Pharmaceutical Care of Over Active Bladder (OAB)

Question 1

What is OAB?

Answer 1

Squeezes suddenly without you having control + when the bladder is not full

Question 2

What is urinary frequency?

Answer 2

Perceived urination too often during the day
More than 8 voids a day = frequent

Question 3

What is urgency?

Answer 3

Sudden compelling desire to urinate
Difficult delay

Question 4

What is nocturia?

Answer 4

If woken at least once during sleep to urinate

Question 5

What is enuresis?

Answer 5

Involuntary urination at night

Question 6

When can OAB develop as a result of nerve-or brain-related disease?

Answer 6

Following stroke
Parkinson’s disease
Multiple sclerosis
After spinal cord injury

Question 7

What is OAB associated with?

Answer 7

Increased risk of falling + sustaining a fracture

Question 8

What are the risk factors for urinary incontinence in women?

Answer 8

Age
Postmenopausal urogenital changes
Overweight
No. of children
Poor obstetric care

Question 9

What is the most common cause of lower urinary tract symptoms (LUTS) in men?

Answer 9

Benign prostate enlargement (BPH)

Question 10

What are red flag symptoms in women?

Answer 10

Persisting bladder or urethral pain
Palpable bladder
Clinically benign pelvic mass
Associated faecal incontinence
Suspected neurological disease
Symptoms of voiding difficulty

Question 11

What is the aim of non-pharmacological treatment?

Answer 11

Measures to control symptoms should be attempted before any other therapy + encouraged throughout treatment

Question 12

What is the 1st line treatments?

Answer 12

Reduce symptoms by simple lifestyle changes = reduce urinary frequency + increase bladder volume

Question 13

What are examples of behavioural treatments?

Answer 13

Bladder retraining
“Double voiding” = spending extra time at toilet
Biofeedback
Pelvic muscle exercises

Question 14

What are pelvic muscle exercises?

Answer 14

Physical therapy kegel exercises = strengthen pelvic floor muscles = support uterus, bladder, small intestine + rectum

Question 15

What is some lifestyle advice?

Answer 15

Drink enough fluids
Limit intake on fizzy drinks, caffeine + alcohol
Lose weight = BMI over 30
Stop smoking
Limit alcohol consumption

Question 16

Why must they drink enough fluids?

Answer 16

Less H2O = more concentrated = irritation = more chance of infection

Question 17

What is bladder training?

Answer 17

1st line = min 6 weeks
Involves = pelvic muscle training, scheduled voiding intervals + distraction/relaxation techniques

Question 18

Before starting treatment what must be explained?

Answer 18

Likelihood of success
Adverse effects
Take at least 4 weeks
Long term effects - eg. anticholinergics

Question 19

What must you take in account for women when offering anticholinergics?

Answer 19

Coexisting conditions
Current use of other medication
Risk of adverse effects

Question 20

What is first line for pharmacological intervention?

Answer 20

Antimuscarinics (anticholinergics)

Question 21

What are examples of anticholinergics?

Answer 21

Oxybutynin
Tolterodine
Solifenacin

Question 22

What are the adverse effects of anticholinergics?

Answer 22

Constipation
Dizziness
Dry mouth
Vision disorders
Headaches
Urinary disorders

Question 23

What happens if first drug is not well-tolerated?

Answer 23

Offer another drug

Question 24

Who do we not offer oxybutynin to?

Answer 24

Frail older women
= risk of fall

Question 25

What can be offered instead if oral not tolerated?

Answer 25

Transdermal

Question 26

What is anticholinergic load + why is it important?

Answer 26

Cumulative effect of taking medication with anticholinergic properties Lots of other medications have antimuscarinic action

Question 27

What other drugs have antimuscarinic action?

Answer 27

TCAs Sedative antihistamines Antipsychotics Anticholinergic respiratory agents Atropine Ipratropium bromide

Question 28

What can a high anticholinergic load lead to?

Answer 28

Physical + cognitive impairment in older adults = feel side effects more

Question 29

What is Mirabegron?

Answer 29

Selective beta3 agonist

Question 30

What is Mirabegron licensed for?

Answer 30

Urinary frequency, urgency + urge incontinence associated with OAB

Question 31

When is Mirabegron recommended?

Answer 31

Antimuscarinic drugs are contraindicated or clinically ineffective

Question 32

When is Desmopressin considered?

Answer 32

To reduce troublesome nocturia in women with UI or OAB

Question 33

When is Desmopressin cautioned?

Answer 33

Women with cystic fibrosis + those over 65 with cardiovascular disease/hypertension

Question 34

What is Duloxetine?

Answer 34

SSRI

Question 35

When do you NOT use Duloxetine as 1st line?

Answer 35

Women with predominant stress UI

Question 36

What does duloxetine require?

Answer 36

Counselling on adverse effects

Question 37

What is OAB in older women associated with?

Answer 37

Falls Hip fractures Anxiety/depression Social isolation = decrease QoL

Question 38

What is frailty?

Answer 38

Decline in physiologic reserves = increase susceptibility to adverse events