Therapeutics - Urinary Incontinence 2

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Therapeutics - Urinary Incontinence 2
2014-08-27 12:51:35
Therapeutics Urinary Incontinence
Therapeutics - Urinary Incontinence 2
Therapeutics - Urinary Incontinence 2
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  1. What are the requirements for use of the oxytrol patch?
    • Indicated for WOMEN with 2 of the following symptoms for 3 months:
    • 1) Urinating 8 or more times per day
    • 2) Urgent need to urinate
    • 3) Inability to control the urge to go
  2. What are the CIs for the Oxytrol patch?
    • UTI or GERD symptoms
    • Uncontrolled narrow angle glaucoma
    • Esophagitis
  3. Other than Oxybutynin, what other drugs are first line for Urge UI?
    • Tolterodine (Detrol)
    • Fesoterodine (Toviaz)
  4. What class of drug is Tolterodine?
    Muscarinic receptor antagonist
  5. What are the dosage forms available for Tolterodine (Detrol)?
    LA and XL
  6. What special characteristic does the LA form of Tolterodine (Detrol) have?
    More effective than the XL form, but may take up to 8 weeks to be effective
  7. How is Tolterodine metabolized?
    By 2D6, 3A4
  8. What DDIs does Tolterodine (Detrol) have?
    Antacids cause rapid release of the drug in the LA form
  9. What are the AE of Tolterodine (Detrol)?
    • Dry mouth
    • Dyspepsia
    • HA
    • Constipation
    • Dry eyes
  10. Fesoterodine (Toviaz) is related to Tolterodine in what way?
    Prodrug (5-hydroxymethyl tolterodine)
  11. What is the dose of Fesoterodine (Toviaz) when CrCl < 30 mL/min or taking potent CYP3A4 inhibitor?
    4 mg/day
  12. What are the AE for Fesoterodine (Toviaz)?
    Dry mouth, constipation, dry eyes
  13. What is Trospium (Sanctura) FDA approved for?
    Overactive bladder with accompanying urgency
  14. How should you take IR and XR Trospium (Sanctura)?
    • Must be taken on empty stomach 1 hr before
    • OR
    • 2 hours after meals
    • XR - alcohol should not be consumed within 2 hours
  15. Which formulation of Trospium (Sanctura) requires renal dose adjustment?
    • IR
    • XR not recommended in renal failure
  16. Solifenacin (Vesicare) is what class of drug?
    M1, M2, M3 antagonist
  17. Dose limits exist for Solifenacin (Vesicare) in what situations?
    Renal and hepatic dysfunction
  18. For Solifenacin (Vesicare), don’t exceed 5 mg under what situations?
    If on other CYP3A4 inhibitors
  19. Darifenacin (Enablex) is what class of drug?
    M1, M3, M5 antagonist
  20. What form of Darifenacin (Enablex) has increased bioavailability?
    ER (compared to IR)
  21. How is Darifenacin (Enablex) metabolized?
    CYP 2D6 and 3A4
  22. What is the Beta 3 agonist used for Urge UI?
    Mirabegron (Myrbetria)
  23. When is Mirabegron (Myrbetria) recommended?
    For patients who don’t tolerate or respond to antimuscarinics
  24. Should you combine Mirabegron (Myrbetria) with antimuscarinics?
    • Not enough evidence for
    • How is Mirabegron (Myrbetria)
    • Metabolized?
    • 2D6
  25. What drug can Mirabegron (Myrbetria) increase the levels of?
  26. What UI drug increases Digoxin?
    Mirabegron (Myrbetria)
  27. What are the AE for Mirabegron?
    • N/D
    • Consitpation
    • Dizziness
    • HTN
    • HA
  28. When is Mirabegron (Myrbetria) not recommended?
    Uncontrolled HTN >180/110
  29. What drugs are available for Urge UI?
    • Oxybutynin (Ditropan)
    • Oxytrol patch
    • Tolterodine (Detrol)
    • Fesoterodine (Toviaz)
    • Solifenacin (Vesicare)
    • Darifenacin (Enablex)
    • Mirabegron (Myrbetria)
    • Botulinum toxin A (Botox)
  30. Is Botox approved for Urege UI by the FDA?
  31. What is the MOA of Botox?
    Inhibits acetylcholine release
  32. What is the OOA of Botox?
    3-7 days
  33. How often must Botox be re-administered for Urge UI?
    4-8 months
  34. What are the AE for botox in the treatment of UI?
    • Urinary retention
    • Dysuria
    • Hematuria
    • UTI
  35. What are the CIs for Botox in the treatment of UI?
    UTI or other infection
  36. What are the treatment options for Overflow incontinence?
    Intermittent catheterization Bethanechol
  37. What are the treatment options for Functional incontinence?
    • Scheduled toileting
    • Placement of urinal or commode at bedside