tolterodine brand name

Answer 15

Detrol

Question 16

How should trospium be taken

Answer 16

on empty stomach

Question 17

Solifenacin brand name

Answer 17

Vesicare

Question 18

Anticholinergic contraindications

Answer 18

narrow angle glaucoma

Question 19

Anticholinergic warnings

Answer 19

agitation, confusion, drowsiness, blurred vision

Question 20

Anticholinergic side effects

Answer 20

dizziness, drowsiness (greatest with oxybutinin), xerostomia, constipation, dry mouth, dry eyes, blurred vision, urinary retention, sedation, cognitive impairment

Question 21

Ditropan XL counseling point

Answer 21

OROS formulation - ghost tablet

Question 22

Oxybutinin patch and gel cause less

Answer 22

dry mouth

Question 23

Which drug has a lower incidence of dry mouth and can be used in patients who cannot tolerate anticholinergics?

Answer 23

Mirabegron

Question 24

What is the mechanism of action (MOA) of Mirabegron?

Answer 24

Relaxes detrusor muscle and increases bladder capacity by activating B3 receptors

Question 25

What is a warning associated with Mirabegron?

Answer 25

Urinary retention

Question 26

What is a side effect (SE) of Mirabegron?

Answer 26

HTN

Question 27

Which drug is used for nocturia?

Answer 27

desmopressin (ADH analog)

Question 28

What is the mechanism of action (MOA) of desmopressin?

Answer 28

temporarily decreases urine production (ADH analog)

Question 29

What is the black box warning (BW) for desmopressin?

Answer 29

hyponatremia

Question 30

What are the contraindications (CI) for desmopressin?

Answer 30

fluid retention

Question 31

What should be monitored when using desmopressin?

Answer 31

serum NA