OAB

Question 1

Which is the best choice for patients with OAB and cognitive dysfunction?

a) PO oxybutinin
b) tolterodine
c) solifenacin or darifenacin
d) transdermal oxybutinin
e) fesoterodine

Answer 1

c

Question 2

Which of the following is true?

a) bladder training is more effective than anticholinergic therapy for OAB
b) electric stimulation is more effective than anticholinergics for OAB
c) anticholinergics are more effective than either bladder training or electric stimulation
d) bladder training, electric stimulation, and anticholinergics are all equally effective
e) combination of more than one modality is more effective than any one treatment for OAB

Answer 2

d

Question 3

Choose all correct approaches to patient experiencing significant ADEs with oxybutinin:

a) lower dose
b) change from transdermal to oral dosing
c) change from extended release to immediate release
d) change medication to solifenacin

Answer 3

a true
b false -TD less ADEs
c false ER less ADEs than IR
d true

Question 4

Options for OAB not-responding to anticholinergic therapy include:

a) PO low dose estrogen
b) botulinum injection
c) sacral nerve stimulation
d) vaginal estrogen applied topically

Answer 4

a) false
b) true
c) true
d) true

Question 5

Choose all correct answers:

a) anticholinergics competitively inhibit acetylcholine stimulation of M2 and M3 receptors at the bladder and muscarinic receptors at the level of detrusor
b) anticholinergics are lipophilic and therefore cross the blood brain barrier
c) tolterodine (detrol) and solifenacin (vesicare) can cause inc in QT interval
d) trospium is the only ACh med metabolized by CYP450

Answer 5

a) true
b) true
c) true
d) false -trospium is the only ACh NOT metabolized by CYP450

Question 6

Choose all correct answers:

a) detrol has low CYP450 metabolism and is therefore a good choice for patients on other CYP450 meds
b) the most common side effect with vesicare is dry mouth
c) enablex is a selective M2 blocker
d) enablex is less likely than other ACh drugs to cause changes in heart rate or cognitive impairment

Answer 6

a) true
b) true
c) false -selective M3 blocker
d) true

Question 7

List 4 absolute contraindications to Anticholinergic medication use.

Answer 7

1. uncontrolled closed angle glaucoma
2. urinary retention
3. gastric retention
4. known hypersensitivity

Question 8

List 5 relative contraindications to Anticholinergic medication use.

Answer 8

1. controlled narrow-angle glaucoma
2. bladder outlet obstruction
3. hepatic/renal dysfunction
4. cognitive impairment
5. decreased GI motility (constipation)
6. myasthenia gravis
7. excessive EtOH intake (added sedating effect)

Question 9

Of patients started on an ACh for OAB, what percentage will still be taking the med in one year?

Answer 9

13% (high discontinuation rate due to side effect profile)

improved continuation rate if: white race, prev hospitalization, starting with tolterodine or oxybutinin XR

Question 10

Choose all correct answers:

a) tricyclic antidepressants are as effective for the control of OAB symptoms as anticholinergics
b) tricyclic antidepressants are more effective than ACh medications for the treatment of night symptoms
c) myrbetriq is a beta-3 agonist which is just as effective as the ACh agents for the treatment of OAB
d) myrbetriq can be used in patients with contraindication to ACh including narrow-angle glaucoma
e) myrbetriq is contraindicated in patients with uncontrolled HTN

Answer 10

a) false
b) true
c) true
d) true
e) true