Urinary Incontinence

Question 1

What are the three major types of UI?

Answer 1

Stress, urge, overflow

Question 2

Which medications are indicated for STRESS UI

Answer 2

None. Only off label: duloxetine and alpha agonists

Question 3

What medications are indicated for URGE UI?

Answer 3

Antimuscarinics and beta-1 agaonists

Question 4

What are the antimuscurinics used in UI?

Answer 4

1. Enablex - darifenacin
2. Toviaz - fesoterodine ER
3. Ditropan (XL) - oxybutynin; Gelnique - oxybutynin gel ; Oxytrol - oxybutynin patch
4. Vesicare - solifenacin
5. Detrol (LA) - tolteridone
6. Sanctura (XR) - trospium

Question 5

What are the 2 beta-2 agonists used in UI?

Answer 5

Myrbetriq- Mirabegron
Gemtasa - Vibegron

Question 6

What are the 3 medications used in UI that can prolong QT?

Answer 6

Vesicare, Detrol, and Myrbetriq

Question 7

Which UI meds do not need to be adjusted for renal impairment?

Answer 7

Oxybutynin and darifenacin (Enablex)

Question 8

Which is the best UI med for cognitive impairment? Which is the worse? and why?

Answer 8

Trospium, does not cross BBB, less cognitive adverse effects. Enablex is most selective for M3
Oxybutynin most like to cross BBB

Question 9

T/F: M1 receptors are in brain. M3 receptors are in bladder?

Answer 9

True.

Question 10

Which UI medications are cause the most constipation and dry mouth?

Answer 10

Oxybutynin and darifenacin. Oxybutynin IR > dry mouth

Question 11

T/F: trospium’s bioavailability is affected by food, so it must be taken on an empty stomach

Answer 11

True. food decreases its bioavailability by 70-80%. Administer 1 hr before meal on an empty stomach (XR recommends in morning)

*Ir and XR avail, XR better with dry mouth and constipation
* Lowest risk for drug-drug interactions

Question 12

T/F: beta-3 agonists used for UI can cause high blood pressure, use with caution in these patients with uncontrolled HTN

Answer 12

True.

Question 13

Which UI meds must be adjusted for hepatic impairment?

Answer 13

darifenacin (CYP3A4 adjustments as well)
solifenacin (CYP3A4)
tolteridone (CYP3A4) not rec for severe hepatic impairment
mirabegron no adjustment for mild to mod hepatic or renal impairment, severe hepatic impairment = not recommended

Question 14

T/F. Beta-3 muscarinics used in UI can cause nasopharyngitis

Answer 14

True

Question 15

How long should the trial time be for UI medications before deeming it unsuccessful?

Answer 15

4-8 weeks

Question 16

T/F: For you UI, antimuscarinics and beta-3 agonists are second line to nonpharm?

Answer 16

True

Question 17

T/F: antimuscarinics and beta-3 agonists can be used together in UI?

Answer 17

True. ie. oxybutin and mybetriq

Question 18

Which antimuscurinic is the prodrug for tolteridone (Detrol)?

Answer 18

fesoteridone (Toviaz)