Deyaniri Hernandez

20 hours ago, at 11:20 PM



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1.What factors in MP's history would help support a diagnosis of overactive bladder?

The term overactive bladder was first used in 1997. It refers to a group of conditions, including bladder instability, unstable bladder, urgency incontinence, and frequency-urgency syndrome. The International Continence Society (ICS) defines  overactive bladder as a syndrome characterized by urgency, with or without urgency incontinence, usually with increased daytime frequency and nocturia in a setting with no proven infection or other pathology.

Factor in MP's history that support the diagnosis of overactive bladder :

1.Age (55 years old) and menopause: The decrease in estrogen levels at this life stage in women has been related to atrophic modifications in the lower urinary tract. Estrogen receptors can be found in the bladder (trigone) and urethra, disturbing detrusor function and urethral closure(Stewart et al., 2019.

2. Patient's inability to hold urine, accompanied by incidents where urine leakage occurs with increased intraabdominal pressure, like when laughing or coughing, supports the specific diagnosis of mixed urinary incontinence because both stress and urge urinary incontinence are present.

3. Six vaginal deliveries, all to full term, could lead to changes in the pelvic floor structure.

4. Finding of the enlarged uterus at palpation: Pressure exerted on the bladder results in early filling and discomfort, resulting in symptoms of overactive bladder, similar to what pregnant patients experience because of an expanding uterus. (Stewart et al., 2019)

3.   The clinician prescribes oxybutynin 10 mg (extended-release). What does MP need to know about this drug? 

The clinician should know that oxybutynin is a competitive agonist for M1, M2, and M3 muscarinic acetylcholine receptors. This medication can produce significant side effects such as dry mouth, dry eyes, constipation, blurred vision, dyspepsia, UTI secondary to urinary retention, and altered mental status in patients 60 years and older (Stewart et al., 2019).It is contraindicated in patients with urinary retention, bladder obstruction, poorly narrow-angle controlled glaucoma, obstructive gastric disorders, gastric dysmotility and in patients with hypersensitivity to the drug or its components (Homma et al., 2020).

4.  If oxybutynin is ineffective, the clinician could use mirabegron, a beta-3 agonist. What does MP need to know about this new drug?

Myrbetriq (mirabegron) targets the ß3-adrenergic receptor (AR) pathway. It is indicated alone or in combination with solifenacin succinate for treating overactive bladder. This medication is contraindicated in patients with known hypersensitivity reactions to miragebron or any of its inactive ingredients. It can cause side effects like hypertension, and it should be used with caution in patients where systolic blood pressure is higher or equal to 180 mmHg and /or diastolic blood pressure is higher or equal to equal to 110 mmHg). Caution also needs to be exercised when bladder outlet obstruction is

Natacha Cardentey

Discussion 5

Overactive Bladder Syndrome: Causes and Treatment

1. The main factor that supports MP's overactive bladder (OAB) diagnosis is her vaginal deliveries. MP has had six full-term pregnancies, all of which were vaginally delivered, which may have weakened her pelvic floor muscles and made her more susceptible to OAB. Overactive bladder is also common in older people, but it can begin in midlife for some women (Zhu et al., 2019). Because of the reduction in estrogen levels, which occurs with post-menopause, the urethra's lining and the muscles around it can become thinner and weaker, a condition known as pelvic relaxation. Moreover, smoking can increase the prevalence and severity of overactive bladder symptoms (AOB). Research shows that present and former smokers face urine incontinence more frequently than non-smokers (Kawahara et al., 2020). However, family history and osteoarthritis are rare causes of incontinence, even though they account for a sizable proportion of the risks among people with AOB.

2. MP should know that oxybutynin can cause drowsiness and blurred vision. Therefore, she should only drive or operate machinery once she knows how the drug affects her. Moreover, she should be aware that oxybutynin might impair her body's ability to cool down, which could be dangerous in extreme heat (American Society of Health-System Pharmacists,2021). Therefore, she should avoid intense heat exposure and seek medical attention if she develops a fever or other symptoms of heat stroke, such as nausea, dizziness, confusion, headache, and quick pulse.

3. MP should know that mirabegron, a beta-3 agonist for OAB, is a safe alternative to treat her OAB symptoms and improve her quality of life. This new drug reduces incidents of incontinence and micturitions per day. However, she should take note of likely mirabegron reactions such as hypertension, tachycardia, headaches, and fatigue. Other possible side effects include constipation, arthralgia, upper stomach pain, nasopharyngitis, and urinary tract infection (Bragg et al., 2015). However, she should know that overall, mirabegron is a safe and effective alternative to oxybutynin for people with OAB.

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