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Pharm II Exam 2 Questions And Answers
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Pharm II Exam 2 Questions And Answers Pharm II Exam 2 Questions And Answers Pharm II Exam 2 Questions And Answers
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Pharm II Exam 2 Questions AndAnswers
___ closes to prevent incontinence when bladder fills - ANS Urethral sphincter
Occurs with decrease in urethral sphincter tone and bladder contraction - ANS Bladder emptying
Primary neurotransmitter for bladder emptying and contractions - ANS Ach
Which muscarinic receptors mediate bladder emptying and involuntary bladder contractions? - ANS
M2/M3
Results from increased abdominal pressure under stress (weak pelvic floor muscles, ex: childbirth,
aging) - ANS Stress incontinence
Due to involuntary bladder muscle contractions - ANS Urge incontinence
How is urge incontinence often treated? - ANS Pharmacologically
Caused by blockage of the urethra or overstretched bladder (ex: BPH) - ANS Overflow incontinence
What is first line for treating urge incontinence? - ANS Non pharmacologic methods
Non-pharmacologic method to manage urinary incontinence - ANS Bladder training
Pelvic floor strengthening (Kegels, weights) --> stress incontinence
Biofeedback
Extracorporeal magnetic innervation
Intravaginal supports
,Disposable pads
Catheters for overflow incontinence
Surgery
Exercises like Kegals to address stress incontinence - ANS Pelvic floor strengthening exercises
Medications that block M3 receptors for urge incontinence and decrease detrusor muscle
contraction - ANS Anticholinergics/ antispasmodics
Older anticholinergic for urge incontinence, nonselective, CYP3A4 - ANS Oxybutynin (IR and XL)
Why is Oxybutynin no longer recommended? - ANS B/c it is nonselective and has a lot of side
effects!
Newer anticholinergic for urge incontinence - ANS Darifenacin, fesoterodine, solifenacin, tolterodine
What is the biggest hindrance to use when it comes to using these newer anticholinergics to treat
urge incontinence? - ANS Anticholinergic side effects
What are the anticholinergic side effects? - ANS Sedation, dry mouth, dilated pupils, blurred vision,
weight gain, potential effect on cognition (older drugs)
Why do anticholinergic drugs have the possibility of causing tachycardia, palpitations, and cardiac
rhythm disorders? - ANS B/c of muscarinc receptors in the heart (increase in HR by acting on M1
receptors)
All OAB antimuscarinics are contraindicated in patients with what comorbidities? - ANS Heart
disease
Myasthenia gravis
,Long QT
Neurologic disorders
Constipation
Bladder outflow obstruction (ex: tumor pressing on bladder outflow tract)
It can take up to ____ weeks for urge incontinence medications to work - ANS 4 weeks
Most common newer anticholinergic for urge incontinence - ANS Tolterodine (Detrol)
What is the MOA of tolterodine (Detrol)? - ANS Muscarinic receptor blocker used for urge
incontinence
What is the pharmacology of tolterodine? - ANS Eliminated by hepatic metabolism (CYP2D6), watch
for drug interactions
Most common A/E of tolterodine? - ANS Dry mouth/dry eyes
HA
Constipation
The long acting form of tolterodine may have fewer side effects and is better tolerated than
oxybutynin. Why? - ANS B/c more constant and lower level of drug in the system than big peaks and
valleys with shorter acting drugs
Newer antimuscarinic drugs that are more selective and better tolerated (also more expensive) -
ANS Vesicare (Solifenacin succinate)
Enablex (darifenacin Hydrochloride)
, What is the MOA of vesicare? - ANS Antimuscarinic drug that blocks Ach and relaxes smooth muscle
in the bladder wall
What is the MOA of Enablex? - ANS Selective antagonist of M3 muscarinic receptor that limits
bladder contractions, reducing symptoms of bladder irritability/ovaractivity
AE of Vesicare and Enablex? - ANS Anticholinergic (dry mouth/dry eyes, HA, constipation)
Antimuscarinic for tx of urge incontinence that is a direct antagonist at muscarinic acetylcholine
receptors in cholinergically innervated orgANS (M3 in bladder) - ANS Trospium Cl (SANCTURA XR)
What are the benefits of using trospium Cl over other antimuscarinics to treat urge incontinence? -
ANS Fewer drug interactions d/t less hepatic metabolism
Trospium Cl has renal clearance, so careful in those with _____ - ANS Kidney disease
AE of Trospium Cl - ANS Dry mouth (less than others)/dry eyes
HA
Constipation
Antimuscarinic used in treatment of urge incontinence that is similar to Detrol LA (tolterodine). Both
have same active metabolite and same efficacy and AE at 4 mg dose, but ____ also comes in 8 mg
tab which can increase efficacy - ANS Toviaz (fesoterodine)
New TOPICAL form of oxybutynin - ANS Gelnique
What are the benefits of using Gelnique for urge incontinence treatment? - ANS Applying topically
produces lower blood levels and avoids the first pass metabolism so there are fewer anticholinergic
effects
Where do you apply gelnique? - ANS Shoulders, upper arms, abdomen
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