Overactive bladder

Question 1

what are 6 anticholinergics for overactive bladder

Answer 1

oxybutynin 
Tolterodine 
Fesoterodine 
Solifenacin 
Darifenacin

Question 2

a lot of pts have ___ with oxybutynin IR

Answer 2

tolerability issues

Question 3

half life of oxybutynin IR

Answer 3

1-3 hours

Question 4

oxybutynin ADR

Answer 4

dizzy, confusion, somnolence
constipation
vision impairment
cognitive dysfunction, tachycardia

Question 5

with oxybutynin “ “

Answer 5

start low dose and go slow

Question 6

XL oxybutynin reaches full effect after

Answer 6

4 weeks

Question 7

___ avoids first pass

Answer 7

oxbutynin patch

Question 8

MOA of tolterodine

Answer 8

competitive muscarinic receptor antagonist

Question 9

3 specific indications tolterodine

Answer 9

urge incontinence, urinary frequency or urgency

Question 10

ADR of tolterodine

Answer 10

dry mouth, dyspepsia, HA, constipation, dry eyes

Question 11

full effect of tolterodine at

Answer 11

8 wks

Question 12

p450 and tolterodine

Answer 12

needs 2D6 and 3A4..decreased elimination with cirrhosis

Question 13

what drug requires ___ reduction of dose if there is cirrhosis or ____

Answer 13

50%
taking a 3A4 inhibitor
answer: tolterodine

Question 14

concerns for ____ in 2D6 poor metabolizers with ___med

Answer 14

long QT

tolterodine

Question 15

___ messes up tolterodine kinetics

Answer 15

antacids omeprazole - leads to rapid LA release

Question 16

______ med is good for renal pts who need overactive bladder tx

Answer 16

fesoterodine

Question 17

usually for overactive bladder use ____

Answer 17

oxybutynin or tolterodine

Question 18

fesoterodine reduces ____

Answer 18

daily micturitions, frequency of weekly urination and urgency episodes

Question 19

ADR of fesoterodine_

Answer 19

dry mouth, constipation, dry eyes

Question 20

____ does not require dose adjustment for mild to moderate liver or renal impairment

Answer 20

fesoterodine

Question 21

___ is a prodrug

Answer 21

fesoterodine

Question 22

indication of fesoterodine

Answer 22

alternative therapy for urge incontince, urinary frequency or urgency

Question 23

___ has increased ADR in pts over 75

Answer 23

trospium

Question 24

___ not recommended in severe renal impairment

Answer 24

trospium

Question 25

Trospium not as effect yet 2 benefits are___

Answer 25

no p450 interactions good for renal pts

Question 26

____ is a selective muscarinic antagonist

Answer 26

solifenacin

M1,2 and 3 receptors

Question 27

____ is ___ protein bound

Answer 27

solifenacin

98%

Question 28

p450 and solifenacin

Answer 28

CYP3A4

Question 29

darifenacin has greater affininty for ___

Answer 29

M3 receptors

Question 30

p450 and darifenacin

Answer 30

2D6 - no dose changes needed with inhibitors

3A4: max 7.5 mg if taking inhibitor

Question 31

mirabegron is the first___

Answer 31

b3 agonist

Question 32

mirabegron does 2 things

Answer 32

relaxes detrusor muscle

increases bladder capacity

Question 33

concern with mirabegron

Answer 33

can activate beta 1 at high doses

Question 34

p450 and mirabegron

Answer 34

CYP2D6 inhibitor - careful with metoprolol and despiramine

Question 35

first line for OAB

Answer 35

behavioral therapy

Question 36

second line OAB

Answer 36

antimuscarinic or b3 agonist

use XR if available

Question 37

what are main OAB cautions

Answer 37

narrow angle glaucoma
impaired gastric emptying
urinary retention

Question 38

3rd line OAB

Answer 38

botox injections into detrusor muscle

removes spasms and contractions