Terms in this set (12)
These drugs bind primarily to the muscarinic M3 receptor on the bladder muscle wall. - The agents used for urge incontinence are anticholinergics (or acetylcholine antagonists) that block acetylcholine at the M3 receptor. Some are more specific for M3 and some hit other receptors as well.
Drugs used for urge incontinence bind to a specific subtype of anticholinergic receptor. Choose the correct statement concerning the receptor:
Limit consumption of caffeinated beverages
Start oxybutynin OTC transdermal patch
Perform pelvic floor muscle exercises
Patty Ravani is a 67 year-old woman who reports frequent nightly awakenings and trips to the bathroom several nights per week. She explains that she often gets the urge to urinate unexpectedly and cannot always make it to the bathroom in time. She tells of an incident the other day when she "was out with friends and had an accident in the restaurant." Ms. Ravani was extremely embarrassed and does not want that to happen again. She of her pharmacist what she can do to treat her frequent and sometimes uncontrollable urge to go to the bathroom. Which of the following are appropriate recommendations? (Select ALL that apply.)
Prior vaginal delivery
History of stroke or dementia
Increased age - Obesity, not underweight, increases incontinence risk. Other risk factors include diabetes, hysterectomy, neurologic conditions (such as having had a stroke, dementia or Parkinson's disease), and pelvic injury.
Pharmacists who work in the community and witness the large numbers of elderly patients purchasing Depends and other adult diapers understand the high prevalence of incontinence. Over half of elderly women have some form of incontinence. Which of the following are risk factors for incontinence? (Select ALL that apply.)
The most common side effects are dry mouth and constipation.
Do not use this or other urge incontinence medications if the patient has glaucoma.
Darifenacin should be swallowed whole and not chewed, divided or crushed.
Darifenacin is taken once daily, with liquid. - Darifenacin is taken once daily, with liquid, and with or without food. The anticholinergics are not safe to use if the patient has glaucoma. Nothing that has considerable anticholinergic properties can be used safely with glaucoma; they can raise intraocular pressure.
A female with overactive bladder has been prescribed darifenacin once daily. Choose the correct statements concerning darifenacin: (Select ALL that apply.)
She is likely to experience some dry mouth and should be counseled on ways to relieve this condition.
It is best to combine the use of prescription drugs with pelvic floor (Kegel) exercises. - The agents in common use do not penetrate the CNS to a great degree; if they did, they could not be used for this purpose. However, some will experience more CNS effects than others, and the risk is present with any of these agents. A centrally-acting anticholinergic such as benztropine (and even diphenhydramine, to some extent) would cause urinary retention, but would have much higher CNS penetration and CNS side effects. Patients having incontinence should not always be treated with prescription agents even though incontinence episodes are a major contributor to nursing home placement; the anticholinergics used for urge incontinence have mild benefit and contribute (primarily) to dry mouth.
Agnes Simba, an 82 year-old female, will begin Detrol LA for urge incontinence. Which of the following statements concerning Detrol LA are correct? (Select ALL that apply.)
Urge - The term "overflow incontinence" is used primarily for BPH, and "functional incontinence" means that the person cannot reach the restroom in time, which could be due to having a problem with movement from a stroke, Parkinson's disease, paralysis or other conditions.
Older women predominantly have a problem with a sudden need to use the restroom, which can result in leakage of a larger amount of urine. What is the term for this type of incontinence?
A patient gave the pharmacist a prescription for Enablex 7.5 mg once daily #30. Which of the following is an appropriate generic substitution for Enablex?
Reduce the dose with severe renal impairment (15-29 mL/min) and avoid use altogether with a CrCl less than 15 mL/min.
The side effect of most concern with the use of this drug is blood pressure elevation. - The brand name of mirabegron is Myrbetriq.
Which of the following statements concerning mirabegron are correct? (Select ALL that apply.)
Encourage the patient to use sugarless hard candy or gum.
Over-the-counter saliva substitutes may provide some benefit.
Reduce the use of other drugs that cause dry mouth, such as clonidine, tricyclics and antihistamines.
Change to long-acting anticholinergics, the topical oxybutynin gel or patch. - Try to encourage patients to use pelvic floor muscle ("Kegel") exercises. Strengthening the pelvic floor muscles can reduce incontinence episodes more than the use of prescription medications. In many patients, the combination of exercises and medicine can significantly enhance the quality of life. Many patients do not do Kegel exercises correctly.
A female with overactive bladder has been prescribed Detrol LA. The recently-graduated pharmacist is wondering if he should take the time to give the patient a handout on Kegel exercises and what type of counseling is required. Choose the correct responses concerning incontinence, drugs used for overactive bladder and side effect management: (Select ALL that apply.)
Stress - Stress incontinence results when the muscles and tissue that help support the bladder become weak. The muscles can be strengthened with exercise.
There are different types of incontinence. Younger women predominantly have a problem with leakage of urine when they laugh, sneeze, cough, jog, or lift something heavy. What is the term for this type of incontinence?
The long-acting formulation has less dry mouth because it does not cause a high drug "peak". - Side effects generally occur when drugs hit the "wrong" receptor. When an immediate-release formulation is used, it reaches a higher peak than the longer-acting formulation. More of the drug is available to interact with the "wrong" receptor and side effects increase.
A physician is wondering if he should use oxybutynin immediate-release or the long-acting formulation. Both are on the patient's formulary. He asks the pharmacist which formulation is likely to cause more side effects such as dry mouth or blurry vision. He also wants to know why the formulation changes the side effect profile. Choose the most appropriate response:
A patient gave the pharmacist a prescription for Vesicare 5 mg once daily #30. Which of the following is an appropriate generic substitution for Vesicare?