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INTRODUCTION

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CASE LEARNING OBJECTIVES

  • Contrast the pathophysiology of overactive bladder with other major types of urinary incontinence (i.e., stress, overflow, functional)

  • Recognize the signs and symptoms of overactive bladder

  • List the treatment goals for a patient with urinary incontinence, including overactive bladder

  • Compare and contrast anticholinergics/antispasmodics, vaginal estrogens, tricyclic antidepressants, and α-adrenoceptor antagonists in terms of mechanism of action, treatment outcomes, adverse effects, and drug–drug interaction potential when used to manage overactive bladder

  • Identify the factors that guide drug selection for an individual patient

  • Describe the indicators for combination drug therapy of urinary incontinence

  • Describe the nonpharmacologic treatment approaches (including surgery) for overactive bladder

  • Formulate appropriate patient-counseling information for patients undergoing drug therapy for overactive bladder

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Chief Complaint

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"I tried bladder medicine but it didn't help my overactive bladder very much. Do you have any better pads than these to protect me when I need it?"

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History of Present Illness

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Phoebe J. Engling, a 72-year-old woman, comes to the pharmacy for a refill of her pain medicine. She was recently hospitalized for dehydration and possible head injury after falling. Despite behavioral therapy and regular use of absorbent pads and undergarments, she is embarrassed and bothered by uncontrollable wetting of her clothing for at least a couple of years. She was initially told by her physician not to worry about urine leakage, that this can be expected with aging. With trepidation, she revealed she may have become dehydrated while trying to relieve her wetting accidents by limiting her fluid consumption and doubling the dose of her prescribed diuretic. This led to being hospitalized last month for severe dehydration with a fall without hitting head or bone fracture. At hospital discharge, she was given a prescription for oxybutynin. In a hurry to get home before she had another "accident" she declined medication counseling from the pharmacist. She stopped taking oxybutynin after a few days' use due to the lack of substantial improvement in her urinary symptoms.

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Past Medical History

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Overactive bladder (diagnosed 2 years ago)

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Type 2 DM (diagnosed 4 years ago)

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HTN (for over 10 years)

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OA (diagnosed last year)

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Dehydration (one month ago) (resolved)

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Fall (last month, and twice more the past year)

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Depression (diagnosed 6 months ago)

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Insomnia (diagnosed 6 months ago)

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Cerebrovascular disease (stroke 5 years ago) with gait disturbance

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Glaucoma, open angle (diagnosed 1987)

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Chronic constipation

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Family History

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No details

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Social History

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Widowed, 3 children, worked as a hospital laboratory phlebotomist for 40 years

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Tobacco/Ethanol/Substance Use

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Denies tobacco; drinks one glass of wine at bedtime to help sleep; ...

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