overactive bladder (application)

Question 1

firs line pharm therapy for OAB

Answer 1

Antimuscarinics (Anticholinergics)
Oxybutynin
Tolterodine
Solifenacin
Trospium
Darifenacin
Fesoterodine

Question 2

why do Antimuscarinics (Anticholinergics) work?

Answer 2

Block M3 muscarinic receptors → ↓ detrusor muscle contractions → ↑ bladder capacity → ↓ urgency & frequency.

Question 3

when do you use Antimuscarinics (Anticholinergics)?

Answer 3

Use when patient has:
Urinary urgency
Frequency
Urge incontinence

Typical overactive bladder symptoms

Question 3

when to avoid Antimuscarinics (Anticholinergics)?

Answer 3

Narrow-angle glaucoma
Urinary retention
Bladder outlet obstruction
Elderly (cognitive risk)

Question 4

major side effects of Antimuscarinics (Anticholinergics)?

Answer 4

Anticholinergic effects:
Dry mouth
Constipation
Blurry vision
Tachycardia
Dementia risk with long-term use

Question 5

Beta-3 Adrenergic Agonists examples

Answer 5

Mirabegron
Vibegron

Question 6

why do Beta-3 Adrenergic Agonists work?

Answer 6

Stimulate β3 receptors in bladder → detrusor relaxation → ↑ bladder storage capacity.

Question 7

when to use Beta-3 Adrenergic Agonists?

Answer 7

• Patient cannot tolerate anticholinergic side effects
• Concern for cognitive impairment
• Often preferred before adding anticholinergic combo therapy.

Question 8

Beta-3 Adrenergic Agonists advantages

Answer 8

Less:
Dry mouth
Constipation
Cognitive effects

Question 9

Beta-3 Adrenergic Agonists Side Effects

Answer 9

Hypertension
Tachycardia
Palpitations

Question 10

why does Botulinum Toxin (Botox) work?

Answer 10

Blocks acetylcholine release at neuromuscular junction → detrusor paralysis → ↓ urgency and incontinence.

Question 11

when to use Botulinum Toxin (Botox)?

Answer 11

Third-line therapy

Question 12

when to use Botulinum Toxin (Botox)?

Answer 12

Behavioral therapy failed
Medications failed
Severe OAB symptoms

Question 13

important requirement for Botox

Answer 13

Patient must be able to self-catheterize.

Question 14

major risks of Botox

Answer 14

Urinary retention
UTIs

Question 15

Alpha-Blockers examples

Answer 15

Tamsulosin
Terazosin
Doxazosin
Alfuzosin
Silodosin

Question 16

why do Alpha-Blockers work?

Answer 16

Relax smooth muscle of bladder neck and prostate.

Question 17

when to use Alpha-Blockers?

Answer 17

OAB symptoms with BPH

Question 18

what are Alpha- Blockers combined with?

Answer 18

Antimuscarinic
Beta-3 agonist

Question 19

Desmopressin (DDAVP) when to use?

Answer 19

Nocturnal enuresis
Adults or children with nighttime urination

Question 20

why does Desmopressin (DDAVP) work?

Answer 20

Synthetic vasopressin → ↑ water reabsorption → ↓ urine production.

Question 21

Desmopressin (DDAVP) major risk

Answer 21

Hyponatremia

Question 22

why do Cholinergics (Bethanechol) work?

Answer 22

Stimulates muscarinic receptors → bladder contraction

Question 23

Desmopressin (DDAVP) contraindication

Answer 23

History of hyponatremia
CrCl < 50

Question 24

when to use Cholinergics (Bethanechol)?

Answer 24

Urinary retention

Question 25

examples of urinary retention to use Cholinergics (Bethanechol)

Answer 25

Postoperative retention Neurogenic bladder Postpartum retention

Question 25

Cholinergics (Bethanechol) major side effects

Answer 25

SLUDGE Salivation Lacrimation Urination Diarrhea GI cramps Emesis

Question 26

OAB Algorithm

Answer 26

Step 1 - Behavioral therapy - Bladder training - Pelvic floor exercises Step 2 - Medication - Antimuscarinic OR - Beta-3 agonist Step 3 - Combination therapy Step 4 - Procedures - Botox - Neuromodulation

Question 27

overactive bladder drug

Answer 27

Antimuscarinic

Question 28

OAB with cognitive risk drug

Answer 28

Mirabegron

Question 29

OAB refractory drug

Answer 29

Botox

Question 30

OAB + BPH drug

Answer 30

Alpha blocker

Question 31

Nocturnal enuresis drug

Answer 31

Desmopressin

Question 32

Urinary retention drug

Answer 32

Bethanechol