Chapter 52: Urinary Incontinence

Question 1

Urinary urgency

Answer 1

a sudden feeling of needing to urinate

Question 2

urinary incontinence

Answer 2

involuntary leakage of urine

Question 3

Urge incontinence is associated with

Answer 3

Neuropathy

Question 4

What is stress incontinence

Answer 4

Urine leaks out during any form of exertion

Question 5

What is the most common cause of overflow incontinence

Answer 5

BPH

Question 6

Overactive Bladder (OAB) cause

Answer 6

inappropriate stimulation of the muscarinic receptors on the detrusor muscle causing involuntary contractions and the feeling of urinary urgency

Question 7

The detrusor muscle is innervated mainly by the ___ nervous system

Answer 7

parasympathetic (Ach acting on muscarinic receptors)

Question 8

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

Answer 8

M3

M2 and M3 on the bladder in 3:1 ratio

Question 9

Risk factors for overactive bladder

Answer 9

Age > 40 years
Diabetes
Prior vaginal delivery
Drugs that increase incontinence

Question 10

First-line to improve overactive bladder symptoms

Answer 10

Behavioral therapies (pelvic floor muscle exercises - Kegel exercises), avoiding caffeine, fluid management, weight loss

Question 11

First-line drugs for urge/mixed incontinence

Answer 11

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

OnabotulinumtoxinA (Botox) high efficacy, very expensive so not 1st line

Question 12

Which formulation of anticholinergics are preferred for OAB

Answer 12

ER due to a lower risk of dry mouth

Question 13

Anticholinergics should be avoided in

Answer 13

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

Question 14

Oxybutinin ER brand name

Answer 14

Ditropan XL

Question 15

Oxybutinin patch brand name

Answer 15

Oxytrol

Question 16

How often is oxybutinin patch applied

Answer 16

twice weekly

Question 17

Tolterodine brand name

Answer 17

Detrol/ Detrol LA

Question 18

How should trospium be taken

Answer 18

on empty stomach

Question 19

Solifenacin brand name

Answer 19

Vesicare

Question 20

Anticholinergic CI

Answer 20

uncontrolled narrow angle glaucoma

Question 21

Anticholinergic warnings

Answer 21

agitation, confusion, drowsiness, blurred vision

Question 22

Anticholinergic SE

Answer 22

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

Question 23

Ditropan XL counseling point

Answer 23

OROS formulation - ghost tablet

Question 24

Oxybutinin patch and gel cause less

Answer 24

dry mouth

Question 25

Which anticholinergic is also available OTC

Answer 25

oxybutinin patch

Question 26

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

Answer 26

Mirabegron

Question 27

Mirabegron MOA

Answer 27

beta-3 receptor agonist that causes relaxation of the detrusor muscle (prevents contraction)

Question 28

Mirabegron warning

Answer 28

urinary retention

Question 29

Mirabegron SE

Answer 29

HTN

Question 30

Which drug is used for nocturia

Answer 30

desmopressin (ADH analog)

Question 31

Desmopressin MOA

Answer 31

temporarily decreases urine production (ADH analog)

Question 32

Desmopressin BW

Answer 32

severe hyponatremia (life-threatening)

Question 33

Desmopressin CI

Answer 33

fluid retention

Question 34

Desmopressin monitoring

Answer 34

serum Na